Recent Events

NRL has worked in Indonesia since 2007 to improve the capacity and quality of testing laboratories in Indonesia. Between 6 and 17 February 2012, Thu-Anh Pham, Tamara McDonald and Geraldine Kong conducted laboratory assessments of six public health laboratories in Indonesia. These assessments were conducted in collaboration with the World Health Organization (WHO) Indonesia and the Ministry of Health (MoH) Indonesia, and funded by the HIV Consortium for Partnerships in Asia and the Pacific, of which NRL is a member.

The six public health laboratories assessed represented the different geographic regions of Indonesia and included Jakarta, Bandung, Surabaya, Jayapura, Palembang and Makassar. The findings from the assessment will enable NRL, WHO and the MoH to review the progress of the laboratories to date, and to help identify and coordinate future activities.

The findings from the laboratory assessment will be formally reported back to relevant stakeholders at a meeting in Indonesia, to be held in two to three months time.

The Vietnam Ministry of Health (MOH) is facilitating the implementation of the World Health Organisation (WHO) HIV Treatment 2.0 programme, by initiating a pilot study in two provinces. HIV Treatment 2.0 seeks to simplify the way HIV treatment is provided and to scale up access to life-saving medicines. One of the pillars of the Treatment 2.0 programme is to provide point of care (POC) HIV diagnosis. In Vietnam an algorithm will be used where HIV antibody screening and confirmatory testing is performed using rapid tests.

The Vietnam office of WHO (WHO VN) has sought NRL’s advice with the implementation of HIV Treatment 2.0 and assistance with training programmes for the people involved. In July this year, WHO VN invited NRL’s Director, Sue Best to Vietnam to meet with stakeholders and with them, develop a plan for the HIV Treatment 2.0 pilot study.

Subsequently, in November, WHO VN invited NRL to return to conduct a train the trainer programme in Vietnam and to generate the training materials required to train staff in primary health care centers in conducting HIV confirmatory testing on site. During the visit, Kim Wilson (NRL) facilitated the development of the framework under which the testing will be conducted, developed the training curriculum, the training materials, the standard operating procedures and other related documents. Once implemented, NRL will provide technical support as necessary.
Initially a pilot study is being established to provide proof of principle and monitor the performance of the testing. The pilot study will be initiated in the provinces of Dien Bien and Can Tho. Staff in several primary health care centres in a number of districts in each province will be trained to perform the rapid HIV testing algorithm.

Between 31 October and 11 November, 2011, Thu-Anh Pham and Wayne Dimech returned to Ulaanbaatar, Mongolia to conduct the second in a series of training sessions. These training sessions form part of the a long-term, step–by-step action plan to strengthen quality assurance and management systems for STI/HIV and TB laboratories in Mongolia, under a Memoradum of Understanding between NRL and the Ministry of Health, Mongolia.

During this training session, NRL staff provided:

• technical assistance in conducting a pilot EQAS for serology (HIV, HCV, HBV, syphilis and brucella), bacteriology and TB;
• technical support in improving capacity of laboratory staff;
• training in the theory of quality control;
• a review of procurement and licensing of test kits.

NRL’s work with Mongolia is supported by the World Health Organisation (WHO), Mongolia and Global Fund for AIDs, TB and Malaria. NRL would like to thank the trainees from the National Centre for Communicable Diseases and the National Centre for Transfusiology for their enthusiasm and commitment.

From 17 – 21 October 2011, three senior staff from the National Institute for Control of Vaccines and Biologicals (NICVB) in Vietnam attended a 5-day training session at NRL on the evaluation of HIV test kits and the development of a national sample bank. The Ministry of Health in Vietnam consults NICVB on matters relating to the quality of HIV test kits, vaccines and biologicals. NICVB is also responsible for the pre-market evaluation and post-market monitoring of diagnostic kits and vaccines in Vietnam.

The training comprised a mix of presentations and discussions, and covered topics such as the regulation of HIV test kits in Vietnam and Australia; quality management systems; requirements of pre-market evaluations; development of a national sample bank; development of testing strategies; and post-market monitoring of HIV test kits. The training was sponsored and funded by the World Health Organization and supported by the Department of Health and Ageing, Australia.

The participants raised challenging issues during the training, generating robust discussion . All those involved in the training, including NRL staff, benefited from these discussions.

NRL has worked with Vietnam’s Ministry of Health since last year on the development of a HIV test kit evaluation framework in Vietnam. In August 2010, a high level delegation of Vietnamese stakeholders involved in various functional aspects relating to HIV testing visited NRL for a study tour.

The purpose of the study tour was to advance the development of;

• policies and technical guidance on HIV testing and the evaluation of HIV test kits
• standard criteria for laboratories and procedures for a national sample bank.

Following the study tour, NRL assisted the Ministry of Health with the design of a system for HIV test kit evaluations appropriate for the local context. Since then, four documents have been developed: (1) National Guidelines on HIV Testing; (2) National Protocol on HIV Test Kit Evaluation, (3) standard criteria for national reference laboratories and regional and confirmatory laboratories, and (4) a protocol and plan for development and maintenance of a national sample bank.

NRL will follow up with the participants on their progress following the training and to offer ongoing support. NRL will also continue to work with WHO and the relevant authorities in Vietnam to provide ongoing support for the development of a national HIV evaluations framework.

Since 2008 NRL has, through the HIV Consortium for Partnerships in Asia and the Pacific and with funding from the Australian Agency for International Development (AusAID), organised an annual Regional Laboratory Seminar in conjunction with the Annual Conference of the Australasian Society for HIV Medicine (ASHM Conference). Each year, the Seminar focuses on a different aspect of HIV testing and laboratory management.

This year, immediately following the ASHM Conference, NRL ran the two-day 2011 Regional Laboratory Seminar, titled “Developing Testing Strategies for HIV Rapid Tests”. The Seminar was facilitated by Kim Wilson and Philip Cunningham from St Vincent’s Hospital in Sydney. HIV rapid testing, including point-of-care testing, is very topical in the region at present. Many countries are considering rapid testing at point-of-care, with some considering rapid confirmatory testing at point-of-care as well. Understanding testing strategies is therefore critical for these programmes’ future success.

The Seminar brought together a total of twelve delegates from six countries in the Asia and Pacific regions, namely Cambodia, East Timor, Fiji, Indonesia, Myanmar and Vietnam. There were two representatives per country and in most cases, one representative was a technical person from the laboratory while the other was a policy person from the Ministry of Health. This meant that the delegates were able to discuss and establish an understanding of the relevant issues relating to the development of testing strategies within their country. Overall, the discussions were insightful and there was a lot to be learnt from one another. Through their participation in the ASHM Conference, the delegates also had the opportunity to learn more about the latest developments in HIV, hepatitis and related diseases, and network with their counterparts in Australia and the region.

It was indeed a fruitful week for all involved.

From 26 to 30 August, Thein-Thein Aye, Geraldine Kong and Thu-Anh Pham attended the 10th ICAAP, held in Busan, Republic of Korea. This congress brings together regional governments (donors, community groups, researchers and other stakeholders) to collaborate and advance their mutual objectives in the response to HIV/AIDS. In addition to attending the congress, NRL participated as an exhibitor.

NRL has been active in the Asia and Pacific regions for over 20 years. The congress enabled us to conduct several country-specific meetings with relevant partners in the region, including those from Thailand, Laos PDR, Philippines, Vietnam, Myanmar, Mongolia, Cambodia, Indonesia.

We also met with AusAID for an original perspective. These meetings aimed to review the countries’ laboratory strengthening strategies and establish partnerships between the countries and NRL.

We look forward to following up the outcomes from these meetings and continue the laboratory strengthening, training, education, and partnerships in this region.

Fifteen participants from the public health laboratories in Jakarta, Bandung, Surabaya, Palembang,  Makassar and Papua, as well as from the Directorate of Medical Support Services (DMSS) and Health Facilities under the Indonesian Ministry of Health, attended the training. The training programme comprised a mix of presentations, discussions and laboratory activities focused on the provision of EQAS and the analysis of EQAS results.  The training culminated in a Coordinating Meeting held on Saturday 18 June, which involved the participants, DMSS, WHO Indonesia and NRL. The participants’ recommendations arising from the training were discussed at the Coordinating Meeting and agreed upon.  The recommendations, which included laboratory assessments to be jointly undertaken by DMSS and NRL, informed the development of a plan of action to further progress the training outcomes.  It was proposed that NRL train the laboratories in internal quality control processes for testing. Also the participants sought tools to assist them with preparation for the laboratory assessments, which will occur before the end of 2011.

Ten staff from Thailand’s National Institute of Health (NIH) attended a training course at NRL from 21 March to 1 April 2011. The training was on the establishment, management and preparation of External Quality Assessment Schemes (EQAS). The sessions were highly interactive and comprised a mix of presentations, discussions, laboratory activities and workshops.

NRL first trained staff from the NIH in the mid-1990s in EQAS, quality control and test kit evaluations. Today, the NIH provide 13 different schemes to over 1,000 participants throughout Thailand. NRL continues to maintain contact with the trainees through the provision of post-training support and looks forward to strengthening its long-standing relationship with the Thai NIH.