1. National External Quality Assessment Scheme for HIV Antibody Testing in Myanmar
Htay Htay Tin, Khin Yi Oo, Latt Latt Kyaw, Win Win Yee, Tin Tin Htay
National Health Laboratory
Myanmar

2. Current situation of HIV epidemics in Myanmar
HIV infection is one of the major infectious diseases
National AIDS program – prevent & control HIV Infection
Myanmar has developed a multi-sectoral broad-based National Strategic HIV/AIDS Plan (NSP)
High priority is directed to reduce HIV related risk, vulnerability and impact among mobile populations in National Strategic Direction.
HIV prevalence among years age group has been gradually declining from 0.67% in 2007 to 0.47% in 2013
The HIV epidemics in Myanmar are largely concentrated among key populations with higher risk, particularly FSW, MSM, IDUs.

3. Role of National Health Laboratory
(Established in October 1963 , formarly Pasteur Institut)
To develop and implement the laboratory support services in line with the National Health Policy.
To function as the Central Reference Laboratory for Clinical and Public Health Services.
To promote and maintain Quality Assurance Scheme throughout the laboratory services.
To conduct applied research activities.

4. Government laboratories in Myanmar, 2013
Level
Type
No. of Beds
Qty
Responsible person
Central (NHL)
Reference ー 1
Director ( Labs )
Teaching Hosp. A
300 & above 11
Prof. Path
General Hosp.
200 37
SCS/CS Path.
Specialist Hosp. 30
District Hosp. B
100 52
Lab officer / Med . Tech
Township Hosp. C
344
Grade I & II
Station Hosp D 16
402
Grade I
Total
877

5. Need to assess the quality of HIV testing results
Many testing sites for HIV diagnosis –
-Blood safety in government hospitals labs
- VCCT
- PMCT in government hospitals labs, STD labs , NGOs and INGOs
Need to assess the quality of HIV testing results

6. HIV testing algorithm Strategy II Strategy I Strategy III Repeat D&U
Transfusion Safety
Strategy II
VCCT
Strategy III
PMTCT
Determine®
D(+)
D(-)
Positive
Negative
Positive
D(+) U(+)
Determine®
D(+)
D(-)
Negative
UniGold®
D(+) U(-)
Repeat D&U
D(-) U(-)
Indeterminate
D(+) U(+)
D(+) U(-) S(-)
Risk
Assessment
Positive
D(+) U(+) S(+)
Determine®
D(+)
D(-)
Negative
UniGold®
D(+) U(-)
Repeat D&U
D(-) U(-)
Indeterminate
D(+) U(+) S(-)
or D(+) U(-) S(+)
StatPak®
HIV testing algorithm

7. History of NEQAS Establishment
In 2004, Staff from NHL attended training course of EQA in Thailand for HIV testing
In 2005, JICA Major Infectious Disease Control Project initiated support to strengthen the Blood safety program including screening of HIV
With the funding from the MIDC Project, NHL established the National EQAS for HIV testing with 65 public laboratories in 2005
Participating labs increased annually and expansion of the scope from blood safety to entire HIV testing including VCCT & PMCT, 351 labs (2013)

8. Training for new and low performance laboratories
EQA Process
Provider (NHL)
Participants
Training for new and low performance laboratories
Panel preparation and Distribution
Panel testing and Reporting back to NHL
-Preliminary reporting
-Data collection/ Analysis
-EQA report writing
-Feedback to Participants
-Self evaluation
-Corrective action
Supervisory visit and on-site training for low performance laboratories

9. Objectives of NEQAS
To assess and monitor the quality of HIV testing on a nationwide basis
To identify the problems for corrective actions
To improve and maintain the quality of HIV testing

12. Methods Panel Sample preparation
Convert plasma to serum using thrombin
Add Proclin as a preservative
Inactivate the HIV antibody positive sera (56◦Cx 1 hour)
Homogeneity are done ( Random testing of OD by ELISA on each panel )
Stability tests for any transportation effect

13. Panel distribution and Analysis
Distribute five samples per panel (including HIV antibody positive, weak positive & negative sera) twice a year
Analyze the test results and send feedback report
Panel 17 & Panel 18 were distributed & analyzed in 2013

16. Corrective actions Future plan Refresher training
On site testing assessment
Monitoring and supervisory visits
Future plan
Private hospital laboratories to participate in this NEQAS program

17. Training on EQAS for HIV testing

18. Panel Samples
Observation in site visits to NEQAS participated laboratory

19. Running cost for NEQAS Activities
Unit cost
Qty/year
Cost
Preparation of panel samples (5 each)
Posting cost (Panel samples)
Communication cost (Follow up)
Report publication
Posting cost (Report)
6000 Ks/site
400 Ks /site ®
3000 Ks/site- air
200 Ks/site
400 Ks/copy
300 Ks/site 2
12000 Ks
800 Ks
400 Ks
600 Ks
Total estimated cost per year/site
38000 Ks
(USD 40)
Refresher training (20 participants) estimated USD 3000
Supervisory visits
※Collecting registration fee from laboratories supported by INGOs
(50 USD per year for 2 panels )

20. Operational research for better practice and policy
Findings from our Operational Research
Myanmar has established a functioning External Quality Assurance System for HIV testing nationwide, but still needs continuous effort to maintain the system, especially for keeping high reporting rate.
Systematic approach, commitment of responsible persons , continuous financial and technical support are key for the successful implementation of EQAS for HIV testing
Expanding the program into other Laboratory Testing: Syphilis testing
(New National Guidelines　will be published soon)
Experiences compiled in
the National Guidelines,
2010

21. Acknowledgement
We would like to thank DFAT for the Australia Fellowship Awards allowing us to attend International AIDS 2014 Conference
National Reference Laboratory NRL, Australia for the continuous technical support to the improvement of quality in the labs
To JICA (MIDC project) and WHO for their support to establish and sustain this NEQAS (HIV) program
Last but not the least, to the participants of this NEQAS program for their active participation

22. Thank you for your kind attention
National Health Laboratory