Mentorship Strengthens HIV-1 Viral Load Laboratory Quality and Testing in Mozambique. (11th September 2019) - Basu, Debby
Abstract: Objectives: In response to the urgent need for high-quality HIV viral load (VL) testing scale-up to reach the UNAIDS goal of 90% of HIV+ patients on ART treatment and 90% of these patients reaching viral suppression worldwide, the American Society for Clinical Pathology (ASCP) has directed a VL mentorship program across six provinces in Mozambique. Methods: Through this program, three in-country consultants with advanced molecular biology and quality management system skills have mentored nine molecular biology laboratories conducting VL testing (four new laboratories, five established laboratories) through both in-person and remote mentorship methods. Using external audit evaluations conducted by CDC and Ministry of Health using the CDC VL Scorecard (scored 1-5), mentors have directed targeted interventions to address laboratory needs including (but not limited to) the following: biosafety, document control, quality control, corrective actions, assay troubleshooting, and codevelopment of key technical and quality-based SOPs and job aids with local laboratory management. In-person mentorship visits also focus on skills building of laboratory staff and management. Results: Excluding two new laboratories with only baseline assessments available, the majority of mentored laboratories (six of seven; 85%) showed improvement at follow-up audits compared to baseline assessment scores, with only one laboratory showing a one-level backslide between sequential audits. Potential reasons for this backslide include more limited in-person mentorship during the time period or interevaluator scoring variability. Conclusion: These data suggest that mentorship focused on test methodology and quality management is an effective way to promote laboratory quality while scaling up services; however, additional efforts, including integration of methods for improved remote mentorship to in-laboratory mentors and management, are needed in order to sustain high laboratory quality in the absence of an external mentor.