Funding will be used to strengthen the quality of clinical lab activities in support of HIV/TB diagnosis and treatment, including quality assurance to strengthen lab capacity by providing technical assistance to national stakeholders and on-site supervision at testing and treatment sites. During FY07, the Emergency Plan will build on previous activities and continue to prioritize HIV-TB integration and increased service coverage. Of ~26,500 TB patients, 60% will receive routine CT services, while of 33,000 HIV-infected clients attending HIV service sites, at least 50% will receive routine screening for TB disease at "HIV" points of entry (i.e. CT, PMTCT, etc). Integration of routine CT and comprehensive care and treatment for both HIV and TB is planned for at least 86 TB diagnostic and care service sites (94% of the 91 national sites). EP-supported sites will use adapted WHO screening tools and data recorded in the facility reporting systems. As part of a family-centered approach, children will be the focus of intensified case detection and household follow-up. Care for TB/HIV co-infected persons and their families will be linked with other prevention and palliative-care services. A range of individually focused health education and support, referrals, community interventions, and advocacy will be integrated.

The EP will also support expanded TB diagnostic capabilities for mycobacterial culture and drug susceptibility testing. Substantial efforts will be made to prevent and manage drug-resistant TB among HIV-infected TB patients. The EP will also work with WHO and the PNLT to adapt the national TB surveillance system to include HIV and improve systems to capture TB screening data at HIV entry points.

With the approval of additional plus-up funds, the CDC Lab coalition will: • Improve TB/HIV surveillance. These activities will complement PNLT activities funded by the GFATM for several aspects of the integration of HIV data in the TB recording and reporting system.

The selected CDC Lab Coalition partner will support the PNLT to adapt the Electronic TB Register (ETR.Net) developed in Botswana and South Africa for data capture, report generation, and analysis in CI. Resources will be dedicated to software programming and to supporting pre-implementation adaptation, training, and support. • Improve lab strengthening as decentralization occurs for quality-assured microscopy (QA/QC). • Identify new and reliable technologies for improved diagnosis and drug-susceptibility testing that are applicable to the Cote d'Ivoire context. This will include testing new algorithms for smear-negative TB and assessing impact on HIV/AIDS sensitivity • Create a network of best practices and lessons learned across EP countries to improve the overall strength of TB activities. • Engage a local focal point to assist with coordination and provide support while the team recruits for a long-term TB resident adviser. • Assess needs at the national reference laboratory (Institut Pasteur) to help ensure adequate laboratory facilities for TB culture, drug-suceptibility testing, and MDR surveillance. • Develop human-resource capacities by providing training of trainers in TB-related activities, quality management, and biosafety.

TBD was changed to EGPAF and was added to EGPAF HTXS in the previous reprogramming round.

Funds are being transferred to a more appropriate partner to implement comparable activities. The reallocation is based on guidance from the Laboratory Technical Working Group, which will be communicating further with the in-country team and CDC Lab Coalition partners to define scopes of work, including identifying appropriate laboratory cooperative agreement partners and funding levels.

With FY07 EP funds, in collaboration with the Ministry of Health and other EP partners, the CDC Lab coalition will: 1. Provide technical assistance for laboratory management training (PNPEC, LNSP), training of trainers for laboratory-related activities (HIV testing, CD4 technologies), and training in EQA implementation. 2. Provide technical assistance for development of a national laboratory strategic plan integrating services related to diseases of public health importance (HIV, TB, and malaria). 3. Provide technical assistance for elaboration of training tools and guides for HIV testing and CD4 counts and elaboration of standardized tools and guides for laboratory assessment and supervision. 4. Provide technical assistance to implement an EQA program for HIV serology (LNSP) and CD4 counts (RETRO-CI) at all laboratories providing HIV testing (> 100) and CD4 enumeration ( >35). 5. Support implementation of a finger-prick-based algorithm at the national level with a view to scaling up VCT and PMTCT services and extending HIV testing to hard-to-reach settings. 6. Provide technical assistance to customize the WHO protocol and develop a national protocol for monitoring of HIV drug resistance emerging during ARV therapy and related program factors. 7. Support efforts to build capacity at the national reference laboratory (LNSP) to improve reference testing capabilities for HIV diagnosis and implement a QA program. 8. Provide technical assistance through cooperative-agreement partners (ASCP, CLSI) to support accreditation of the RETRO-CI laboratory with a view to supporting the national laboratory network in moving toward an accreditation process. 9. Support training of national experts in biosafety, especially in maintenance and certification of biological safety cabinets (BSC) and biosafety level standards. 10. Support development of a national policy on procurement of equipment and reagents (SCMS, PSP). As part of the above activities, at least 260 health workers will be trained, including: - 75 lab technicians and scientists, in laboratory management - 10 trainers in laboratory management and laboratory-related activities (HIV, CD4) - 110 lab techs in EQA - 2 lab techs in biosafety - 60 lab techs in HIV finger-prick-based testing algorithm - 3 scientists at the national reference laboratory

Funding will be used to support and improve the quality of clinical lab activities, including quality assurance to strengthen lab capacity by providing technical assistance to national stakeholders and on-site supervision at more than 100 CT and PMTCT service-delivery sites.