In Cameroon, Improving HIV Diagnoses through a Volunteer Quality Corps

Cameroon has an HIV prevalence rate of 4.3% in adults, [1] one of the highest in West and Central Africa, with an average of 34,754 new HIV infections annually. [2] Despite increasing access to antiretroviral drugs, Cameroon is not on track to meet the Millennium Development Goal of halting and reversing the spread of HIV/AIDS by 2015. [3] While health education and treatment are essential, access to reliable, accurate HIV rapid tests is also critical. False positive and false negative results can have a detrimental impact on treatment options and the spread of the virus, raising significant public health concerns.

Global Health Systems Solutions (GHSS), an NGO based in Cameroon, has attempted to address the recurrence of inaccurate HIV rapid test results in the country. Though GHSS implemented measures to conquer this problem of inaccuracy, it discovered a central obstacle to its goal: a lack of human resources. To ensure the generation of high-quality test results, it is necessary to strengthen the capacity of clinical laboratories. With inspiration from the principles of the American Peace Corps, including working with communities to develop sustainable practices to address specific problems, Quality Corps (Q-Corps) was developed. According to Q-Corps volunteer Nzang Frankline Ajoeh, “Training a body of individuals to work and be closely followed by the GHSS is just one big step toward [addressing] the human resource problem affecting the full realisation of quality HIV testing.”

Q-Corps is staffed by Ministry of Health personnel (MCQs) who supervise community volunteers (VCQs). Q-Corps members work closely with GHSS. MCQs and VCQs are trained in quality assurance, including use of proficiency testing (PT) panels and quality assurance logbooks. VCQs serve as intermediaries to reduce the turnaround time between distribution of PT panels and the arrival of results at GHSS. They provide logbooks to clinic staff for data collection, and then Q-Corps members enter the data into a central database and analyse it.

The Corps uses both the baseline checklist and the Stepwise Process for Improving the Quality of HIV-Related Point of Care (SPI-POCT) checklist in evaluating clinics, a task completed by the VCQs. The MCQs use the information gleaned from these evaluations to identify nonconformities and aid clinic staff in preparing and implementing corrective actions. To monitor improvements, Q-Corps conducts periodic site visits to locations implementing corrective actions.

In its pilot field implementation initiative, Q-Corps included 75 facilities for site visits, with 25 of these sites serving as controls. Q-Corps staff was divided into six groups based on educational backgrounds and performances during the QII training. Each group was tasked with visiting an average of 13 sites.

The Q-Corps members show true commitment and initiative. They are selected by GHSS based on academic qualifications, experience and location. Additionally, laboratory staff members working in some of the facilities enrolled in the PT programme have been selected as MCQs based on their laboratories’ HIV PT performance and their location. Ajoeh has described his experience with the Corps as “exciting, adventurous [and] motivating, with so many interesting challenges”, and as providing “the opportunity to share knowledge and experience with others.” Another Q-Corps volunteer, Ewoukap Maccollins, whose role entails improving HIV diagnoses, joined the Corps after seeing a GHSS advertisement. He was inspired to participate when he learned of the organisation’s aim to improve HIV testing in remote areas. He was drawn to Q-Corps by “the idea of saving [lives]” and the opportunity to gain knowledge that will allow him to have a positive impact in his local community.

Q-Corps’ mission is to improve the quality of rapid HIV testing and hence client satisfaction, and to reduce the occurrence of false HIV rapid test results to zero and thereby diminish the impact of misdiagnosis on treatment decisions. Though the Corps is still young, the implementation of activities to achieve its well-defined aims has so far been successful in spite of challenges encountered when working with remote sites, such as poor network facilities for communication and a lack of electricity. As the Corps continues to work successfully in South west region of Cameroon, it is making plans to expand to other regions of the country. Its expansion will provide inspired and committed individuals with opportunities to improve the quality of testing and treatment in their communities, a significant step in the reduction of HIV incidence in Africa.

By: Jessica Fried, MPH (Editorial Team); Contributors: Nzang Frankline Ajoeh (Bota District Hospital, Limbe), Ewoukap Maccollins, BSc (Q-Corps), Juliana Ndasi, PhD (GHSS), Priscilla Bobimwoh Mosoke (GHSS), Anna Kadaa Gwanfogbe (GHSS), Mongu Beatrice Mangwa (GHSS), Simon Achakeng Nkemasong (GHSS), Aji Desmond Abang (GHSS), Awungafac George (GHSS), and Judith Ndofor Meya-nui (GHSS)

Originally published in the August 2014 issue of Lab Culture newsletter.

[1] Cameroon. (2013, January 1). Retrieved from: http://www.unaids.org/en/regionscountries/countries/cameroon/

[2] Cameroon Operational Plan Report FY 2013. (2014, January 14). Retrieved from: http://www.pepfar.gov/documents/organization/222156.pdf

[3] National Report: Cameroon. (2013, January 1). Retrieved from: http://www.commonwealthfoundation.com/sites/cwf/files/downloads/MDG Reports Cameroon_FINAL_1.pdf