NRL is a not-for-profit and independent organisation that supports laboratories performing testing for human infectious diseases to achieve high quality and accurate test results. NRL is also designated a WHO Collaborating Centre for Diagnostics and Laboratory Support for HIV/AIDS and other Blood-borne Infections. Since its establishment in 1985, NRL has delivered high quality education and training in quality management systems, quality assurance programs, evaluation of test kits, validation of testing algorithms and laboratory testing using a model called NRL STEPs (Sustainable Training, Education and Partnerships).
NRL STEPs is a structured, stepwise approach to strengthening laboratory systems. Using NRL STEPs, our laboratory capacity building model identifies areas for improvement; responds to needs through education and training; and ensures sustainability of improved laboratory services. Integral to any laboratory quality management system are external quality assessment schemes (EQAS; also known as proficiency testing). EQAS serve to monitor the performance of laboratory processes and test kits.
Using NRL STEPs, NRL has worked with partners in Indonesia, Vietnam, Mongolia and Fiji to establish national EQAS, resulting in:
• national EQAS for HIV, HCV and HBV being provided to 43 blood transfusion laboratories in Vietnam;
• EQAS for HIV being implemented in six provinces in Indonesia;
• pilot EQAS for HIV, HCV, HBV and Syphilis being provided to 30 provincial laboratories in Mongolia with a view to expanding to >350 laboratories;
and • pilot EQAS for HIV, which will be delivered in Fiji by the end of 2012.
In order to build the elements of quality in laboratory testing, NRL works with partners to enable change that will lead to measureable and sustainable improvements. NRL STEPs provides the foundation for laboratories to deliver accurate test results and better patient outcomes. Using NRL STEPs, national EQAS have been implemented in several regions, contributing to the improvement of laboratory quality.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Most Australian guidelines for clinical screening of chlamydia infection advise testing sexually active individuals aged 16-24 years. Recent research shows that age at first sex in Australia is decreasing; a recent Victorian survey showed 29% of respondents reported being sexually active before age 16 years. There is also evidence that younger age at first sex is associated with risk behavior such as unprotected sex and having multiple sex partners.