Rapid HIV Testing - Training by UUzgpZav

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									Rapid HIV Testing - Training
    Stacy M. Howard, MT(ASCP)
   Division of Laboratory Systems
Public Health Practice Program Office
    Rapid HIV Testing
Traditional Training Model




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Decentralization of HIV Testing
                 Surveillance, VCT and
                  PMTCT Services

                 Few skilled trainers to
                  meet demand for
                  testing



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                      Lessons Learned –
                     Technical Difficulties
Nurse Counselors                                Laboratory Scientists
   Difficulty with volume concepts – 50µl          Difficulty doing a finger stick –
   General fear of fingersticks                     Uneasy dealing directly with clients
                                                     who come for HIV test.
       Difficulty using auto lancets
                                                    Mixing up buffers especially when
   Mixing up buffers –                              testing in parallel
       Contamination of buffer bottles             Not observing universal precautions –
   Not observing universal precautions –            leaving used lancets on bench
    leaving used lancets on bench                   Placing wet DBS paper flat on bench
   Capillus - device wrong side up!                Test Interpretation
   Test Interpretation                                 Intensity of line
       Intensity of line                               Latex agglutination
       Latex agglutination
   Timing of tests

Ref. Zimbabwe training experiences – Eileen Burke


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Rapid HIV Testing
Training Package
          Videotape
          Trainer’s Guide
          Participant Manual
          Workshop Application
               Integrate traditional
                classroom instruction
                with videotape
                demonstration
               Hands on practical
               Assessments
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          Videotape Contents
 Highlights safety, quality assurance
 Initial steps
   Required supplies
   Preparation
 Rapid test procedures
   Capillus, Determine, Hema-Strip, OraQuick,
    Uni-Gold, Virocheck
 Performing multiple tests at one time
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        Training Curriculum - Theory
 Ethics
 Testing Technologies
    Types of kits / formats
    Supplies, specimens
 Quality Assurance
    Safety and Infection Control
    SOPs
    Sample Handling & Storage
    Quality Control
    Test interpretation/reporting
    External Quality Assessments
    Inventory Control

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   Training Curriculum - Practical
 Performing a fingerstick
 Separating serum and plasma from cells
 Testing from reference panel of serum, whole blood
  and plasma with all approved rapid HIV test kits
 Testing of trainer from fingerstick
 Testing from fingerstick if volunteers come forward
 Spotting whole blood onto S&S filter paper




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        Structure of Trainer’s Guide
 Step-by-Step guide for conducting the workshop
      Preparation (before, during & after )
   Target audience
   Materials/Supplies required
      Composition of panel
   PowerPoint slides
   Exercises & instructions for the practical
   Module summary

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                Participant Manual
 Safety guidelines
 Test procedures , Testing algorithm
 Quality Assurance
      Site / Space requirements
      Sample collection
      Quality Control
         Procedural controls
         Preparation, storage, & characterization of in-house controls
         Commercial controls
         Frequency of QC controls
      Record keeping
      Equipment
      DBS –collection, storage, & shipment procedures
         Sampling, e.g. every 20th specimen
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       Considerations for conducting
         Training - Rapid HIV Test
   Who will conduct the training?
   Who will be trained?
   Order of training, i.e., MLS first
   Where to conduct the training
      Adequate space, etc.
   Duration of training
   Available resources
   Health Delivery system
      Support from the National Reference Laboratory
   Logistics

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 Good lab setup prior to
the practical is essential




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                   Assessment
 Written exam
 Practical exam
   Testing of panel of
    specimens
 Certification
   Only students who
    pass are awarded a
    certificate of
    competence
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       Follow-up after Training
 Support from a medical laboratory scientist
 Percentage of specimens tested by EIA
  before nurse counselor releases results to the
  client
 Monitoring of EQA results
    Corrective actions, if necessary



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               Next Steps
 Training package made widely available
 Development of job aides, wall charts
 Future regional TOT Rapid HIV Testing
  Workshop




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DBS Training




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Rapid HIV Test Information




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