Ensuring quality in HIV point of care testing for recent infections in a surveillance program


BACKGROUND: The Eswatini HIV-1 Recent Infection Surveillance (EHRIS) program is a national surveillance program to track new HIV infections. From July 2019, testers already deployed at health facilities and community points with HIV testing services (HTS) were trained on EHRIS. These testers offered a rapid test for recent infections (RTRI) to all newly diagnosed individuals 15+ years, and RTRI quality was assessed through proficiency testing (PT) every 6 months.
METHODS: PT was conducted using prepared Dried Tube Specimen with 5 panels containing three types of specimens (HIV-negative, HIV-positive long term, and HIV-positive recent). Testers were eligible to participate in PT if they had implemented EHRIS for approximately 6 months. PT was conducted in March and September 2020. Each eligible tester was provided 5 panels and given a two-week period to test the 5 PT panels and report their results electronically using tablets loaded with an Open Data Kit form. To pass the PT, testers were required to get the correct result for all 5 PT panels. Testers who failed underwent a corrective action and preventive action (CAPA) intervention and were given 5 new PT panels to repeat PT. We analysed PT outcomes using descriptive analyses.
RESULTS: In March 2020, 183 testers at 52 sites conducted PT, and in September 2020, 387 testers at 123 sites participated. Most testers correctly reported all 5 PT panels: 85% (n=156) in March and 96% (n=370), in September. The percentage of testers correctly reporting all 5 PT panels was similar among those conducting EHRIS at health facilities (85% (146/172) in March and 95% (341/358) in September) vs community testing points (91% (10/11) in March and 29/29 (100%) in September). Following a CAPA intervention 20% (n=36) and 9% (n=17) of testers from March and September respectively passed the PT at second attempt; and the rest at third attempt.
CONCLUSIONS: Testers in health facilities and community testing points exhibited high PT performance, with improvement over time. These results provide assurance in the quality of point of care testing for HIV recent infections in this national surveillance program.