The National Institute of Public Health (NIPH), with technical assistance from the USG, will continue its work

in establishing a national public health laboratory network. The objective of the laboratory network is to

increase availability of a minimum package of laboratory tests, decrease dependence on the NIPH

Laboratory (NIPHL) in Phnom Penh for such tests, and reduce the proportion of samples that need to be

sent to NIPHL for testing. NIPH will continue to emphasize quality laboratory systems and will support the

development of guidelines and standard operating procedures for integrated laboratories, including

standardization of staffing, equipment, and operations.

NIPH, with technical support from the USG and the Clinton Foundation, will expand the capacity of NIPHL

to provide DNA polymerase chain reaction (PCR) testing for the timely diagnosis of HIV infection in infants.

Expansion of infant diagnosis is urgently needed. Among an estimated 4,420 pregnant women who were

HIV-positive in 2006, only 311 received antiretroviral treatment at the time of delivery. If treatment has a 5%

failure rate and the probability of HIV transmission from an infected mother to her child is 35%, then

approximately 1,455 infants were born with HIV in 2006. Initial plans are to make testing available in five

provinces.

CD4 testing, important for assessing eligibility for and monitoring ARV treatment, is available at NIPHL and

in three provincial hospital laboratories. The USG will continue to work with NIPHL where nearly 30,000

CD4 tests will be performed in 2007. NIPH, with USG technical assistance, will support a quality assurance

network for CD4+ testing in the other three laboratories, as well.

For health care providers of HIV patients receiving ARV treatment, measurements of viral load to monitor

the effectiveness of treatment on viral suppression are extremely important. Presently, within the Ministry of

Health and the national laboratory network, viral load assays are only available at NIPHL and this testing

has only just become available. The demand for viral load monitoring is expected to increase as an

increasing number of persons living with HIV/AIDS survive longer due to benefits of receiving ARV

treatment. NIPH, with assistance from the USG, will work to increase the number of viral load assays

NIPHL can perform. NIPH cooperative agreement funds will be used to purchase kits for viral load testing

and reagents for HIV screening at NIPHL.

To enable laboratories to provide reliable HIV antibody test results, NIPHL will continue to produce and

distribute serum panels to laboratories throughout the country. The number of laboratories supported by

the external quality assurance (EQA) system will be expanded to include national hospitals and voluntary

confidential counseling and testing (VCT) sites under the supervision of NCHADS. Presently, NIPHL

distributes EQA panels to the blood transfusion centers, but the national hospitals are not enrolled in any

formal EQA program. This issue will be addressed in the next year. The Pasteur Institute has been

providing the175 VCT sites with EQA panels, but this responsibility will shift to NIPHL. Additionally, the

number of VCT sites will increase to 230 and EQA will have to be provided for all of these sites.

In FY 08, USG funds, through a cooperative agreement, will support NIPHL in improving and expanding HIV

laboratory testing as outlined in the Program Area Context. The activities will focus on workshops and

travel to regional HIV reference laboratories so that the NIPH leadership can define and implement the

activities of a national HIV reference laboratory. This funding will also support the purchase of laboratory

reagents and equipment maintenance agreements. Additionally, the NIPHL staff will provide training and

supervision at one provincial hospital laboratory to be used as a model for integrated laboratory

development and supervisory visits to other provincial laboratories. The emphasis of this activity will be on

providing technical assistance for the definition of the tasks of a National Reference Laboratory for HIV and

for the implementation of those tasks.

These activities are consistent with the strategic approaches for strengthening laboratory capacity and

infrastructure outlined in the USG Cambodia HIV/AIDS Strategy 2006-2010. In summary, the USG will

support: quality assurance (QA) systems, laboratory staff capacity building, equipment for expanding

diagnostic and monitoring capacity, reagents and supplies, facilities, laboratory staff, supervision and

networking, and establishment of regional and national referral networks to increase coverage and access

to necessary diagnostic tests.