Global HIV drug resistance laboratory network
2008 status update
The WHO Global HIV Drug Resistance Laboratory Network has been established and member laboratories have provided quality-assured results for HIV drug resistance surveys. At annual meetings with an independent panel of experts, findings of the assessment visits, laboratory performance, and accreditation status is reviewed in accordance with WHO requirements. Laboratory assessments were performed and technical assistance provided in 22 countries by WHO staff or consultants. As of February 2009, 21 labs have been accredited. A table of all accredited laboratories and a map, illustrating the location of accredited laboratories and the laboratories assessed or currently undergoing assessment are available here:
The procedures, the accreditation criteria and checklists used for genotyping laboratories assessment have been finalized and published on the WHO website. These have also been published in Antiviral Therapy in May 2008, together with a summary of the WHO HIV drug resistance laboratory strategy, by the HIVResNet laboratory advisory group.
Other laboratory-related activities are summarized below:
- Laboratory training and capacity building. Training to laboratory technicians has been provided through the WHO team and their consultants directly during site visits. Laboratory sessions were also presented as part of regional workshops on HIV drug resistance training in Tanzania (Oct 2008) and Russia (September 2008). A twinning program, coordinated by WHO, links WHO accredited laboratories with strong capacity in HIVDR genotyping to labs with less capacity and experience. This method has been very useful to increase technology transfer and knowledge sharing between labs with different capacities.
- Update: The HIVDR laboratory training package is now available. Please find the training package under "related links". An HIVDR laboratory training package is under development in collaboration with one of the specialized drug resistance laboratories. A draft training package was completed in December 2008. The final version of the training package will be produced by June 2009, after piloting the material in two regional workshops during the first half of 2009 in Africa and Asia.
- External Quality Assurance. External QA of laboratory performance for genotyping from plasma is carried out using proficiency panels (PP) samples provided by the VQA programme of NIH. NIH has modified the VQA panel to accommodate WHO specifications. Two shipments of the PP were made in 2008 and sent to a total of 33 labs. Reports have been produced - including recommendations and next steps – for each of the labs individually. PP results from 2007-2008 were presented in a poster at the Conference on Retroviruses and Opportunistic Infections in Montreal in February, 2009. Please find the poster under "related links".
- Dried blood spots (DBS) testing. Expert meetings to discuss feasibility and development of proficiency panels using DBS were held in Chicago in November 2008, and Madrid in December 2008. A specific plan to develop a proficiency panel using DBS has been developed and will be finalized in Q1 2009; DBS proficiency panels will be distributed by NIH to the network labs in Q3 2009 . The network is currently reviewing evidence on use of DBS for genotyping in treated populations with low viral load and planning operational research on DBS-related issues.
- Key operational research questions have been identified that are important for the network and implementation of the HIVDR strategy at country level including:
- Stability of HIV in DBS over time and at different temperature conditions. A study has been designed with the collaboration of an accredited laboratory in Uganda and a specialized laboratory who are committed to the WHO ResNet research agenda.
- Viral load correlation in DBS vs plasma and equivalence in specimens with VL < 10,000 copies/ml.
- Network laboratories use different methods for DBS genotyping, that differ in performance and cost. The WHO ResNet laboratory group has developed standard criteria to validate in-house methods for DBS genotyping. A validation panel has been produced by two specialized laboratories and will be shipped to 15 network laboratories to validate their extraction and sequencing method using DBS by Q2 2009.