Annually there are an estimated 70,000 new TB cases in Cote d'Ivoire and approximately 36% of these

patients (28,000) are co-infected with HIV. The TB case detection rate remains low at 27% for all the Tb

cases and 42% for sputum smear positive cases. In 2006, the TB case notification rate was 108 per

100,000 population with a total of 21,000 TB cases reported of which 12,000 were sputum smear positive.

Cote d'Ivoire has 11 stand alone TB treatment centers (CATs) and 81 CDTs integrated into general

hospitals across the country. Currently Cote d'Ivoire has two laboratories with capacity for performing TB

culture: Institute Pasteur CI and CeDreS Laboratory. In 2006 < 500 TB cultures were performed as part of

the work up for presumed treatment failure of patients with active tuberculosis. Since July 2007, the CDC

International Laboratory Coalition Partners (via the American Society of Microbiology {ASM}) has been

designated to provide technical assistance for strengthening the capacity of the TB laboratory network for

smear microscopy, culture and drug susceptibility testing. The first phase of this activity has been focused

on improving the TB diagnosis capacity at the national reference laboratory (Institute Pasteur Cote d'Ivoire-

IPCI) and at the largest of Cote d'Ivoire's regional TB centers (CATs), the CAT Adjame, which serves more

than 5000 TB patients per year, nearly a quarter of the country's TB patients currently under treatment.

In FY 08 the CDC Lab Coalition Partners will continue to focus on strengthening TB/HIV laboratory services

by:

- providing technical assistance for laboratory assessment, design and infrastructure development for

renovations and improvement, including decentralization of TB culture at 3-4 regional TB centers in the

Northern, Western and Central parts of the country to facilitate diagnosis of smear negative TB in suspected

patients as well as to perform culture and drug susceptibility testing for patients failing primary TB treatment.

- supporting laboratory capacity building at the national reference laboratory (Institute Pasteur Cote d'Ivoire)

to:

- strengthen TB diagnosis and management by smear-microscopy

- improve capacities for rapid TB culture

- develop the capability for drug susceptibility testing for rapid detection of TB drug resistance in patients

with treatment failure

- perform drug resistance surveillance to detect and manage patients with MDR/XDR-TB according to

recommended guidelines

- providing technical assistance for building culture capacity at the major CAT in Adjame

- supporting TB culture and DST at CeDRes Laboratory as needed

- providing technical assistance to the national TB program in the establishment of a national referral

system for the transport of specimens from specimen collection sites to the reference laboratories for

culture and DST

- supporting the national TB program to expand access to quality sputum smear-microscopy at the national

level including the roll out of the WHO/CDC/IUATLD/APHL/RIT direct smear- microscopy training package

- supporting the national TB program to improve the external quality assurance system, (on-site

supervision, slides rechecking and proficiency testing)

- providing technical assistance to develop a national TB infection control plan for prevention of TB

transmission among laboratory personnel

- providing technical assistance for implementation of a new diagnostic algorithm and procedures to

diagnose smear negative, extrapulmonary, and pediatric TB as they become available.

Since 2002, APHL provided support to: the National Reference Public Health Laboratory (NRL/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 related targeted evaluation and surveillance activities.

APHL 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 the EP funded Prevention, Care

and Treatment activities. Through intermittent trips from a lead consultant and 3 other consultants, APHL

supported laboratory networking, training and the promotion of quality laboratory services.

In 2007, there were several major challenges in the technical area of lab, including the political instability

and the re-organization of the MSHP with difficulty in having access to MSHP counterparts. Coordinating

the lab portfolio in Cote D'Ivoire in terms of trainings, QA and procurement, as well as managing

collaborative projects between the various in-country partners is also challenging without an in country

presence. PEPFAR decided to fund the CDC International Lab coalition which is a CDC HQ based program

that allows country programs to access TA from four leading organizations (APHL, CLSI, ASM, ASCP),

with laboratory expertise. In July, ASM was designated to provide technical assistance for strengthening

the capacity of the TB laboratory network for smear microscopy, culture and drug susceptibility testing. The

first phase of this activity was focused on improving the TB diagnosis capacity at the national reference

laboratory and at the largest of the TB regional centers.

In FY 08, the CDC Lab coalition partners in collaboration with HHS/CDC HQ, RETRO-CI, EP-implementing

partners, WHO, the MOH, the national HIV/TB/Malaria programs, the public health national reference

laboratory (LNSP), the national TB reference laboratory (IPCI), and the national laboratory networks, will

focus on six key program areas:

Strategic planning for laboratory services:

- providing technical assistance for the implementation of the national public-health laboratory strategic plan

to:

- build a sustainable national laboratory system

- improve HIV/TB/Malaria laboratory services

- establish a quality assurance program for the system

Laboratory quality assurance technical assistance for:

- the implementation of a national guide, standardized forms and checklist for supervision of HIV testing and

ARV therapy monitoring laboratories

- the development of national laboratory quality assurance standards

- the development and harmonization of Standard Operating Procedures (SOPs)

- evaluating, developing, improving and maintaining laboratory quality management systems (managerial

and technical) in compliance with CLSI and ISO 15189 requirements

Supporting laboratory network and training:

- to develop mechanisms to ensure sustainable strengthening of the national public health laboratory

system such as implementation of quality management system practices and related trainings

- to provide technical assistance to assess and improve the quality management system within the

laboratory network

- to continue to support the development of management and technical capacities at the

national reference laboratories by:

- providing targeted training and twinning with appropriate institutions in Europe, Africa and/or the US

- organizing exchange visits to reference laboratories for learning best practices and organizational models

- to continue to provide TA to build appropriate reference testing capabilities and facilities within the National

Reference Laboratory (LNSP) and work with staff to develop a laboratory quality assurance system

- to continue to support human capacity building through a comprehensive training plan including training of

managers on laboratory management and quality systems, strategic planning, and biosafety and

certification of biological safety cabinets

- to provide technical assistance for French translation of training materials

Improved access to quality services for the diagnosis of opportunistic infections

- assess the availability and quality of Opportunistic Infections (OIs) diagnosis within the network

- provide technical assistance to improve access to quality OIs diagnostic services

Improvement of laboratory information management system (LIMS)

- 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

- provide recommendations for the harmonization and implementation of cost-effective LIMS, and the

creation of a national laboratory database