The Association Public Health laboratories (APHL) laboratory technical assistance project is a cooperative agreement awarded by HHS/CDC from 2008 to 2011, with a total potential value of $935,181. APHL supports strengthening of public health and clinical laboratories with emphasis on national strategic planning, policy development and implementation, HIV quality testing, management and information system in Lesotho.

APHL is a membership organization comprised of public health laboratories and has about 5,000 professionals. The Association Public Health laboratories (APHL) laboratory technical assistance project is a cooperative agreement awarded by HHS/CDC from 2008 to 2011, with a total potential value of $935,181. APHL supports strengthening of public health and clinical laboratories with emphasis on

national strategic planning, policy development and implementation, HIV quality testing, management and information system in Lesotho.

APHL is a membership organization comprised of public health laboratories and has about 5,000 professionalsIt has diverse expertise to support HHS/CDC including strategic planning for national laboratory networks, implementing training programs, planning and managing renovation projects, implementing laboratory management information systems, procuring equipment and supplies, and providing US-based and in-country advanced training for laboratory professionals.

In PEPFAR supported countries, the five-year strategic plan for APHL activities include core training initiatives that support laboratory strengthening, country-specific action plans, and strategic partnerships. APHL provides comprehensive training in test methods, quality management systems, laboratory safety and policy development. APHL support procurement of lab commodities, deploying consultants to provide technical assistance in countries including training-of-trainer activities. APHL has developed quality training tools such as External Quality Assessment (EQA) for AFB smear microscopy, HIV and equipment maintenance and provided technical assistance in laboratory capacity building.

APHL implements specific short-term best practices to strengthen laboratory services while working systematically to gain long-term improvements in quality management and infrastructure of laboratories. APHL adapts its work plans and training materials to meet the specific needs and outcome objectives of each country plan. APHL organizes the technical assistance (TA) teams and logistical support to complete the activity successfully. A hallmark of APHL performance has been flexibility in response to changing schedules and responding to unexpected events.

APHL provides training and technical assistance to strengthen key areas of laboratory capabilities and capacities: 1) Laboratory management training provides supervisors and directors with the knowledge, skills and abilities to be more effective in their jobs. Outputs of this training and follow-up include strength, weakness, opportunity and threat (SWOT) analyses, organizational improvements and coaching initiatives. 2) Strategic and operational planning workshops provide laboratory professionals with knowledge, skills and tools to develop effective strategic plans that guide development of annual operational plans for systematic, sustainable improvements in laboratory services. Outputs include strategic and operational plans. 3) Twinning agreements between major US public health laboratories and national referral laboratories cultivate close working relationships, learning opportunities and information sharing. Outputs include technology transfer and competency in new test methods, and long-term affiliations. 4) Implementation of laboratory information systems (LIS) provides increased efficiency of testing, better monitoring of quality control, supply and equipment management, and data for surveillance, trend monitoring and evidence-based decisions. Outputs are operating local area networks in national

and provincial laboratories with automated equipment interfaces and capability for electronic transfer of test information. 5) Technical assistance in the development, implementation and management of QA and EQA programs. 6) Technical assistance in laboratory design and safety in collaboration with an APHL laboratory design partner and using APHL training materials for laboratory biosafety and biosecurity.

The technical supports include training in performing HIV Rapid Tests, assisting with implementing EQA; training and mentoring in performing TB microscopy and culture; and implementation of national standard paper-based lab forms and LIS for patient and summary test reporting. Moreover, APHL activities build sustainable capacity through TOT, long-term twinning agreements and internships at U.S. public health laboratories. Importantly, APHL efforts assisting countries in the development of effective strategic plans is a key factor in the success of the Emergency Plan

APHL partners with George Washington University School of Public Health and Health Sciences to offer advanced seminars in leadership, laboratory science, and strategic planning, and with Miami Dade College Medical Campus to provide medical laboratory science training. APHL is a partner in the World Health Organization's "Laboratory Twinning Initiative," a program that matches national laboratories in developing countries with "expert" institutions to improve quality laboratory practice and international infectious disease surveillance and response. APHL also collaborates with WHO/AFRO to support a national laboratory communications network and with the WHO Lyon Office in initiatives to strengthen public health laboratories. In Africa, APHL supports training courses at the African Center for Integrated Laboratory Training with faculty and curricula.

In Lesotho, APHL convenes and collaborates with a number of local partners. The jointly sponsored meetings provide forums for planning for HIV activities in the country. These meetings also offer training and networking opportunities for the local laboratory community. APHL's provision of mentoring, training and skills transfer ensures local capacity building. Senior counselors at health centers trained by APHL, for example, are in-charge of training testers on areas of HIV rapid testing in the health and community- based services. APHL support of the EQA program in Lesotho will strengthen local capacity, and ultimately ensure quality laboratory testing for the country for years to come.

As part of improving quality of services, APHL in collaboration with MOHSW will strengthen the laboratory monitoring and evaluation activities including, revising and standardizing recording and reporting forms, registers/logbooks and reporting forms and ensuring implementation at all sites providing the HIV rapid testing. A monitoring and evaluation system will be implemented for the effectiveness of EQA.

APHL will institute a program evaluation component for its activities in Lesotho. A comprehensive monitoring and evaluation plan will be implemented to evaluate all program activities within the country. Tracking of mentoring and training activities will be carefully monitored and recorded. Facilities participating in the EQA program will be recorded and their performances tracked.

As part of health system strengthening, APHL will primarily focus on three areas of support. 1) in-service training in laboratory management, HIV rapid testing and biosafety: APHL will support leadership/management skills training. This training will target laboratory managers, supervisors and directors. Follow-up support will be provided to participants to measure the impact and encourage the implementation of the training.

HIV rapid testing training will be rolled out all district using customized and revised training modules. APHL will also provide laboratory safety training using the in-country customized curriculum. A total of 50 individuals will be trained. APHL will be involved in developing mentorship training/procedures at the national level and district levels.

2) Technical sport ins tenting public health laboratory system APHL will provide a mid to long term consultant to provide technical assistance with the establishment of the national public health laboratory system. Technical support includes development of the national laboratory system, review renovation design, procurement of equipment and follows up. In addition, assistance will be providing to Lesotho Defense Military Hospital laboratory renovation and procurement of laboratory commodities. APHL will collaborate with all partners to reach the goals and objectives of the MOHSW strategic and operational plan, and receives direction and leadership from the MOHSW. APHL will provide input into the annual operational plan for the country. APHL will support the coordination of the laboratory including supporting the annual laboratory and stakeholders meeting. APHL will provide technical assistance to strengthen the national laboratory regulatory body in Lesotho that will over sight monitor and the implementation of policy, guideline s and accreditation of lab services APHL will support a number of activities to assist laboratories attain accreditation.

In FY10, APHL will continue to provide technical assistance in the following key areas: (1)Support the Directorate of Laboratory Services to strengthen quality management system; (2) QA program -strengthening and expansion for HIV rapid test EQA program, and accreditation of laboratories, and (3) Support the implementation of laboratory information system (LIS).

APHL will support the strengthening and expansion of the EQA program to 6 districts. Senior counselors from each testing site will be trained in quality assurance an EQA schemes and proficiency panel testing. Proficiency test panels and quality control samples will be provided for testing by all testers at their respective sites. EQA results will be collated, analyzed and report feedback to sites. Testing sites will be supervised and their performances monitored.

As part of quality improvement, APHL will support procurement of lab supplies, minor equipment, accessories and furniture.

APHL in collaboration with NICD and MOHSW will support Strengthening Laboratory Management toward Accreditation (SLMTA) that leads to accreditation of clinical laboratories in the country.

There is a need for robust Laboratory Information Systems (LIS) in laboratories throughout Lesotho.

APHL will provide project management expertise to assist the Lesotho Ministry of Health (MOH) in the effective development and implementation of LIS Including the procurement of the appropriate software, hardware and accessories, installation, training and piloting. All the necessary equipment, computers, printers, barcodes, furniture will be purchased The LIS implementation will follow the Office of the Global AID Coordinator (OGAC) approved guidelines that were developed by APHL in 2005. APHL will develop the scope of work and assess selected laboratory sites to strengthen paper based information system and identify high level functional requirements for a pilot and expansion of electronic LIS in reference and all hospital laboratories.

APHL will assist with the formation of an LIS Working Group with representation from CDC, MOH and other stakeholders in Lesotho. In consultation with CDC and MOH, APHL will develop an RFP to identify and award a contract to an appropriate LIS provider for the pilot LIS. APHL will work with local partners to ensure proper LIS related skills developed. APHL will also identify local consultants to support the LIS implementation and maintenance. This support will enable the country to generate reliable data for planning, and interventions planned by the MOH.