Evaluation of continuous quality improvement of tuberculosis and HIV diagnostic services in Amhara Public Health Institute, Ethiopia

Background: Unreliable laboratory results lead to unnecessary tests, procedures or treatments which may harm the patient. Continuous quality improvement (CQI) is a useful objective tool to improve processes and services. The use of quality indicators that meet requirements for effectiveness is an important quality improvement tool. However, the quality of critical aspects of pre-examination, examination, and post-examination processes have not been evaluated in Ethiopia including our setting. Hence, this study aimed to assess the performance of continuous quality improvement of TB and HIV laboratory tests in the Amhara Public Health Institute (APHI). Methods: A cross-sectional study was conducted to evaluate the quality indicators of advanced TB and HIV related laboratory tests in APHI from 01 January to 30 September 2019. HIV viral load, exposed infant diagnosis (EID), GeneXpert and TB culture quality indicators data were used as a quality improvement tool and evaluated in comparison to established targets. Data were extracted from excel database and record review of patient information, and entered and analyzed using SPSS V20 software. Results: A total of 26,487 samples were received from 01 January to 30 September 2019. The overall specimen rejection rate was 0.43% (115/26,487). Specifically, viral load and TB culture had 0.43% and 1.14% rejection rates, respectively. The highest monthly rejection was documented for TB culture (5.3%) and viral load (2.4%) in September 2019. Centrifugation problems (46.1% [53/115]) and the use of the wrong container (40.9% [47/115]) were the main reasons for the rejections. Moreover, EID test was interrupted for a total of 54 days and 22 days due to reagent stock out and equipment down time, respectively. Similarly, about 82% of viral load and 100% of the EID tests had long turnaround time (TAT) with an average of 24.1 and 29.3 days respectively in September 2019. Conclusions: There were high rates of TB culture and viral load specimen rejection, and EID test interruptions. The TAT of viral load and EID tests were longer than the targeted goal (10 days) average TAT. Hence, training of sample collectors, functional equipment maintenance systems and supply chain management are recommended for continuous quality improvement.