ASLM Collaborating Centres Feature: Institute of Human Virology Nigeria (IHVN)

Advancing the quality of laboratory medicine across Africa is an initiative that cannot be realised without strong collaboration among the leading institutions in the field. The experience in other sectors of development in the continent also provides testament to the importance of building partnerships towards a common goal. Based on that principle, ASLM has successfully collaborated with six centres of excellence across the continent to build local capacity, improve service quality, bring about high standards of care and improve outcomes for Africans. These centres are well recognised in their research, policy, technology assessment and implementation, and training in laboratory medicine. One of ASLM’s reputable collaborating centres championing the goal of providing high standard of laboratory medicine is the Institute of Human Virology Nigeria (IHVN).

Partnership to Improve Outcomes

Since 2004, IHVN (www.ihvnigeria.org) has worked to actively strengthen Nigeria’s laboratory capacity to mitigate HIV, tuberculosis and other infectious diseases. As a local organisation and one of Nigeria’s largest implementing partners of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria, the Institute is providing laboratory support to over 70 facilities in the country.

This support is in the form of provision of equipment and infrastructure to carry out high throughput blood screening tests (hemogram) clinical chemistry, CD4 monitoring, HIV-1 RNA (viral load) testing for adults and children, early infant diagnosis (EID), tuberculosis (TB) culture, and first and second line drug susceptibility testing for TB, amongst others. IHVN also supports the roll out of optical TB smear microscopy with fluorescent microscopes, reagents, supplies and technical supervision. Technical assistance is also provided to the Federal Government of Nigeria in developing policy documents for laboratories at the national level.

IHVN Expertise

With its laboratory and clinical expertise, IHVN has built upon an ongoing collaboration with the National TB and Leprosy Training Centre (NTBLTC). This collaboration focuses on strengthening the integration of high quality TB and HIV care delivery in support of the National TB Control Strategy.

At all points of service directly supported by IHVN, all newly presenting HIV positive patients or existing care and support patients are screened for TB and linked to on-site DOTS (directly observed treatment, short course) centres for treatment if necessary. NTBLTC has several laboratories including HIV diagnostics, CD4 testing, haematological tests, hepatitis, chemistry analysis, microscopy, GeneXpert and BSL-2 (biosafety laboratory) section for TB diagnosis using solid culture. It also has a containerised BSL-3 laboratory with its own mechanical room. It is the main facility for supporting surveillance for drug resistant TB in Nigeria.

NTBLTC also houses a polymerase chain reaction (PCR) suite for TB and multi drug resistant TB (MDR-TB) diagnoses by Hain using Line Probe Assay (LPA) method. The genotype tests include MTBDRplus, MTBDRsl, and common mycobacteria (CM) and additional species (AS) molecular assays.

The BSL-3 has also provided a platform for training on TB culture, first line, second line drug susceptibility testing and Hain assay for upcoming zonal TB laboratories. NTBLTC demonstrated the superiority of the iLED fluorescent scope over Ziehl–Neelsen (ZN) staining within the Nigerian setting, and supported a national survey of MDR-TB by analysis of sputum samples from selected sites from the northern part of the country. It also analysed 1,319 sputum samples from clients demonstrating the prevalence (%) of MDR-TB in Nigeria while 3,139 samples were analysed for the National TB Prevalence Survey.

IHVN and ASLM

It was back in December 2012 that the African Society for Laboratory Medicine (ASLM) made two of the Institute’s supported laboratories collaborating centres. These centres are the Asokoro Laboratory Training Centre in Asokoro District Hospital, Abuja, and the Plateau State Human Virology Research Centre in Jos. The Asokoro Laboratory Training Centre (ALTC) serves as the central PEPFAR training laboratory for the Institute.

The Asokoro Laboratory Training Centre

The laboratory is set up as a model clinical laboratory that has separate training areas for haematology, clinical chemistry, enhanced smear microscopy, fungal cryptococcal antigen, serology for Hepatitis B and C, and syphilis and rapid HIV testing and all instrument platforms employed at sites. ALTC also houses specialised services including PCR for early infant diagnosis test training and genetic analysers for HIV drug resistance testing.

The main laboratory holds equipment for sample separation, processing and storage. Facilities available there include a 10 m2 virology laboratory and a state-of-the-art 55 m2 laboratory equipped for comprehensive serologic testing with equipment such as centrifuges, refrigerators, standard equipment/commodities necessary for good laboratory practice, ELISA plate washer, Vitros 350 clinical chemistry analyser, Sysmex hemogram counter, FACS Count flow-cytometry, -80 freezer, hood, thermocycler for Roche Amplicor PCR, ABI 3130xl and 3500xl automated sequencers and clean isolation facility for PCR.

The GeneXpert Partnership

IHVN is the only ASLM collaborating partner in the GeneXpert roll out project in West and Central Africa. The Institute has over ten GeneXpert machines deployed to its supported facilities with many patients to increase TB detection among people living with HIV across the country. GeneXpert is an automated diagnostic test that can rapidly identify TB and resistance to the treatment drug rifampicin (RIF).

Training and Accreditation

The partnership between ASLM and IHVN has also resulted in the training of 50 laboratory scientists on laboratory quality management systems under the SHaRING project, a laboratory pre- and in-service collaborative agreement funded by the US Centers for Disease Control and Prevention (CDC)/PEPFAR. Steps are also being taken to ensure national accreditation for 30 laboratories and international accreditation for eight laboratories supported by IHVN.

The collaborative work that ASLM undertakes with IHVN is just one of the many partnerships that are established to bring about visible improvements in laboratory medicine and care in Africa. ASLM is currently working with some of the high performing laboratories for international ISO-based accreditation.

Writers: Blessing Ukpabi (IHVN), Yosef Tiruneh Demissie (ASLM), Corey White (ASLM)