QASI, an international quality management system for CD4 T‐cell enumeration focused to make a global difference

Background: A significant worldwide mobilization effort to treat people with HIV disease began in 2003. Most guidelines for initiating antiretroviral therapy require reliable and reproducible CD4 T‐cell counting. Therefore, any effort that improves global availability of quality managed assessment schemes for CD4 T‐cell enumeration is a positive achievement for the clinical management of AIDS on a worldwide scale. Methods: The Canadian QASI‐Quality Management System (QMS) has been in operation for over a decade. More recently, QMS has fine‐tuned its strategy to optimize its global impact in the fight against the HIV/AIDS pandemic. Three modifications were implemented: (1) introduction of skills and knowledge transfer workshops pertaining to the initiation of national quality management programs for CD4 counting, (2) introduction of a road map to establish domestic EQAP for countries that are ready, and (3) introduction of a statistical analysis package which permits continuous monitoring of global impact of the QASI‐QMS. Results: Based on QASI‐QMS distribution of specimens over four consecutive participation cycles, there was decreased interlaboratory variation for both low and medium CD4 T‐cell levels. After three cycles of consecutive participation, there is an average of 38 and 26% error reduction reported for the mid and low CD4 levels, respectively. Conclusion: The program improvements mentioned earlier appear to have had a profound effect with regard to enhancing the performance of laboratories participating in the QASI‐QMS. Specifically, there is a significant reduction in interlaboratory variability of CD4 T‐cell counts resulting from continuous participation in the QASI‐QMS. © 2009 Clinical Cytometry Society