Mugauri Hamufare, Mugurungi Owen, Chadambuka Addmore, Juru Tsitsi, Gombe Notion Tafara, Shambira Gerald, Tshimanga Mufuta
Department of Community Medicine, University of Zimbabwe, Zimbabwe.
Ministry of Health and Child Care, Zimbabwe.
AIDS Res Treat. 2018 Jul 26;2018:4234256. doi: 10.1155/2018/4234256. eCollection 2018.
In 2016, Mashonaland West Province had 7.4% (520) dried blood spot (DBS) samples for early infant diagnosis (EID) rejected by the Zimbabwe National Microbiology Reference Laboratory (NMRL). The samples were suboptimal, delaying treatment initiation for HIV-infected children. EID is the entry point to HIV treatment services in exposed infants. We determined reasons for DBS sample rejections and suggested solutions.
A cause-effect analysis, modelled on Ishikawa, was used to identify factors impacting DBS sample quality. Interviewer-administered questionnaires and evaluation of sample collection process, using Standard Operating Procedure (SOP) was conducted. Rejected samples were reviewed. Epi Info™ was used to analyze findings.
Eleven (73.3%) facilities did not adhere to SOP and (86.7%) did not evaluate DBS sample quality before sending for testing. Delayed feedback (up to 4 weeks) from NMRL extended EID delay for 14 (93.3%) of the facilities. Of the 53 participants, 62% knew valid sample identification. Insufficient samples resulted in most rejections (77.9%). Lack of training (94.3%) and ineffective supervision (69.8%) were also cited.
Sample rejections could have been averted through SOP adherence. Ineffective supervision, exacerbated by delayed communication of rejections, extended EID delay, disadvantaging potential ART beneficiaries. Following this study, enhanced quality control through perstage evaluations was recommended to enhance DBS sample quality.
2016年，西马绍纳兰省有7.4%（520份）用于早期婴儿诊断（EID）的干血斑（DBS）样本被津巴布韦国家微生物学参考实验室（NMRL）拒收。这些样本质量欠佳，延误了HIV感染儿童的治疗启动。早期婴儿诊断是接触HIV婴儿进入HIV治疗服务的切入点。我们确定了DBS样本被拒收的原因并提出了解决方案。
采用基于石川图的因果分析来确定影响DBS样本质量的因素。使用标准操作程序（SOP）进行了访谈式问卷调查并评估样本采集过程。对被拒收的样本进行了复查。使用Epi Info™分析结果。
11家（73.3%）机构未遵守标准操作程序，86.7%在送检前未评估DBS样本质量。NMRL延迟反馈（长达4周）使14家（93.3%）机构的早期婴儿诊断延误延长。在53名参与者中，62%知道有效的样本识别方法。样本不足导致了大多数拒收情况（77.9%）。还提到了缺乏培训（94.3%）和监督不力（69.8%）。
通过遵守标准操作程序本可避免样本被拒收。拒收信息传达延迟加剧了监督不力，延长了早期婴儿诊断延误，使潜在的抗逆转录病毒治疗受益者处于不利地位。在这项研究之后，建议通过各阶段评估加强质量控制，以提高DBS样本质量。
