International Collaborations

Collaboration with Northern Hemisphere Nations

The CIQAP exists to support the reduction of HIV infection in Canada and around the world. The emphasis is on diagnostic/prognostic immunological methodology harmonization/optimization. Key international partners are:

• AIDS Clinical Trials Group (ACTG) of National Institutes of Health, USA
• Center for Disease Control and Prevention (CDC), National Center for Infectious Diseases, USA
• QAP for Immunology, Australian Immunology Society, Australia
• National External Quality Assessment Schemes (NEQAS), UK
• Center for Biologics Evaluation and Research (CBER), FDA, USA
• European Working Group on Clinical Cell Analysis (EWGCCA), Germany

Collaboration with Other Nations

NLHI has teamed with clinical and laboratory leaders in both developing and "science-enabled" countries that suffer from an acute lack of infrastructure for quality controlled diagnostic tests in infectious immunology. Some national QAPs for leukocyte immunophenotyping are now designed after the Canadian model, including the Brazilian system and a new national QAP system in India, which was lauched earlier this year in close consultation with NLHI. Some developing nations have also participated in bilingual skill building workshops dedicated to cost effective biotechnology transfer and conducted by NLHI personnel . The goal is to help build a clinical laboratory infrastructure under extremely challenging conditions and thus achieve improvement in local patient care. NLHI invests only professional time in these efforts, with all financial support coming from non-Canadian partners at present. Supporting organizations include:

• World Health Organization (WHO), Immunology Training Unit
• Joint United Nations Programme on HIV/AIDS (UNAIDS), Vaccine Unit
• Pan American Health Organization (PAHO)
• Fogarty International Center
• Harvard School of Public Health
• Indian Immunology Society (IIC)
• International Union of Immunology Societies (IUIS)
• Organisation panafricaine de lutte contre le sida (OPALS)
• Quality Assessment & Standardization for Immunological Measures (QASI) operating in over 40 countries (see global map)

NLHI Has Provided Assistance to the Following Nations:

• Brazil
• Burkina Faso
• Congo
• Cuba
• Hungary
• India
• Ivory Coast
• Kenya
• Senegal
• Thailand
• Togo
• Tobago/Trinidad

Quality Assessment and Standardization for Immunological measures (QASI)

QASI is an international program for Quality Assessment and Standardization for Immunological measures relevant to HIV/AIDS. The program was first initiated during the 1996 International AIDS Congress as a means of addressing the proficiency testing needs of countries where such services were not readily available. Distribution of quality assessment material commenced the following year.

Quantitative CD4 T-cell testing has proven essential for clinical staging of HIV disease, for epidemiological studies, and for decisions regarding prophylactic therapies for opportunistic infections. For many developing countries, it is the only feasible/economic way to assess HIV disease state. Satisfactory performance in CD4 T-cell proficiency testing programs is also a requirement for participation in HIV clinical drug trials, and it is highly likely that future HIV vaccine trials will be conducted in countries were incidence and prevalence of HIV infection is high. Quality assessment and proficiency testing programs of national or regional scope would be an important means of assuring the reliability and value of CD4 T-cell measurements in these countries. QASI's primary goal is to provide an inexpensive CD4 T-cell proficiency-testing program where it is most needed.

The QASI Proficiency-Testing Program for T-cell Subset Enumeration distributes to over 120 laboratories in 45 countries located primarily in the Southern Hemisphere. Approximately twice a year, stabilized whole blood samples are sent out, at no charge, to the recipient laboratories. Flow cytometric results on CD4, CD8 and CD3 levels are reported to the NLHI which then collates the performance to all laboratories on the pooled values. All data from individual laboratories is kept strictly confidential. The program has financial support from the Fogarty International Center AITPR program at UCLA (John Fahey), and from the Clinical Immunology Committee of the International Union of Immunology Societies (IUIS). Technical support is provided by two institutions: (1) the National Laboratory for HIV Immunology (NLHI), Bureau of HIV/AIDS, STD and TB, PHAC, Health Canada (Francis Mandy); and (2) the Flinders Medical Centre, Immunology Department, Australia (John Bradley). International organizations, including the UNAIDS and PAHO, exchange information regularly, aiding QASI staff in reaching those laboratories requiring assistance.

Countries Currently Participating in the QASI Program

The Americas	Asia/Pacific Region	Africa
Argentina	Australia	Burkina Faso
Brazil	China	Cameroon
Bolivia	India	Ivory Coast
Canada	Union of Myanmar	Kenya
Chile	Malaysia	Senegal
Cuba	Thailand	South Africa
Mexico	New Zealand	Uganda
USA	Philippines	Togo
Uruguay	Vietnam	Tunisia
Venezuela	Cambodia	Tanzania
Columbia	Israel	Zimbabwe
Panama	Bahrain	Benin
Dominican Republic		Congo
Honduras		Ethiopia
Paraguay		Ghana
Peru		Nigeria
Trinidad & Tobago		Republic of Malawi