Virology Quality Assurance (VQA) Participation Application

Virology Quality Assurance (VQA) Participation Application
The National Institute of Allergy and Infectious Diseases (NIAID), Division of AIDS (DAIDS) Virology Quality Assurance (VQA) Program provides quality assurance and proficiency testing (PT) to labs that are performing virologic-based assays for HIV and other pathogens in support of NIAID-funded clinical trials. All laboratories must be approved by NIAID prior to joining the VQA program. Please fill-out the fields below. This Application will be used to request approval from NIAID to join the program and to register your site.
Laboratory Information
Date

DayMonthYear
Date
Institution:*
Preferred Laboratory Name:
Please List All Applicable Clinical Trials Protocols For Your Site*
VQA Proficiency Testing Program of Interest*

Quantitative HIV-1 RNAGenotypic HIV-1 Drug ResistanceQualitative HIV-1 Total Nucleic Acid Testing
Network Quant HIV-1 RNA Testing*

ACTGIMPAACTIMPAACT NICHDHPTNHVTNNoneOther
Quant HIV-1 RNA Assay*

Abbott m2000Abbott Alinity mHologic Panther AptimaCepheid GeneXpertRoche cobas 4800Roche cobas 5800Roche cobas 6800Roche cobas 8800Other
HIV-1 Gene Region*

Protease / Reverse Transcriptase (combined)ProteaseReverse TranscriptaseIntegrase
Network GEN HIV-1 Drug Resistance Testing*

ACTGIMPAACTIMPAACT NICHDHPTNHVTNWHONoneOther
GEN HIV-1 Drug Resistance Sequencing Assay Specifics (indicate Sanger or NGS and in-house or commercial kit)*
Network HIV-1 Qual NAT Testing*

ACTGIMPAACTIMPAACT NICHDHPTNHVTNNoneOther
HIV-1 Qual NAT Derivative*

Whole BloodDried Blood SpotPlasma/SerumCell Pellet
HIV-1 Qual Assay Specifics (i.e. GeneXpert, in-house)*
VQA Web-system Registration
Name of Primary Investigator or Director

First NameLast Name
Phone Number of Primary Investigator or Director
Email of Primary Investigator or Director
example@example.com
Name of Primary Laboratory Contact (Responsible for PT Program)

First NameLast Name
Phone Number of Primary Laboratory Contact
Email of Primary Laboratory Contact
example@example.com
Other Site Personnel to Register for access to the VQA Web-system (name & email)
Shipping Information
Shipping Contact Name
Shipping Contact Number
Shipping Address *
Preferred Courier
Does your Laboratory Need an Import Permit to Receive Biological Materials

YesNo
Does Your Laboratory Have a Currently Valid Import Permit

YesNo
Please Indicate Any Additional Requirements or Documents Needed for Shipment
Should be Empty:

Virology Quality Assurance (VQA) Participation Application

Laboratory Information

VQA Web-system Registration

Shipping Information