Kanal Koum, Chou Thai Leang, Sovann Ly, Morikawa Yasuo, Mukoyama Yumi, Kakimoto Kazuhiro
Japan International Cooperation Agency Maternal and Child Health Project in Cambodia, P,O, Box 613 Phnom Penh, Cambodia.
AIDS Res Ther. 2005 May 20;2(1):5. doi: 10.1186/1742-6405-2-5.
In Cambodia, nearly half of pregnant women attend antenatal care (ANC), which is an entry point of services for prevention of mother-to-child transmission of HIV (PMTCT). However, most of ANC services are provided in health centres or fields, where laboratory services by technicians are not available. In this study, those voluntary confidential counselling and testing (VCCT) counsellors involved in PMTCT were trained by experienced laboratory technicians in our centre on HIV testing using Determine (Abbot Laboratories) HIV1/2 test kits through a half-day training course, which consisted of use of a pipette, how to process whole blood samples, and how to read test result. The trained counsellors were midwives working for ANC and delivery ward in our centre without any experience on laboratory works. The objective of this study was to assess the feasibility of the training by evaluating the proficiency of the trained non-laboratory staffs. The trained counsellors withdrew blood sample after pre-test counselling following ANC, and performed the rapid test. Laboratory technicians routinely did the same test and returned reports of the test results to counsellors. Reports by the counsellors and the laboratory technicians were compared, and discordant reports in two groups were re-tested with the same rapid test kit using the same blood sample. Cause of discordance was detected in discussion with both groups. Of 563 blood samples tested by six trained VCCT counsellors and three laboratory technicians, 11 samples (2.0%) were reported positive in each group, however four discordant reports (0.7%) between the groups were observed, in which two positive reports and two negative reports by the counsellors were negative and positive by the laboratory technicians, respectively. Further investigation confirmed that all the reports by the counsellors were correct, and that human error in writing reports in the laboratory was a cause of these discordant reports. These findings lead us the conclusion that the half-day training using the rapid and simple test was feasible for non-laboratory staffs to attain enough proficiency to implement VCCT services for PMTCT in resource-limited settings, and that human error was more likely to occur in laboratory before giving reports to counsellors.
在柬埔寨，近一半的孕妇接受产前护理（ANC），这是预防母婴传播艾滋病毒（PMTCT）服务的切入点。然而，大多数产前护理服务是在卫生中心或野外提供的，那里没有技术人员提供实验室服务。在本研究中，参与预防母婴传播的自愿咨询和检测（VCCT）顾问由我们中心经验丰富的实验室技术人员通过为期半天的培训课程，使用Determine（雅培实验室）HIV1/2检测试剂盒进行艾滋病毒检测培训，培训内容包括移液器的使用、如何处理全血样本以及如何读取检测结果。接受培训的顾问是在我们中心从事产前护理和产房工作的助产士，他们没有任何实验室工作经验。本研究的目的是通过评估接受培训的非实验室工作人员的熟练程度来评估培训的可行性。接受培训的顾问在产前护理的预测试咨询后采集血样，并进行快速检测。实验室技术人员常规进行相同的检测，并将检测结果报告返回给顾问。比较顾问和实验室技术人员的报告，两组中不一致的报告使用相同的血样用相同的快速检测试剂盒重新检测。通过与两组人员的讨论找出不一致的原因。在由六名接受培训的VCCT顾问和三名实验室技术人员检测的563份血样中，每组有11份样本（2.0%）报告为阳性，但两组之间观察到四份不一致的报告（0.7%），其中顾问的两份阳性报告和两份阴性报告在实验室技术人员处分别为阴性和阳性。进一步调查证实顾问的所有报告都是正确的，实验室报告书写中的人为错误是这些不一致报告的原因。这些发现使我们得出结论，对于非实验室工作人员来说，使用快速简单检测进行半天培训在资源有限的环境中达到足够的熟练程度以实施预防母婴传播的自愿咨询和检测服务是可行的，并且在向顾问报告之前实验室中更可能发生人为错误。
