# Presentation: 404450

## Ethiopia: Report from Assessment Team

- Kyle Bond
- David McAlister

## Concerns from last ANC Surveillance Survey

- High discordance seen between testing conducted at regional level and QC retesting at the National HIV Reference Lab (NRL)

## In the next Surveillance Survey, 2005, closer attention will be given to improving:

**Sample Quality **
**Testing Quality**

## Sample Quality

- Initial collection
- Cold storage at collection sites
- Cold chains
- Transport Control
- Compressed Time Line
- Supervisory visits
- Specimen rejection policy
- DBS as a sample collection technique?

## Initial collection

- Specimens seen at NRL with:
- bacterial and fungal growth
- inadequate volume
- Promote the use of Vacutainer collection system.
- Many ANC sites are using needles and syringes to collect blood then transfer to non-sterile test tube.
- Vacutainers are a sterile closed container
- Plan to provide training material for use of Vacutainers during ToT

## Cold storage at collection sites

- Policy for storage (to reduce repeated freeze-thaw cycles):
- 	4oC before testing
- 	-20oC after regional testing complete
- Provide freezer log
- Repair / Install Kerosine refrigerators
- Increase frequency of specimen transport from collection to testing sites
- Every 2 weeks

## Cold chain

- Cold boxes and freezer packs will be provided.
- Sample transfer form will be used
- Cryoboxes
- reduce spillage and contamination, help organize specimens

## Transport Control

- Well characterized serum samples will be distributed by NRL to all testing labs
- Will provide information about storage conditions at the testing lab and transport back to NRL.

## Supervisory Visits

- Survey teams will include personnel from all agencies  (MoH, NHRL, CDC)
**SUPERVISION FORM**
- Teams need to have the mandate to improve conditions.
- Two visits planned:
- Immediately before survey begins to survey site and staff. Correct any deficiencies.
- After collection and testing have started
- Due to large number of sites (22 testing sites and 80 collection sites) data from the last survey will be used to identify those sites which need the most support.

## Specimen Rejection Policy

- Policy is clearly outlined in the protocol
- Form will be used to document rejected specimens
- Reasons for rejection include:

| ANC surveillance specimens with compromised quantity/quality |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| () 1st Testing Center:                                                           () EHNRI |  |  |  |  |  |
| # | CODE | QUANTITY
(Check) | QUALITY
(Circle) | TEMP at arrival (Circle) | Accepted for testing
(Circle) |
| 1 | __-___-___ | ()Empty    ()<0.1ml | Haem|Overgr|Clotted | Ambient | Warm | YES  |  NO |
| 2 | __-___-___ | ()Empty    ()<0.1ml | Haem|Overgr|Clotted | Ambient | Warm | YES  |  NO |

## Use of DBS as a sample collection technique

- During the 2005 survey the NRL will pilot the use of DBS for possible use in future surveys.
- Two phase pilot
- A small number of matching samples (DBS and Plasma) will be collected and used to evaluate the performance of different test products (EIA)
- Collection and testing of matching specimens from a limited number of selected sites during the 2005 survey
- NRL will develop a DBS Proficiency program to support regional testing labs.

## Improving Testing

- Standardized SOP’s
- All aspects of sample handling and testing
- Reduce transcriptional errors
- Link EIA reader to computer
- Raw EIA data will be available to NRL
- Use of an ‘In-house Control’
- Rewarding those labs which perform well.

## In-house Control

- Created by NRL, specific for survey EIA

## In-house Control

- Distributed to all regional testing labs, used on each EIA plate
- Data returned to NRL, analyzed

## Reward testing labs which perform well.

- Criteria was subjective, but mainly focused on data and specimen quality.
- Reward:  EpiInfo Training (sponsored by GAP in South Africa)