PEPFAR-CI has procured technical assistance since FY07 from the CDC International Lab Coalition, a

CDC HQ-based funding mechanism that allows country programs to procure technical assistance from four

leading organizations with laboratory expertise (APHL, CLSI, ASM, and ASCP) in support of the USG effort

to address challenges in coordinating the Cote d'Ivoire lab portfolio relative to trainings, quality assurance,

procurement, and management of collaborative projects between in-country partners.

In FY09, the American Society of Microbiology (ASM) will continue to support the development of TB/HIV

laboratory and human capacity in Cote d'Ivoire, primarily at the central reference laboratory level, through

ongoing efforts to establish quality-assured diagnosis of TB and strengthen the TB external quality

assurance program. Specific activities related to TB diagnostic and drug sensitivity capacity development

will include:

1)Strengthening Institut Pasteur Côte d'Ivoire (IPCI) to better perform its role as the national TB reference

laboratory

2)Reinforcing Tuberculosis (TB) culture and drug susceptibility testing (DST) capacity at the Centre de

Diagnostique et de Recherche sur le SIDA (CeDReS) in order to establish a provisional central level

laboratory to perform these tests

3)Decentralizing TB culture capacity to Centres Anti-Tuberculeux (CATs) with CAT-Adjame (the largest TB

treatment center in Cote d'Ivoire) as the first site

4)Providing expert guidance for TB laboratory design and infrastructure development including renovations

and upgrades

5)Improving training and external quality assessment (EQA) for acid-fast bacillus (AFB) smear microscopy

(including support for use of the CDC/WHO smear microscopy training package and the appropriate

introduction and training related to fluorescent LED microscopy to help improve speed and accuracy of

sputum screening in higher-volume settings).

ASM's technical support activities for strengthening the national TB laboratory network of Côte d'Ivoire will

include:

1)Providing technical guidance and detailed requirements for laboratory renovations;

2)Developing detailed lists of equipment, consumables, reagents, etc. needed for each laboratory

performing TB culture and DST;

3)Negotiating with different organizations (eg. FIND) for procuring and/or renting the recommended

laboratory equipment and materials and following-up with the organization procuring the recommended

materials;

4)Overseeing the laboratory renovations and installation of equipment;

5)Implementing TB culture and DST through onsite training and technical assistance;

6)Offering guidance for improving AFB microscopy trainings and EQA; and

7)Providing recommendations for improving TB laboratory workflow and setting up a specimen referral

system.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.12:

PEPFAR funded the CDC International Lab Coalition, a CDC HQ-based program that allows country

programs to tap into four leading organizations with laboratory expertise (APHL, CLSI, ASM, and ASCP), in

order to address challenges in coordinating the Cote d'Ivoire lab portfolio in terms of trainings, quality

assurance, procurement, and management of collaborative projects between in-country partners.

FY09 funding will continue to support the CDC Lab Coalition in the program areas of Laboratory

Infrastructure and TB/HIV.

ASCP

ASCP (American Society for Clinical Pathology) is a dynamic organization focused on improving global

health by implementing innovative methods and partnerships that improve laboratory practices. ASCP was

granted funding for Cote D'Ivoire in 2008 to provide technical laboratory assistance through in-service

trainings with current laboratory professionals and pre-service training curriculum development with the

National Institute of Training for Medical Technologists (INFAS). ASCP provides in-service laboratory

training to working laboratorians so that they may update skills in preparation for the use of new

technologies that will enhance and improve the diagnosis and laboratory monitoring of HIV/AIDS patients.

Sustainability of this effort is provided through training of trainer (TOT) workshops, which develop master

trainers from in-country senior laboratorians. In FY08 ASCP made an initial visit to Cote d'Ivoire to assess

the school of laboratory technicians (INFAS) and develop a consensual workplan for the revision of

curriculum to aid in teaching laboratory focused methods and courses.

Pre-Service Curriculum Development (Phase 2) FY09 funds will complement FY08 carry over funding to

complete activities started in FY08. ASCP will organize pre-service training with faculty and students of

INFAS to update curriculum that reflects the inclusion of new technologies with a focus on HIV testing and

quality assurance. ASCP will be involved in the following activities: review curriculum content and ensure

inclusion of information on new technologies, instrumentation and procedures; provide training of faculty on

quality assurance and new technologies in the clinical laboratory; twinning of INFAS with another

educational institution supported by ASCP to provide information sharing related to faculty interactive

teaching techniques.

Phase 2 of the Pre-Service Curriculum Development includes: (1) A Monitoring and Evaluation activity

facilitated by 2 ASCP consultants and 1 staff member. This activity will include traveling to INFAS (Cote

d'Ivoire), observing new materials being taught and meeting with faculty. (2) An additional 300 hours of

professional curriculum development and finalization by the ASCP Pre-Service Work Group. (3) Mentorship

Technical Assistance: an ASCP consultant serving as a mentor and educator at INFAS for 2 months at a

time. Phase 2 of Curriculum Development will take approximately 12 months to complete. This will include

work group curriculum development, and Monitoring and Evaluation of this year's activities.

ASM

ASM (American Society of Microbiology): Opportunistic Infections (OIs) and sexually transmitted infections

(STIs) are common in HIV populations and are a major threat to People Living with HIV/AIDS (PLWHA)

both prior to diagnosis as well as during care and treatment. Basic microbiology laboratory services for

blood stream and other infections which have high morbidity in HIV infected patients are limited in their

availability and often, when available, lacking in quality.

In fiscal year (FY) 2009, the American Society for Microbiology (ASM) technical experts (mentors) will

continue to provide in-country support for microbiology and OIs, laboratory systems and strategic planning,

standardization of protocols for cost effective testing, and good laboratory and clinical practices. ASM's

major emphasis area will be to continue technical and human capacity development.

In FY08, funds were requested to strengthen TB diagnostics in Cote d'Ivoire. In FY09, the activity has been

modified to include strengthening diagnostics of other OIs and STIs, in addition to ongoing efforts towards

establishing quality-assured diagnosis of TB and strengthening the TB external quality assurance program.

Specific activities with respect to assistance for OIs and STIs in FY09 include: (1) Evaluation of OI (other

than TB) and STI diagnostic capacity in-country. (2) Strengthening and expansion of core functions of the

National Microbiology Reference Laboratory (IPCI). (3) Collaboration with the IPCI to develop and facilitate

basic microbiology workshops to be presented at six regional laboratories. (4) Follow up mentoring in the six

labs where microbiology workshops have been presented to ensure proper retention and implementation of

demonstrated procedures. (5) Provision of onsite training of IPCI staff in the monitoring and evaluation of OI

and STI training activities. (6) Assistance with development of a laboratory quality assurance program for

microbiology to include a training plan for laboratory personnel and guidelines for supervision and oversight

related to standards of quality. (7) Strengthen pre-service, in-service, and continuing education for

microbiology.

APHL

Since 2002, APHL (Association of Public Health Laboratories) has provided support to: the National

Reference Public Health Laboratory (LNSP), the Public Health Pharmacy, the National HIV and TB

programs, the National Institute responsible for training laboratory technicians (INFAS) and the national

network of laboratories. APHL's goal was to build national capacity for the delivery of quality decentralized

HIV laboratory services in support of HIV/AIDS prevention, care and treatment efforts including targeted

evaluation and surveillance activities.

APHL has collaborated with CDC/Projet RETRO-CI and the national network of laboratories to provide

technical expertise to enhance the quality and scope of laboratory services as part of PEPFAR funded

Prevention, Care and Treatment activities. Through trips from a lead consultant and 3 other consultants,

APHL supported laboratory networking, training and the promotion of quality laboratory services. In FY 09,

no funding is requested for APHL in the COP09 submission; activities will be carried out by APHL during the

COP09 program period with funds carried over from the FY07 and FY08 budget periods.

In collaboration with PEPFAR-implementing partners, WHO, CDC, the MOH, the national HIV/TB/Malaria

Activity Narrative: programs, the public health national reference laboratory (LNSP), the national TB reference laboratory

(IPCI), and the national laboratory networks, APHL will focus on 2 key program areas:

1 - Strategic planning for laboratory services: providing technical assistance for the development and

implementation of the national public-health laboratory strategic plan to:

(1) build an integrated and sustainable national laboratory system; (2) improve HIV/TB/Malaria laboratory

services; (3) establish a quality assurance program for the system; (4) develop laboratory related human

capacity, with an emphasis on career development for motivation and retention; (5)develop a national

monitoring and evaluation system/program for the lab network; (6) infrastructure and equipment

standardization and improvement; (7) develop a budget for the implementation of the plan and assign

partner roles in the implementation process.

2 - Improvement of laboratory information management system (LIMS): (1) support an assessment of the

LIMS available within the public health laboratory system based both on electronic and paper-based tools

used to collect and report laboratory data and results;

(2) provide technical support for implementation of cost-effective LIMS, and the creation of a national

laboratory database.

CLSI

The provision of quality laboratory services and the conduct of reliable diagnostic testing are challenges in

many international settings where resources are limited. Quality laboratory testing is an integral element in

the clinical diagnosis framework, infectious disease surveillance, and the formation of public health policy.

Good laboratory practices prove to be cost-effective and promote reliable and accurate results, contributing

to good patient care, and thereby can promote a positive attitude by patients towards testing. CLSI (Clinical

and Laboratory Standards Institute)is committed to facilitating the development of quality systems in the

laboratory, and providing on-going advisement to sustain quality improvements. CLSI will build capacity

through the provision of laboratory standards and guidelines, and providing technical assistance, training,

and technology transfer to individuals and organizations.

In FY09 CLSI will continue its current scope of work to assist the following three reference and training

laboratories in their preparation for accreditation:

(1) Projet RETRO-CI ; (2) LNSP ; and (3) Institute Pasteur - Cote d'Ivoire (IPCI).

CLSI will prepare each site for the accreditation model chosen by the laboratory leadership of Cote d'Ivoire:

ISO 15189. As each laboratory is unique, CLSI will customize the activities for each site and proceed

methodically in the assessment and implementation of the 12 Quality System Essentials (QSEs) as the

primary focal areas. Laboratories will focus on 3-4 QSEs to start. CLSI's workplan will be carried out in six

phases: (1) gap analysis I of the baseline Quality Management System; (2) action plan development to fill

gaps to strengthen laboratory quality system and operation; (3) implementation of milestones through

mentorship/twinning; (4) self-assessment of progress by the laboratory management; (5) quality

improvement and on-going assistance based on needs; (5) gap Analysis II. Standard Operating Procedures

and Accreditation Workshops will be provided based on country requests.

Becton Dickinson Public Private Partnership with PEPFAR

Becton Dickinson (BD) is a leading global medical technology company that manufactures and sells medical

services, instruments systems and reagents. In October 2007, PEPFAR signed an MOU with BD to

establish a public private partnership to improve overall laboratory systems and services in African countries

affected by HIV/AIDS and tuberculosis. Activities of BD will be focusing on strengthening Cote d'Ivoire

laboratory system by: (1) working with ASM/ PNLT /IPCI to develop and implement a sample referral

system for TB liquid and solid culture (2) work closely with LNSP/Cedres to strengthen the QC program for

CD4 count and develop related training curricula. (3) Work with central labs to develop training materials for

sample management and phlebotomy.

TA from the CDC International Laboratory Branch

A consensus document for laboratory management has been developed by the CDC International

Laboratory Branch in collaboration with the CDC-International Lab Coalition. RETRO-CI will request

technical assistance visits from CDC-HQ for a TOT training of a national pool of trainers based at central

and regional laboratory institutions. Following the training of trainers two training sessions for laboratory

managers will be organized to improve the quality of laboratory management within the network. Trainings

will cover topics like quality management systems, good laboratory practices, and biosafety.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16774

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16774 12215.08 HHS/Centers for CDC International 7224 7224.08 CDC Lab $600,000

Disease Control & Lab Coalition Coalition

Prevention

12215 12215.07 HHS/Centers for CDC International 7323 7323.07 CDC/Lab $77,836

Disease Control & Lab Coalition Coalition

Prevention

Emphasis Areas

Health-related Wraparound Programs

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $125,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16: