QASI, an international quality management system for CD4 T-cell enumeration focused to make a global difference.
BACKGROUND
A significant worldwide mobilization effort to treat people with HIV disease began in 2003. Most guidelines for initiating antiretroviral therapy require reliable and reproducible CD4 T-cell counting. Therefore, any effort that improves global availability of quality managed assessment schemes for CD4 T-cell enumeration is a positive achievement for the clinical management of AIDS on a worldwide scale.


METHODS
The Canadian QASI-Quality Management System (QMS) has been in operation for over a decade. More recently, QMS has fine-tuned its strategy to optimize its global impact in the fight against the HIV/AIDS pandemic. Three modifications were implemented: (1) introduction of skills and knowledge transfer workshops pertaining to the initiation of national quality management programs for CD4 counting, (2) introduction of a road map to establish domestic EQAP for countries that are ready, and (3) introduction of a statistical analysis package which permits continuous monitoring of global impact of the QASI-QMS.


RESULTS
Based on QASI-QMS distribution of specimens over four consecutive participation cycles, there was decreased interlaboratory variation for both low and medium CD4 T-cell levels. After three cycles of consecutive participation, there is an average of 38 and 26% error reduction reported for the mid and low CD4 levels, respectively.


CONCLUSIONS
The program improvements mentioned earlier appear to have had a profound effect with regard to enhancing the performance of laboratories participating in the QASI-QMS. Specifically, there is a significant reduction in interlaboratory variability of CD4 T-cell counts resulting from continuous participation in the QASI-QMS.
Bergeron
Michèle
M
National HIV Immunology Laboratory, Public Health Agency of Canada, Ottawa, Ontario, Canada. michele_bergeron@phac-aspc.gc.ca
Ding
Tao
T
Houle
Guy
G
Arès
Linda
L
Chabot
Christian
C
Soucy
Nadia
N
Seely
Peggy
P
Sherring
Alice
A
Bogdanovic
Dragica
D
Faucher
Sylvie
S
Summers
Randy
R
Somorjai
Ray
R
Sandstrom
Paul
P
D015496:CD4-Positive T-Lymphocytes / Q000166:cytology*; D002452:Cell Count; D006801:Humans; D016130:Immunophenotyping; D007391:International Cooperation; D011785:Quality Assurance, Health Care; D011786:Quality Control