Quality Improvement of Clinical Laboratories to Support HIVAIDS Care and Treatment: Laboratory Certi

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Quality Improvement of Clinical Laboratories to
Support HIV/AIDS Care and Treatment Laboratory
Certification in Chiang Rai and Phayao Provinces,
Thailand
S Kanitvittaya,1 A Yowong,1 J Tongtoyai,1 U
Suksai,1 P Thongsuk,2W Manoromana,3 N
Wattanasri,4 V Pobkeeree,5 O Suksripanich,5 J
Tappero,5,6 W Levine 5,6 1Chiang Rai Medical
Sciences Center, Thailand Ministry of Public
Health (MOPH), Chiang Rai, Thailand 2Chiang
Rai Regional Hospital Laboratory, MOPH, Chiang
Rai, Thailand 3Department of Clinical
Pathology, Rajavithi Hospital, MOPH, Bangkok,
Thailand 4National Institute of Health, MOPH,
Nonthaburi, Thailand 5Thailand MOPH-U.S. CDC
Collaboration, Nonthaburi, Thailand 6Global
AIDS Program, Centers for Disease Control and
Prevention, Atlanta, GA, USA
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Issues

• The success of Thailands national program of
  access to antiretroviral
• therapy will depend largely on the
  availability and quality of laboratory
• services, including serologic testing for HIV
  and CD4 T- lymphocyte
• count determination
• To strengthen the quality of laboratory services,
  a certification
• program was initiated for 29 laboratories in
  Chiang Rai and Phayao
• provinces, which in 2003 performed
  approximately 95,000 HIV serologic
• tests and 5,000 CD4 tests

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Community Hospitals
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Laboratories in Community Hospitals
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Laboratories in Community Hospitals.
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Description

• The primary aim of the certification is to
  improve quality management of diagnostic services
  by voluntary participation
• We performed the following activities
• Organized workshops during which each laboratory
  performed a
• self- assessment using the checklist of the
  Association of Medical Technologists of
  Thailand (AMTT) to evaluate 10 areas of
• laboratory quality standards including
  internal and external quality
• assurance programs
• Analyzed laboratory quality management problems
  by analysis of Strength, Weaknesses,
  Opportunities, and Threats (SWOT) and
  balance score card strategies and classified
  activities into 6 main
• areas

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Main Activities

• Updated staff on laboratory quality management
• Provided participating laboratories with
  materials on internal quality control, i.e.,
  control slide for Gram stain and anti-HIV serum
  control for HIV screening tests
• Provided a calibration service for laboratory
  equipment and instruments
• Performed preliminary auditing (internal audit)
  by peers
• Attempted to solve the problems
• Applied for AMTT laboratory certification to
  approve quality of laboratory system

As of June 2004, six of the 29 laboratories had
made sufficient improvements and are now ready to
receive AMTT certification
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Internal quality control materials
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Internal Auditing by Peers
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Lessons Learned

• Many factors influence the readiness and
• capacity of laboratories for quality
  improvement

• Existing knowledge of quality improvement and
  previous laboratory quality management
• Number and attitude of laboratory staff
• Funding to support quality improvement activities
• Commitment of laboratory directors to this
  process

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Recommendations

• To support the Thai national effort to strengthen
  HIV/AIDS care and treatment services, the
  Ministry of Public Health should

• Consider the availability and quality of
  diagnostic testing
• Establish high standards for those services
• Set criteria and provide these to all
  laboratories apply Thailand medical technology
  standards and ISO 151892003
• The AMTT laboratory certification process
  provides an important mechanism for addressing
  this critical public
• health need

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