ICMR-NARI/PTSOP/SER/04
FORMAT -04
PROFICIENCY TESTING FORM
Name of Proficiency Testing Provider: ICMR-NARI, Pune Year: Round:
Date Panel Dispatched: Closing Date:
Date proficiency panel received:
Date of testing proficiency panel: Date report sent:
HUMAN IMMUNODEFICIENCY VIRUS TYPE-1 (HIV-1) ANTIBODY TESTING
NOTE :
The HIV-1 performance evaluation samples are undiluted, unaltered individual donor
material. It is the intention to provide laboratories with performance evaluation samples that
closely resemble the types of specimens that laboratories encounter in their routine daily
testing.
PT Laboratory Identification No.:
(Number can be found on your panel box)
Laboratory Name :
Type of Laboratory: NRL/SRL/ICTC/PPTCT/FI-ICTC/PPP-ICTC/Blood Bank/Private lab
Address of Laboratory (where testing is undertaken):
Street :
State: Postal Code: Telephone No.
E-mail: Fax No.:
Name of nodal officer:
& Signature
Version 9.0 Page 1 of 3
ICMR-NARI/PTSOP/SER/04
FORMAT -04
PT Lab ID. No.
KIT DETAILS
Kit Details
Test I Test II Test III
Type of Test
(Rapid/ELISA/Western Blot)
Name of the test
Manufacturer
Lot #
Date of Expiry
Principle of the test
FINAL RESULTS
Test Results Final
S.No. Panel Sample ID
Test I Test II Test III Interpretation
R : Reactive ; NR : Nonreactive; P: Positive; I : Indeterminate ; N : Negative
Remarks (if any ) :
Signature of Technician Signature of Nodal Officer
Date: Date:
Version 9.0 Page 2 of 3
ICMR-NARI/PTSOP/SER/04
FORMAT -04
GENERAL INSTRUCTIONS
• Please read all instructions completely before testing.
• Fill relevant pages and record all information legibly within the appropriate spaces.
• Enter EQAS laboratory identification number in the boxes provided. Your EQAS number is present on
the panel box containing proficiency panel.
• Perform the test procedure (s) in the same manner as the routine samples following NACO Strategy
III.
• Do not report for more than three tests.
• As far as possible use the kits provided by NACO and follow all the instructions as per kit insert.
• Enter in the spaces provided the last two digits of the sample code that appears on each vial, e.g.
01 02
• Wherever differentiating kits are used, kindly specify the results as HIV-1/ HIV-2/ HIV-1+2.
• Prior to use, allow samples to reach room temperature (18-30°C).
• Spin the samples before testing to avoid the interference of turbidity in the test results.
• All samples should be treated as potentially infectious and should be handled using Universal Safety
precautions.
• Results should be sent within eight days after receiving the panel.
• If the samples cannot be tested for any reason (eg. Unavailability of kits) store the samples at – 20 °C.
• Any clarification required regarding EQAS programme, please contact the PT provider at the following
address.
Address of Proficiency Testing Provider
ICMR-NATIONAL AIDS RESEARCH INSTITUTE
Plot No. 73, ‘G’ Block, MIDC, Bhosari,
Pune-411026
Phone No. : 020-27331200
Fax : 020-27121071
E mail : ptprovidernari@gmail.com
NON REPORTING CODES
CODE REASONS FOR NOT REPOTING RESULTS
T Test not performed in this laboratory
L Samples lost or destroyed in laboratory
R Test reagents not available
I Insufficient sample volume to perform test
O Other (please specify on results form)
Version 9.0 Page 3 of 3
