Implementation of EQA System for CT Programs in Zambia

1
Implementation of EQA System for CT Programs in
Zambia

• International CT Workshop
• 23rd January 2008
• Intercontinental Hotel

2
Presentation Outline

• Background to HIV Counseling Testing in Zambia
• National Program Update
• Current Status of EQA in Zambia
• Development of Zambia EQA System
• Challenges

3
Background

• 1999 Pilot phase with establishment of 22
  sites
  
• 2000 Consolidation phase
• 2002 Consolidation /expansion phase
• 2003 Expansion phase
• 2004 National VCT/PMTCT Directory
• 2005 National Programme/VCT and PMTCT
  integration
  
• 2006 National CT guidelines/finger prick
• New testing algorithm
• QA tools
• 2007 National Quality Assurance Strategy for
  HIV Counselling Testing
  
• National HIV Rapid Test Training
  Curriculum
  

4
HIV/AIDS Program Strategy

• The Zambian government is committed to
• finding new ways of increasing the number
• of people who are tested and know their HIV
• Status
• The Zambian target is to ensure 25 of the
• Zambian population know their HIV status by 2008
• Scaling up of current testing and counseling
  services through opt out testing (PMTCT, STI
  clinics etc.), diagnostic counselling and testing
  (TB clinics, STI clinics, Outpatient Department
  etc.) and mobile VCT and outreach services

5
Current Status of HIV Testing

• In Zambia, only 10-13 of the total population
  (10.9 million) have ever had an HIV test
  
• This is against the governments efforts of
  having 850 VCT sites and 500 PMTCT sites
  
• However, most of the VCT sites are along the line
  of rail (urban) and the drive now is to open more
  rural sites
  

6

• New Start Network-Contribution
• 8 Fixed and Mobile centers
• 150 counselors
• 136,000 clients counseled and tested in 2007
• 750, 000 clients as National target for 2007

7
Mobile Vs Fixed
8
Zambian Algorithm
9
Development of Zambia EQA System
National Reference Laboratory
EQA for provincial /- QA for DBS
QA of DBS samples Feedback to District
Provincial Laboratory
Collection of DBS Feedback
District Laboratory
Testing collection of DBS
Health facility level
10
EQA Process at New Start

• Serial testing at both fixed and mobile
• Collection of QC samples
• Bio-hazard waste disposal

11
Challenges in EQA

• External QA system is not working-still under
  development
  
• (10 of specimens)
• Piloting DBS for QA in Chongwe and Mumbwa
• Unclear roles at each level (provincial
  laboratory, district laboratory etc)
  
• Multiple players on board

12
Challenges at New Start

• What happens to referred samples?
• How long does it take for a feed back?
• What do you do when you get results back and how
  do we deal with it?
  
• What percentages should be done? 5, 10? 20?
• What about sites that consistently perform well?
  Should they have to do a less percentage?
  
• Retesting is only a good strategy if it feeds
  back to the CT sites.
  

13
Acknowledgements

• Ministry of Health
• National AIDS Council VCT TWG
• Zambia Voluntary Counselling and Testing Service
• Zambia Prevention, Care and Treatment
  Partnership
  
• JICA Zambia
• Zambia Counselling Council
• Zambia Medical Council
• JHPIEGO
• CDC Zambia
• JSI Deliver
• Society for Family Health
• CRS