Pre-analytical errors during HIV viral load (HIV-VL) and early infant diagnosis (EID) testing in Cameroon

HIV Viral Load (HIV-VL) and Early Infant Diagnosis (EID) play a pivotal role in the laboratory surveillance, monitoring of HIV/AIDS, and its elimination as a public concern. However, sample rejection due to sample nonconformity (SNC) resulting from inadequate collection, transportation, and management, especially during the pre-analytical phase, negatively affects laboratory performance. This study aimed to characterize errors observed during the pre-analytical phase of HIV-VL and EID testing across national reference laboratories in Cameroon and to identify factors associated with rejection.

A descriptive and quantitative study of the nonconformities (NC) identified was collected from 11/01/2024 to 08/12/2024 in seventeen HIV reference laboratories, which constitute the national network of HIV-VL and EID testing coverage. For this study, the number of rejected samples, the reason for rejection, and the type of test ordered were recorded monthly.

During the study period, 326,885 and 38,354 specimens received for HIV viral load and EID. Of those 12,748 (3.9%) and 2.7% (1,039) were rejected. The SNC analysis indicates the presence of multiple errors or NC in some samples. For HIV viral load, our results indicate that specimen identification errors for viral load were the most common NC (63.14%; n = 8049; P = 0.031), followed by insufficient specimen volume (43.7%; n = 5571; P = 0.049) and quality errors, including hemolyzed specimens (27.8%; n = 3543; P = 0.054), and specimen transport packaging errors (9.1%; n = 1160; P = 0.069). For HIV EID, specimen rejections were primarily attributed to missing or mismatched identification on the request forms (37.12%, n = 386; P = 0.042), sample unavailability (13.4%; n = 139; P = 0.056), and information discrepancies (44.2%; n = 459; P = 0.033). The observed significant rejection rates for both HIV viral load and EID exceeded the established national rejection rate of <2% of errors. Our results suggest that corrective action is critical, along with the establishment of policies to detect and resolve preanalytical errors in Cameroon.

Our findings highlight the high magnitude of preanalytical errors for HIV-VL and EID tests used in the testing and management of people living with HIV/AIDS in Cameroon. Therefore, the laboratory system should be strengthened to ensure high-quality patient services and support optimization. Suggestions for improvement include distributing a validated specimen-collection manual, creating electronic test-request forms, providing staff training, and regularly on-site supervising the use of available resources, all of which are necessary in this country.