This mechanism supports CARs PEPFAR Strategy Objective 2. Restructuring and strengthening laboratory infrastructure is a high priority for the Ministries of Health (MOH) in Kazakhstan (KZ), Kyrgyzstan (KG) and Tajikistan (TJ). The goal is to increase the KZ, KG and TJ MOHs capacity on laboratory issues in relation to HIV/AIDS and related co-infections. The American Society for Clinical Pathology (ASCP) will work with different vertical healthcare structures of CAR MOHs (HIV/AIDS services, blood transfusion services, tuberculosis control services and others) to ensure integration and broad capacity building. The target population is the MOH and laboratory staff in KZ, KG, and TJ. ASCP will provide TA (TA) to the MOHs for the development and monitoring of laboratory strategic plans; strengthening the technical capacity within MOH laboratories through trainings on internationally-recognized policies; implementing laboratory quality management systems and encouraging the accreditation of laboratories. ASCP will provide direct TA to national reference (and oblast level) laboratories in preparing laboratories for accreditation through the Strengthening Laboratory Management towards Accreditation (SLMTA) program; this activity will be monitored and evaluated under the PEPFAR policy reform area on the development of national policies on laboratory accreditation. The requested funding will target ASCP activities aimed at building the capacity of KZ blood transfusion laboratory services at the national and oblast level and the establishment of the National Reference Laboratory (NRL) for KZ blood transfusion services.

This mechanism supports CARs PEPFAR Strategy Objective 2 & linked to HLAB/CLSI, IM#13970 & Columbia Univ IM#12872. Reliable diagnosis and effective treatment of HIV infection would be impossible without quality laboratory services. Currently, no CAR country has a strategic plan for improving laboratory quality, a functioning national body overseeing laboratory performance standards, nor any system for laboratory accreditation or licensure for specific levels of competence. There is no culture of service quality, or conception that clinicians who collect samples, order tests, and receive results are the laboratorys clients. This lack of quality management and accountability to other components of the public health system creates barriers for people at risk for HIV infection to get tested, to receive and understand the results, and to have confidence in the accuracy of the testing. It is also detrimental to the success of ART programs. The goal of this project with the American Society for Clinical Pathology (ASCP) is to improve and strengthen laboratory capacity of the MOH in KZ, KG, and TJ in the area of HIV/AIDS and co-infection laboratory testing.

ASCP will offer assistance to the CAR MOHs national core groups leading the efforts to strengthen laboratory systems by supporting the development of comprehensive national laboratory strategic plans. ASCP will be supporting selected HIV/AIDS, TB, and blood transfusion services national reference and regional (oblast) level laboratories by using the Strengthening of Laboratory Management Towards Accreditation (SLMTA) scheme which is designed to strengthen laboratory quality management, achieve immediate laboratory improvement and accelerate the process toward accreditation. The SLMTA process will include baseline assessments, followed by a series of training workshops and implementation of specific improvement projects in selected laboratories. As a monitoring and evaluation tool, follow-up assessments will be conducted to measure the level of improvement completed by each laboratory in specific focus areas. Upon completion of the training cycle, each laboratory will be visited for a final time by an ASCP assessment team to use the accreditation checklist and compare the scores from the baseline assessment to measure the progress made during the program. The number of SLMTA supported national reference (and oblast) level laboratories will be 4-5 laboratories per country with further expansion of additional laboratories as agreed with the MOHs and as the capacity of the national teams of laboratory managers and assessors are advanced. The SLMTA progress will regularly be documented and reported at national stakeholders meetings to increase awareness of the strengths and challenges of laboratory operations and facilitate continuous quality improvement. In collaboration with the MOHs, ASCP will determine the types of training most appropriate to each country. Depending on the infrastructure level in each country, basic laboratory operations training, or other content-rich material resources to build capacity and sustainability of personnel will be provided.

The activities listed above will be funded through previous PEPFAR funds. Requested funding for FY12 will target ASCP activities aimed at building the capacity of KZ blood transfusion laboratory services at the national and oblast level and the establishment of the National Reference Laboratory (NRL) for KZ blood transfusion services