Identification of common pre-analytical errors during the HIV viral load and EID testing in Cameroon: A call for strengthening the laboratory systems to support follow-up people living with HIV/AIDS.

BackgroundHIV 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 resulting from sample non-conformity (SNC) due to inadequate collection, transportation, and management of samples, especially during the pre-analytic phase, negatively affects laboratory performance. This study aimed to characterize errors observed during the pre-analytical phase of HIV-VL and EID testing throughout the different national reference laboratories in Cameroon and factors associated with reasons for rejection. MethodsA descriptive and quantitative study of the non-conformities (NC) identified were collected from January to December 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. ResultsDuring the study period, of the 326,885 specimens received for HIV viral load, 12,748 (3.9%) were rejected, and 2.7% (1,039) of the 38,354 specimens received for EID were also rejected. The analysis of SNC shows the presence of more than one error 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; NS). 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. ConclusionOur 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 provide quality services to patients and support optimization. Suggestions for improvement include the distribution of a validated specimen collection manual, the creation of electronic test request forms, staff training, and regular on-site supervision of the use of available resources is necessary in this country.