Background: In January 2010, the implementation of quality management systems toward WHO-AFRO laboratory accreditation commenced in the Antiretroviral Treatment Laboratory of the Infectious Disease Hospital, Kano, Nigeria. Quality improvement projects were instituted in 2011 in line with ISO 15189 requirements for accreditation of medical laboratory. In this study we evaluated the performance of the laboratory through some set of quality indicators (QI). Methodology: This was a retrospective study to evaluate laboratory QIs monitored from January 2011 to December 2013. The QIs were specimen rejection rate (SSR), turnaround time (TAT), proficiency testing performance (PTP) and client satisfaction survey (CSS). Data was collected into an excel file for analysis and percentage performance compared among years. SSR & TAT were evaluated with the Sigma scale. Results: A total of 7920 (2194 in 2011, 2715 in 2012, 3011 in 2013) specimens were received for testing. 22 (0.28%) specimens were rejected and 81 (1.02%) specimens' results were reported after the acceptable TAT, giving a Sigma level of 4.27 and 3.82 for SSR and TAT respectively. There was steady improvement in PTP: CD4+ from 67% in 2011 to 90% in 2013, hematology from 81% in 2012 to 83% in 2013, blood film reading 79% in 2011 to 83% in 2013 and chemistry from 90% in 2011 to 93% in 2013. HIV serology recorded 100% throughout. CSS increased from 59% in 2012 to 78% in 2013. However, there was no statistically significance difference reported for PTP and CSS over the years (P > 0.05). Conclusion: The study highlights the need to continuously evaluate QIs and calls for more effort to improve on PTP and focuses on understanding and improving on clients concerns.

Introduction: A laboratory's ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessment is an extremely rewarding exercise in health care quality improvement processes, it is always considered very time consuming and expensive in developing world settings. A quarterly internal audit was conducted in 25 FHI360 supported Antiretroviral Treatment laboratories in the North West of Nigeria which can surely provide reference for other countries. Methodology: A checklist adapted from the World Health Organization/African Regional Office laboratory accreditation checklist was used to quantitatively evaluate 7 quality essentials (QEs). A team composed of technical staff from FHI360, State Ministry of Health and facility laboratory heads, conducted the audits, developed and monitored intervention plans. Information obtained with the checklist was captured in excel, validated and imported into Grappa Prism software version 5.0 for analysis. Results: Most (92%) facilities were at secondary level with (8%) at tertiary level. The mean total score on all QEs across the facilities was 63.34 ± 9.77 in quarter (Q) 1, 68.8 ± 10.91 in Q2, 72.59 ± 8.02 in Q3 and 72.72 ± 9.16 in Q4 (p ≤ 0.0001). The most improved QE through Q1-Q4 was organization and personnel (32.2%), while signage/bench top reference had an 18.6% point decline. In ranking facilities based on differences of total scores between Q4 and Q1, Kachia General Hospital was the highest with 27 point increase. Considering the mean percentage score for all quarters per facility, 4 had ≥ 80%, 19 had between 60% -80% and 2 had ˂60%. The total non-conformities cited for QI-Q4 were 185, 100, 78 and 64 respectively with highest recorded in internal and external quality control and the least in facility and safety. Conclusion: We recorded some improvement in most QEs confirming the benefits of internal audits, reviews and follow-up. However, much more is needed in terms of technical assistance, capacity building, mentorship, and commitment at facility and state level to meet minimum acceptable laboratory quality stan-* Corresponding author. F. E. Jegede et al. 194 dards.