Long-term external quality assessment program for CD4+ T-lymphocyte enumeration in Thailand

The accuracy and reliability of CD4+ T-lymphocyte enumeration are crucial for HIV healthcare management. Thailand’s CD4 external quality assessment (EQA) program was implemented in 2003. This program aims to improve the quality of CD4 testing by providing the quality control material, remedial action, and technical training. In this article, the overall longitudinal performance of the participating laboratories from 2003 to 2015 is reported. The EQA blood samples were sent to the participating laboratories in Thailand and other Southeast Asian (SEA) countries. The participants were requested to enumerate CD3+ and CD4+ T-lymphocytes. The trimmed mean, standard deviation (SD), coefficient of variation (CV), and standard deviation index (SDI) of both fraction and number were calculated from the returned data. Our result indicated a continuously increasing number of participants. The response rate of 72 trials was 98 %. The outlier rates for the fraction and number of CD4+ T-lymphocytes were 3.3 % and 3.4 %, respectively. The average CV of the fraction and number of CD4+ T-lymphocytes was 7.1 % and 9.4 %, respectively. In addition, the analysis of our current EQA trial no. 072 revealed that more than 98 % of participating laboratories had SDI values between ?2 and +2 for both fraction and number of CD3+ and CD4+ T-lymphocytes. In conclusion, the implementation of the CD4 EQA program in Thailand and other SEA countries has led to a reduction in the variability of the results of the CD4 count between laboratories and a continuous improvement in laboratory performance.