title: Active tracking of rejected dried blood samples in a large program in Nigeria.
abstract: OBJECTIVE
  To study the impact of rejection at different levels of health care by retrospectively reviewing records of dried blood spot samples received at the molecular laboratory for human immunodeficiency virus (HIV) early infant diagnosis (EID) between January 2008 and December 2012.
  
  
  METHODS
  The specimen rejection rate, reasons for rejection and the impact of rejection at different levels of health care was examined. The extracted data were cleaned and checked for consistency and then de-duplicated using the unique patient and clinic identifiers. The cleaned data were ciphered and exported to SPSS version 19 (SPSS 2010 IBM Corp, New York, United States) for statistical analyses.
  
  
  RESULTS
  Sample rejection rate of 2.4% (n = 786/32552) and repeat rate of 8.8% (n = 69/786) were established. The mean age of infants presenting for first HIV molecular test among accepted valid samples was 17.83 wk (95%CI: 17.65-18.01) vs 20.30 wk (95%CI: 16.53-24.06) for repeated samples. HIV infection rate was 9.8% vs 15.9% for accepted and repeated samples. Compared to tertiary healthcare clinics, secondary and primary clinics had two-fold and three-fold higher likelihood of sample rejection, respectively (P < 0.05). We observed a significant increase in sample rejection rate with increasing number of EID clinics (r = 0.893, P = 0.041). The major reasons for rejection were improper sample collection (26.3%), improper labeling (16.4%) and insufficient blood (14.8%).
  
  
  CONCLUSIONS
  Programs should monitor pre-analytical variables and incorporate continuous quality improvement interventions to reduce errors associated with sample rejection and improve patient retention.
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Auchi
authors.initials: A
authors.lastname: Inalegwu
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Sunny
authors.initials: S
authors.lastname: Phillips
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Rawlings
authors.initials: R
authors.lastname: Datir
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chime
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Petronilla
authors.initials: P
authors.lastname: Ozumba
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Samuel
authors.initials: S
authors.lastname: Peters
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Obinna
authors.initials: O
authors.lastname: Ogbanufe
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Charles
authors.initials: C
authors.lastname: Mensah
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Alash'Le
authors.initials: A
authors.lastname: Abimiku
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dakum
authors.affiliation: Auchi Inalegwu, Sunny Phillips, Rawlings Datir, Christopher Chime, Petronilla Ozumba, Samuel Peters, Charles Mensah, Alash'Le Abimiku, Patrick Dakum, Nicaise Ndembi, Institute of Human Virology, Abuja 900246, Federal Capital Territory, Nigeria.
authors.forename: Nicaise
authors.initials: N
authors.lastname: Ndembi
keywords: Dried blood spot; Early infant diagnosis; Human immunodeficiency virus; Pre-analytical error; Prevention of mother-to-child transmission; Sample rejection