External Quality Assessment On Cd4 T-cell Count Using In-house Proficiency Testing Panels For Cd4 Count Laboratories In Addis Ababa Ethiopia.

Back ground: A CD4+ T-cell count External Quality Assessment (EQA) program isrnimportant for the evaluation of performance of CD4 count laboratories. rnObjective: The purpose of the present study is to assess the quality of CD4 count laboratoryrnperformance using in-house Proficiency Testing (PT) panels that perform routine CD4 counts in rnAddis Ababa, Ethiopia. rnMethods: Voluntary sampling technique was employed and 20, 23, and 25 laboratories werernparticipated in trials 1, 2, 3 respectively. In-house prepared fresh whole blood samples both with rn68 “normal” and 68 “low” CD4 count materials were sent according to WHO guidelines tornparticipating laboratories. The percentage and absolute counts of CD4+ T-lymphocytes wererndone using their routine procedures. The data were analyzed using Microsoft Excelrn, sigma plotrnversion 12.3, and Graph Pad® Prism version 5 for each trial, for each participant which included;rnthe trimmed mean, standard deviation (SD), the percent coefficient of variation (%CV), thernresidual, and the standard deviation index (SDI) values for both the absolute counts andrnpercentages of CD4+ lymphocytes (%CD4). Feedback was provided to each respectivernparticipant within one month of result submission in each trial. rnResults: Most participating laboratories produced results that were within 2SD of the meanrn(Mean ± 2SD). The average inter-laboratory precision (trimmed %CV) was 10.87% and 5.14% rnfor CD4 absolute counts and CD4% of Lymphocytes respectively. For the normal level CD4rnEQA material, the trimmed mean %CV (between-laboratory precision) was 9.59% and 3.23%rnfor CD4 absolute counts and %CD4 respectively. For the low level CD4 EQA material, therntrimmed mean %CV (between-laboratory precision) was 12.15% and 7.05% for CD4 absoluterncounts and %CD4 respectively. The percentage outlier rate of absolute CD4+ counts and % CD4rnfor all trials were 4.3% and 4.1% respectively. rnConclusion: CD4 EQA program using In-house PT panels was found to help facilities in earlyrnidentifying their gaps with regard to their CD4 count performance. In-house prepared PT panels rnwas helpful in avoiding the challenges encountered during participation in external EQArnproviders like the high cost, transportation problem, feedback delay, CD4 laboratory coverage. rnTM

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