The need for reliable HIV screening in medical labs

December 6th, 2018

By Dr Ureme Samuel

Human Immuodeficiency virus is the causative agent of Acquired Immune Deficiency Syndrome (AIDS) that has jolted the world into a frenzy since the mid 1980s.

It started as a mystery or strange disease before it was unmasked and unveiled in America through painstaking laboratory research.

Before then, intravenous drug users and gays were known to present in medical clinics symptoms of bacterial and fungal infections. It has not been widely accepted in the scientific community how the virus that was normal and does not cause any abnormality in wild animals crossed species barrier into man to cause immune deficiency in native immune system that confers natural protection.

Screening Tests are non-specific, qualitative indicators of abnormality of a biological process that is vital to healthy life and these are performed in Medical Laboratories.

All that is known about HIV/AIDS is as a result of laboratory efforts and productivity and this must be sustained.

December 1, of every year is dedicated by World Health Organisation(WHO) as World AIDS Day to raise awareness about AIDS, a public health burden and the need to join efforts in the crusade against the scourge.

The theme for this year’s commemoration is “Know Your Status”. The focus of this year’s theme is to encourage all citizens of the world to know their HIV status in order to join global efforts to fight off the scourge.

United Nations through WHO and its affiliate agency like UNAIDS estimates that more than 9.4 million people living with HIV still do not know their status. Stigma and discrimination deter people from taking HIV test.

Access to confidential HIV testing remains an issue of great concern. Many people get tested only after becoming ill and symptomatic. This leads to HIV treatment being initiated late, thereby undermining its many benefits for both treatment and prevention.

Quality HIV testing is essential for expanding treatment to achieve the target of total eradication. In pursuit of this target, the testing must be accurate, reliable and reproducible. Accuracy as a term in analytical process refers to result that is in close proximity to a generally accepted value. Reliable and reproducible results are those that maintain consistent values after many repetitions of the same tests using same procedure and principle.

This implies that irrespective of the locus of the laboratory tests, the results must show uniformity, acceptability precision and congruency.
The primary purpose of HIV laboratory testing is to achieve accurate and reliable results to facilitate informed medical decision which is in tandem with evidence-based medicine. There are some conditions that enhance accuracy and reliability which must be pursued frenetically and captured in policy initiatives and implemented deliberately.

The first is procurement of laboratory equipments, reagents and other consumables. This appears simple but certainly not. Only the laboratory professional that is proficient and adept in the manipulative art of analyses and of course the end-user should be the key personality to decide what, when and where to buy in line with procurement policy.

The system should avoid bureaucratic stiffness and fixation at this level because it is the rate-limiting step in the HIV testing and management chain.

The second item is the proficiency and professional status of the personnel involved in the laboratory tests. Recruitment of this key professional should reflect merit. Politics and politicians have ruined the pursuit of excellence and productivity in Nigeria and this is an ugly commentary on Nigeria and its citizens. A vital consideration as performance indicators is updated training for key laboratory operatives. The world of sciences is witnessing flurries of discoveries and these may necessitate constant improvement in standard of the laboratory workforce and operation.

The third is quality assurance programme of every laboratory or indeed any medical facility where HIV screening is done. It is true that screening kits come with controls, but the environment where the test is performed is very vital. The Laboratory must have quality-enhancement environment to achieve the deliverables and desireable. Quality Assurance is an organization-wide initiative of the institution to achieve high quality of products and services in line with main purpose of its structural existence.

In HIV laboratory, the core value or key performance index (KPI) is accuracy and reliability of test results. Some laboratories do not have quality assurance system as an integral part of the project and this is unwholesome. It must be stressed that any laboratory without this vital facility is not worthy of that designation and certainly constitutes a danger to the citizenry.

The last is the strict adherence to the code of ethics of HIV screening. There is ethical procedure which is internationally acceptable to ensure global best practices and respect for fundamental human rights of clients.

It is very pertinent to state that HIV management is fraught with legal challenges which can be toxic to the career of medical professionals.

Consequently, every operative in the laboratory must be conscious of ethical health and the consequences of ethical infarction or infraction.

The government of Nigeria has a vital role to play in achieving accuracy and reliability of HIV screening results. Presently, all tests, procedures and reagents are imported from foreign countries into Nigeria. The basic scientific principles of these test and its reagents is simple enough to be produced here in our local institutions by many academics and professionals.

What is lacking and may endure for a long time is the paucity of progressive idea that drives development. Since HIV and AIDS became a public health burden in the 1980, every data vital to effective management of the disorder has emerged from foreign climes.

The absurd and sordid inference is that academics, intellectuals and researchers in our universities are lazy, sloppy and slothful to furnish any innovative scientific projects that illuminate dark areas of diseases.

But this is absolutely and comprehensively wrong because Nigerian-trained scientists are bright and sassy to do exploit in all areas of human development. What has been and still is the bane is the abysmal failure of government to supply the necessary stimulus or impetus for development.

Nigerians have excelled in foreign countries to the admiration of other nationalities.

The present government of President Mohammadu Buhari has a duty to change the narrative. World AIDS day 2018 is a loud call to improve laboratory management of AIDS in particular and diseases in general.

Dr Samuel writes from University of Nigeria

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