Significant efforts have been made by the Angolan MOH to support conditions to establish a functional National Reference Laboratory within the National Institute of Public Health (INSP). A solid laboratory network based on quality training and supervision is now essential to support expansion and decentralization of HIV services. Quality systems ensure a gold standard laboratory performance, from management to supply chain management systems, from human resources to the sample traceability, and implementation of external quality assurance programs for testing, including sample re-testing at reference lab and testing of proficiency panels at sites. This is essential for all HIV programmatic areas (VCT, PMTCT, EID), patient follow-up, adherence, systematic disease surveillance and monitoring and evaluation.

The Strengthening Laboratory Management Towards Accreditation (SLMTA) program will provide guidance to lead laboratories through the process of WHO stepwise accreditation. A SLMTA program consists on a set of individual laboratory assessments using the WHO accreditation checklist combined with training workshops for laboratory personnel and assignment/implementation of improvement projects to/by the lab professionals. Sustained steps achieved per each laboratory are accounted into the PEPFAR indicator for laboratory accreditation. The implementation of the program includes involvement of all stakeholders and country ownership in bringing the need for laboratory accreditation into the national agenda and priorities. The program has a major focus on developing national capacity for sustained implementation of the program by the country after first coached stages which invest in certifying national trainers, national assessors, and mentors. SLMTA identifies a matrix of specific needs allowing for a comprehensive approach of MoH and different partners and donors in supporting laboratories aiming for the final target of having certified quality laboratory services.

As per the 2009 INLS first quarterly report, the number of VCT sites increased over 21 times since 2004 and PMTCT services significantly expanded. This expansion of VCT and PMTCT services corresponds to a significant increase in HIV testing. Implementing quality control programs for rapid testing is fundamental to determine the quality of results and design rational interventions where needed, while Angola is increasing coverage of testing. Implementation of quality control of HIV rapid tests has been included in the National HIV/AIDS Strategic Plan which was updated in 2010. The existence of Dry Tube Specimens (DTS) allows for the production of proficiency panels that can be distributed and tested in testing laboratories and sites. Program includes training of central lab technicians on preparation of the proficiency DTS panels, developing national capacity for sustainability, shipping to the testing units, training of testing laboratories and sites on how to manipulate the panels and register results; and interfacing between reference lab, testing units, and supervision.

AFENET is a non-profit organization and networking alliance dedicated to helping Ministries of Health (MOHs) in Africa build strong, effective, sustainable programs and capacity to improve public health systems on the African continent with a mission "To ensure effective prevention and control of epidemics and other priority public health problems in Africa". AFENET has recently initiated a collaborative effort with CDC to support African countries on strengthening laboratory services by improving quality systems.

FY 2011 will focus on continuing support to Strengthen Laboratory Network and Laboratory Quality Systems initiating a partnership with AFENET on laboratory activities. This partnership will allow leveraging efforts of AFENET support to the Angolan FELTP progam. AFENET works with MOHs and other public health institutions to strengthen their countries epidemiology workforce through Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs), which are residency-based programs in applied epidemiology and laboratory practice. FY 2011 activities include the following:

Engage stakeholders with SLMTA, identify people to be trained as trainers and support ToT;

Initiate a SLMTA program (assessments, training workshops and implementation of improvement projects) with small group of laboratories;

Stakeholder meetings to discuss the first steps of implementation of rapid testing EQC and country expansion plan, is proposed;

Training of the reference lab to prepare the DTS panels;

Enroll testing sites providing training to the health professionals on the preparation and testing of the DTS panels as well on registry procedures.