Journal Article

Common causes of EID sample rejection in Zimbabwe and how to mitigate them

Mushavi, Angela, Mangwanya, Douglas, Tweya, Hannock, Mazarura, Exervia, Mabhala, Mzwandile, Senkoro, Mbazi, Zolfo, Maria, Chiku, Charles, Shukusho, Fungai D., Musasa, Patience

2019

Overview

Early infant diagnosis (EID) of HIV provides an opportunity for early HIV detection and access to appropriate Antiretroviral treatment (ART). Dried Blood Spot (DBS) samples are used for EID of exposed infants, born to HIV-positive mothers. However, DBS rejection rates in Zimbabwe have been exceeding the target of less than 2% per month set by the National Microbiology Reference Laboratory (NMRL), in Harare. The aim of this study was to determine the DBS sample rejection rate, the reasons for rejection and the possible associations between rejection and level of health facility where the samples were collected. This is an analytical cross-sectional study using routine DBS sample data from the NMRL in Harare, Zimbabwe, between January and December 2017.A total of 34 950 DBS samples were received at the NMRL. Of these, 1291(4%) were rejected. Reasons for rejection were insufficient specimen volume (72%), missing request form (11%), missing sample (6%), cross-contamination (6%), mismatch of information (4%) and clotted sample (1%). Samples collected from clinics/rural health facilities were five times more likely to be rejected compared to those from a central hospital. Rejection rates were above the set target of <2%. The reasons for rejection were 'pre-analytical' errors including labelling errors, missing or inconsistent data, and insufficient blood collected. Samples collected at primary healthcare facilities had higher rejection rates.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / AIDS / Antiretroviral agents / Antiretroviral therapy / Babies / Biology and Life Sciences / Blood / Causes of / Contamination / Cross-Sectional Studies / Diagnosis / Diagnostic errors / Disease transmission / Dried Blood Spot Testing - methods / Dried Blood Spot Testing - trends / Early Diagnosis / EDTA / Female / Health care facilities / Health facilities / Highly active antiretroviral therapy / HIV / HIV Infections - diagnosis / HIV patients / HIV tests / HIV-1 / Hospital facilities / Human immunodeficiency virus / Humans / Infant / Infant, Newborn / Infants / Internet / Labeling / Labelling / Laboratories / Male / Medical diagnosis / Medical ethics / Medicine and Health Sciences / Methods / Microbiology / Neonatal screening / Pediatric HIV infections / People and Places / Prevention / Primary health care / Rejection rate / Research and Analysis Methods / Rural Health Services / Sample rejection / Specimen Handling - methods / Zimbabwe - epidemiology