The Association Public Health laboratories (APHL) laboratory technical assistance project is a cooperative agreement awarded by HHS/CDC from 2009 to 2014, with a total potential value of $1,638,181. 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 2009 to 2014, with a total potential value of $500,000. 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. It 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 supports 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 support includes 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.

In COP11, APHL will continue to provide technical assistance in the following key areas: (1)Support the Directorate of Laboratory Services to strengthen quality management system and laboratory infrastructure. (2) Assist with expansion for HIV rapid test EQA program and data management (3) Support the implementation of laboratory information system (LIS). (4) Support the lab monitoring and evaluation system

1) APHL will continue to assist MOHSW (together with other partners) in the roll out of SLMTA and provision of TA for site supervision and mentoring. APHL will provide TA for preparation of laboratories towards accreditation. APHL will provide TA as requested by MOHSW in design, build and equipping of the new reference laboratory. 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 (such as SLMTA roll out, site supervision and on-going mentorship as needed).

2) APHL supports strengthening and expansion of the EQA program for HIV RT to 5 districts during COP10. About 500 testers at health center and hospital testing points have enrolled in QC and PPT program. APHL will continue to provide TA as requested during expansion of the program to the remaining 5 districts. Senior counselors from each testing site will be trained in quality assurance an EQA schemes, proficiency panel testing and QC testing. In addition, APHL will assist with data management of the database for the HIV RT EQA program.

3) APHL lead initial electronic LIS implementation at 4 laboratories and will continue to assist MOHSW with expansion of LIS to additional 6 laboratories during 2011-2012 making a total of 10 laboratories. APHL will support procurement of lab and IT equipment and accessories, furniture, furbishing and installation. APHL will continue to assist with strengthening of the paper based system that will standardize the system and facilitate collation of site and national data. APHL will provide assistance with managing this data for use with surveillance and policy development activities. Data mining training and technical assistance will be provided. APHL will assist the MOHSW in developing and implementing a sustainable LIS.

4) 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. 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.