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. 2021 Jun 2;11(1):11536.
doi: 10.1038/s41598-021-91015-7.

Evaluation of a collaborative model for successful implementation of a National CD4 enumeration EQA program in Cameroon

Bertrand Sagnia  1 , Sandra Kiazyk  2   3 , Adrienne F A Meyers  2   3 , Margot Plews  2 , Tamsir O Diallo  2 , Samuel Martin Sosso  4 , Georgia Ambada  4 , Rachel Kamgaing  4 , Nadesh Nji  4 , Paul Sandstrom  2   3 , Blake T Ball  2   3 , Godwin Nchinda  4 , Alexis Ndjolo  4
Affiliations

Evaluation of a collaborative model for successful implementation of a National CD4 enumeration EQA program in Cameroon

Bertrand Sagnia et al. Sci Rep. .

Abstract

Participation in an EQA program is critical to the quality assurance process. Reliable and precise CD4 T-cells enumeration are essential to improve the clinical management of patients by evaluating the disease progression and by monitoring the effectiveness of ART in HIV-patients. The CIRCB, CD4 reference laboratory, in collaboration with the Canadian QASI-program, recruited sites, distributed and analyzed CD4-panels in 61 sites across Cameroon. A trend and performance analysis in the pre-analytical, analytical and post-analytical phases was performed. Continuous training and corrective actions carried out from 2014 to 2018 increased the number of participating sites from 15 to 61 sites, the number of unacceptable results decreased from 50 to 10%. Specific challenges included errors in pre analytic (17.5%), analytic (77.0%) and post-analytic (5.5%) phases. This EQA requires the application of good laboratory practices, fluidic communication between all the stakeholders, continuous training, application of specific on-site corrective measures, and timely equipment maintenance in order to avoid repetitive errors and to increase laboratory performance. It could be extended to other HIV-1 testing like viral load and EID point-of-care. Partnership with QASI serve as a model for implementation of a successful EQA model for resource limited countries wanting to implement EQA for HIV testing and monitoring in alignment with 90-90-90 targets.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Distribution of participants in the CD4 EQA programming within Cameroon.
Figure 2
Figure 2
Performance of all participants. Indicated are pass, fail, and unable to report percentages for 11 EAQ sessions. The blue line indicates the number of participants per session. Unable to report means that these labs registered for a session but did not send results due to no login/broken instrument/no reagents/expired reagents, therefore these labs did not run the sample.
Figure 3
Figure 3
Phase of failures present across sessions. The data here do not include those who were unable to report. This figure is only based on labs who submitted a result.
Figure 4
Figure 4
Observed types of errors across all 11 evaluated EQA sessions: these errors were observed when participants returned an incorrect CD4 result whereas errors made by participants who have not returned a CD4 result (unable to report) are excluded.
Figure 5
Figure 5
Failure Rates for 11 evaluated EAQ sessions broken down by type of instrument used. Failure rates as a percentage of the total are shown for all combined instruments, FACSCount instruments, CyFlow instruments and PIMA instruments. Data shown includes only participants who returned a result, not those who were unable to report a result.
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