NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

This activity has split funding and is the same activity as HTXS ID # 14640

Background

Malawi is striving to increase the number of children who access life-saving ART services from the current

8% of all who ever started ART to 10-15% by 2010. The Early Infant Diagnosis (EID) Program is a

demonstration project aimed at decreasing mortality and morbidity of HIV-infected infants by early

identification and referral for care and treatment. Previously in Malawi, HIV-exposed children born to HIV-

infected mothers could not be reliably diagnosed as HIV infected until the age of 18 months. Without proper

care and treatment, greater than 50% of infants who are HIV infected through MTCT would die before the

age of two.

Under the leadership of the Head of the HIV Unit of the MoH, a consortium comprising the USG, Baylor

College of Medicine, Taiwan Mission, Clinton Foundation, University of North Carolina (UNC), UNICEF, and

WHO was established. The consortium was tasked with developing a one-year demonstration project that

will provide the foundation for the Malawi national scale-up plan for pediatric ART care and treatment. The

USG's specific role in the consortium was to provide leadership and direction, recruit critical staff, provide

training on DBS collection, storage and shipment, provide start-up equipment, train laboratory staff, and

establish a quality assurance program. Other partners provide complementary support such as clinical care,

reagents and supplies, and support for a courier system to collect samples and return results.

To date, the EID Program has established diagnostic capability for children and referral networks for care

and treatment services in the Central and Northern regions which are now operational. Two major sites at

Lilongwe (central) and Mzuzu (north) have become the diagnostic hubs that each supports 7 satellite clinics.

In December 2005, 1,999 children aged 12 years and below were on ART, representing less than 5% of all

patients on ART in Malawi. However, it is estimated that children represent up to 14% of HIV-infected

individuals requiring ART. Ten Laboratory Technicians from Lilongwe and Mzuzu were trained on

Laboratory diagnosis of HIV infection in infants from Dried Blood Spots (DBS) using DNA PCR. Following

the training, 7 lab techs have performed tests successfully using proficiency panels and been certified to

perform DNA PCR testing. As of July 31, 2007, 577 children had been enrolled in the pilot program from 13

health facilities. Among them, 346 test results had been entered into the database and are available to be

entered into the quarterly reporting system. Among the 346 infants that DNA PCR results were available, 64

(18%) were HIV-positive and some have been referred to ART clinics for further evaluation and possible

inclusion in ART. As of August 31st, 2007 809 infant DBS specimens had been tested and children referred

to treatment.

The DBS samples have been tested on infants from 6 weeks to 18 months of age at the two major testing

hubs Mzuzu and Kamuzu Central Hospital Laboratories. With assistance from the EID M&E officer, a

comprehensive quality assurance program has been put in place to manage quality control, proficiency

testing, inventory, specimen management, standard operating procedures, and documentation of lab

results. In the first 2 months of the reporting period a total of 146 infants received single dose NVP within

72 hours and 8% had a positive DNA PCR result. At the same time, 31 children did not receive single dose

NVP and 23% had a positive DNA PCR result.

In FY 2008, HUTAP will use Emergency Plan (EP) funds to continue supporting the expansion and

sustainability of the Ministry of Health (MoH) EID program in the following areas: 1. Laboratory capacity

building; 2. Human capacity building and training; 3. Uninterrupted flow of laboratory supplies and reagents;

4. QA/QC systems and 5. Service contracts for essential laboratory equipment.

Activities under this program area are linked to the laboratory infrastructure program area.

Activity 1: In-Service Training

In-service trainings will be conducted at all the laboratories providing EID. This will not only be restricted to

DNA PCR, but technicians will also be trained in CD4 and CD4% enumeration, chemistries, hematology,

and the diagnosis of common infections including opportunistic infections. The training will be aimed at

building the capacity of lab staff to provide support for other HIV services such as PMTCT and ART

treatment while maintaining quality standards. This activity will build on HUTAP's existing training activities

for strengthening the capacity of laboratory personnel.

During FY 2008, Emergency Plan (EP) funds will be allocated for the expansion of EID services to the

Southern Region of Malawi. Queen Elizabeth Hospital is proposed to become the third major testing hub

for HIV Infant Diagnosis. HUTAP will provide the training support and assist with the establishment of a

Quality Assurance Program for this region.

Activity 2: Procurement of Reagents and Supplies, and Provision of Service Contracts for Equipment

HUTAP, in collaboration with CDC, UNICEF, and the Clinton Foundation will continue to support the MoH in

building the capacity of laboratories to provide testing services for HIV diagnosis and disease monitoring.

Reagents and other consumables will be procured through HUTAP and the Clinton Foundation to

supplement orders currently procured by the MoH through the Global fund and SWAp common fund.

Activity Narrative: Activity 3: Coordination of Diagnostic Testing and Referral Networks

This activity will focus on strengthening the laboratory infrastructure at EID sites as entry points for quality

laboratory testing that would support all HIV/AIDS-related treatment and care. Currently, several of the

sites are linked to PMTCT and ARV programs at district hospitals and rural health centers in the central and

northern regions. Currently the program is relying completely on a local courier service to transport

specimens for PCR, CD4, and Hematology and Chemistry testing due to the limited capacity for these

referral sites to provide routine, consistent testing services. HUTAP will assist the MoH in building the

capacity of the district hospital laboratories/EMLS to carry out routine hematological, chemistry and CD4

testing; develop SOPs; implement quality assurance programs; and improve the laboratory infrastructure

where appropriate. HUTAP will assist the MoH in strengthening the referral system for sites that may not

have the full complement of laboratory capabilities.

Activity 4: Human Resources Support

During FY 2008, HUTAP will continue to build laboratory capacity for EID services through hiring technical

and management staff. Through existing funding, HUTAP hired a Program Manager for the EID program, a

Laboratory Coordinator and three Laboratory Technicians. New funds will be used to retain the current

staffing and fill human resource gaps at other sites where required.

HUTAP will accelerate the implementation of its activity plan to support the rapid scale-up of the ARV

program. In doing so, HUTAP will increase the number of testing sites with diagnostic capability for early

infant diagnosis, PMTCT and disease monitoring; increase the capacity of tests performed at major testing

sites through the placement of trained lab technicians, functioning equipment with backup service and a

consistent supply of reagents; and solid performance in quality assurance programs for HIV, CD4, and PCR

testing.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21082

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21082 21082.08 HHS/Centers for Howard University 9208 9208.08 Howard GHCS $240,000

Disease Control & (State)

Prevention

Table 3.3.09:

NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

New/Continuing Activity: New Activity

Continuing Activity:

Program Budget Code: 12 - HVTB Care: TB/HIV

Total Planned Funding for Program Budget Code: $1,238,193

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Overview

HIV is the most important risk factor for TB patients in Malawi, and TB is the leading cause of HIV-related deaths. Facing a

situation in which an estimated 70 percent of TB patients are HIV-positive, Malawi committed itself to implementing joint TB/HIV

activities. The Malawi Ministry of Health (MOH) formulated a national TB/HIV integration strategy which would deliver increased

HIV services to TB patients, and expand TB services to HIV/AIDS patients through the National TB Program (NTP).

In 2000, as part of the WHO-supported Pro-TEST initiative, Malawi started implementing joint TB/HIV activities. The objective was

to create an environment in which more people would choose to be tested by enhancing voluntary counseling and testing (VCT)

linked to appropriate clinical and supportive services especially in TB settings. Lessons from the Pro-TEST project were applied

to develop the country's first 3-year TB/HIV development plan in 2002. The key objectives of this plan included provision of HIV

testing to TB patients and the general public, provision of cotrimoxazole preventive therapy (CPT) to HIV-positive TB patients, and

provision of antiretroviral (ARV) therapy to HIV-positive TB patients.

Early in 2007 Malawi adopted a provider-initiated testing and counseling strategy with an opt-out clause, as a way of identifying

patients with TB/HIV co-infection and increasing their access to services. A target of 95 percent of all suspected TB cases being

tested for HIV was set to be achieved by 2011. By late 2007, of the 26,229 TB cases registered, 90 percent were tested for HIV,

and 68 percent of those tested, were HIV-positive. A total of 14,294 TB/HIV patients (97 percent of those testing HIV-positive)

were started on CPT. However, this service was only offered to registered TB cases. Expanding this service to suspected TB

cases will be critical to an effective national TB/HIV strategy. With rapidly scaling up of ART services, 4,573 (32 percent) of TB

patients have been initiated on ART as of December 2007. The quality of TB/HIV services in Malawi has also improved over the

years. Today Malawi has 145 TB microscopy sites, 48 TB registration sites, and over 600 TB drug dispensing sites. There are a

total of 620 Health Surveillance Officers that are focal-points for TB services. This provides an excellent opportunity for TB/HIV

integration. Of the 48 TB registration sites in the country only nine have integrated routine HIV testing services as a standard

package of care for TB patients and of the 30 TB officers in the country, only 18 focus on TB/HIV integration.

Multi-drug resistant (MDR)-TB prevalence in Malawi is currently unknown. There are presently 32 MDR-TB cases registered. 20

of these patients are on treatment while 12 are awaiting treatment.

The issue of infection control for TB in HIV service delivery settings is increasing becoming problematic as AIDS patients

congregate in large numbers to receive services. Malawi is considering the incorporation of effective infection control measures in

their new TB/HIV strategy that is being developed.

Malawi successfully applied for Global Fund for AIDS, TB and Malaria (GFATM) support for TB for the first time in 2008. A grant

for $18,000,000 (2008 - 2013) will provide funds to strengthen NTP's capacity to deliver TB treatment. While the additional

resources are welcome, critical gaps still remain for TB/HIV care and activities which the GFATM grant does not support. USG

has identified the need for support for national-level coordination, the quality of services, and the geographic coverage of the

programs. There is a need for improved M&E and more training of health care staff. Expanding the quality of TB sputum smear

microscopy countrywide and strengthening the current reference laboratory capabilities to perform reference and training

functions including the periodic national TB drug resistance surveys are also areas of priority. Infection control for TB/HIV

management in institutional and congregational settings also requires attention.

Previous USG Support

While USG was committed to joint management of TB and HIV interventions through PEPFAR, small amounts of funding limited

our support. PEPFAR funds wrapped around CSH funds for tuberculosis and supported the United States funded Tuberculosis

Control Assistance Program (TBCAP) to provide support to the National TB reference Laboratory and TB/HIV activities in two

selected districts. National coverage will require additional GFATM resources, and greater investments into NTP. TBCAP plans

on using FY08 funding to complete renovations at the national reference lab in preparation for an MDR-TB survey to begin in

2009. PEPFAR funding and technical support to the Lighthouse Trust and NTP assisted develop a new TB/HIV strategy using

and evaluated care models for TB/HIV patients incorporated into the strategy.

Overall, TB/HIV activities in Malawi have been implemented in an environment where National TB and HIV programs are

functioning reasonably well, but do so independently and with relatively weak interactions at the service delivery level. Through

joint programming, the planned TB/HIV activities for FY09 will strive to improve linkages between TB and HIV at the service level.

USG through PEPFAR funds will support the MDR-TB survey which will begin in February 2009. Results from this survey would

help Malawi plan the management of an increasing number of patients with MDR-TB in the country.

FY09 USG Support

i. Training and TB Registration

Through cooperative agreements between USG and its partners, NTP and Lighthouse, training will continue to be a priority. In an

effort to reduce the barriers to access to TB treatment, NTP intends to pilot decentralization of TB registration. Focus will be on

training new TB officers from amongst TB-focal HSA at ART clinics which are not TB registration centers and are not close to any

TB registration site. FY09 funds will be used for the training of 30 new HSAs a year to manage these registration sites. As part of

the process of implementing a model pilot program integrating TB and HIV activities, Lighthouse adapted the WHO/CDC generic

district TB center (DTC) training guidelines to the Malawian context, and used it to provide a two-day training to TB officers.

Collectively, the trained TB officers have done well in the field and increased HIV testing rate for TB patients to over 93 percent

within their clinics. FY09 PEPFAR funds will be used to run a Training of Trainers to train 20 additional TB officers.

ii. MDR-TB Control

FY09 funds will enable NTP to supervise the MDR-treatment centers in the country and conduct biannual meetings with the

districts and health centers MDR-TB management teams. N95 masks will continue to be allocated to centers treating MDR-TB

patients, In addition, FY09 funds will be used to train more health workers in MDR-TB management and procurement of N95

masks.

iii. Infection Prevention Guidelines

NTP developed infection prevention guidelines in addition to the national strategy for infection prevention in medical settings.

Using PEPFAR funds and through support from TBCAP, NTP will be able to print and distribute the infection prevention

guidelines. NTP plans to train health workers on work practice and administration infection prevention control using the FY09

funds.

iv. Support to the National TB Reference Lab

With FY09 PEPFAR funds, TBCAP will continue to provide focused support for the national TB reference laboratory and TB/HIV

activities in the two districts of Zomba and Mangochi. Funds will be used to rebuild and strengthen the capacity of the central

reference lab and selected local labs in the two districts to implement an MDR-TB survey. At the district level, TBCAP will help to

develop SOP's for quality care of TB and TB/HIV treatment, supervision and management of information. In order to strengthen

the integration of TB/HIV/AIDS services at facility level TBCAP will build the capacity of health workers providing ART services in

the management of TB. The project will train health workers from TB registration centers in ART management, Isoniazid

Preventative Therapy (IPT) as well as in management of opportunistic infections for Zomba and Mangochi districts. In Zomba and

Mangochi the project will train laboratory technicians and HSAs in TB microscopy and QA for SS microscopy. TBCAP will also

work towards establishing new sites, implementing SOP's, QA and supervision, bio-safety, laboratory commodity and information

management systems for sputum smear microscopy.

Compact Funding Program Plans

GOM and PEPFAR have discussed a framework under which a new partnership agreement will be developed using FY08 and

FY09 Compact funds. In September 2008, a Concept note was submitted to OGAC, and the country team was given approval to

begin developing a partnership compact with the GOM. TB/HIV is a priority area under consideration.

Should Compact plans be approved, GOM in collaboration with USG will use Compact resources to increase the number of

TB/HIV patients benefiting from coordinated treatment of both infections by building capacity in health care workers, laboratory

and pharmacy staff and referral systems to manage TB/HIV patients. This would include training ART providers in TB screening

and training health workers in TB/HIV integrated services. The electronic data system for proper registration, referral and

monitoring of TB/HIV co-infected patients would be expanded.

The quality of TB smear microscopy and the number of sites performing both HIV and TB testing especially in high-burden

HIV/AIDS care and treatment sites and TB diagnostic sites would be increased. The national TB reference laboratory would be

supported to provide training, quality assurance of smear microscopy and TB drug resistance monitoring.

Continued support for the integration of TB and HIV services so that they are responsive to the patients co-infected with HIV and

TB is critical to effective patient care. Strengthening advocacy, communication and social mobilization around TB/HIV issues

would receive priority consideration for increased funding.

Table 3.3.12:

NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

This activity has split funding with activity ID#10749 and share identical narratives.

Beginning in 2008, HUTAP will request Emergency Plan (EP) funding to retain employees that oversee

activities at the HIV Reference Laboratory and for the Pediatric HIV Diagnosis program. In addition, HUTAP

is proposing a five-year laboratory infrastructure support plan with EP funding to: (1) update pre-service

training curricula that target HIV diagnosis, disease monitoring and opportunistic infections diagnosis; (2)

train trainers and clinical instructors on new HIV curriculum content, educational methodology and

curriculum implementation; (3) conduct in-service-training in management, HIV diagnosis, and disease

monitoring for lab technicians at service delivery sites; (4) support or create Laboratory Centers of

Excellence at key high throughput service-delivery sites for HIV testing and patient monitoring; (5) bridge

human resource gaps through recruitment and hiring of senior level laboratory personnel, and (6) continue

to support the HIV epidemiologist that is implementing the HIV Surveillance activities, including ARV Drug

Resistance and Monitoring, and HIV Behavioral Surveillance studies.

Background

For the previous four years, Howard University has provided technical assistance (TA) to Malawi with a

focus on strengthening laboratory testing capacity for HIV/AIDS services. Until March 2007, the program

received its funding through a cooperative agreement with USG through the CDC-GAP University Technical

Assistance Program (UTAP). Through this program Howard University Technical Assistance Program

(HUTAP) provided support to two pre-service laboratory training institutions which together now graduate as

many as 80 laboratory technicians a year.

In FY 2007, HUTAP expanded its assistance to Malawi through a subcontract with the MoH. An

epidemiologist, a laboratory manager, and a laboratory supervisor were hired and placed at the

Epidemiology Unit and the National HIV Reference laboratory, CHSU. Also, through an existing funding

mechanism, a project manager, laboratory coordinator, and three laboratory technicians were hired for the

scale-up of the pediatric HIV diagnosis and referral network under the MoH.

HUTAP will continue its strategy to improve laboratory services in Malawi through the following activities:

Activity 1: Conduct In-Service-Trainings

HUTAP will build the capacity of laboratory staff in HIV diagnosis and disease monitoring, lab safety, and

management through in-service training. HIV testing workshops will be conducted to cover topics such as

HIV Rapid Testing, ELISA, Flow Cytometry and CD4 enumeration, PCR, and OI diagnosis. This activity will

target laboratory technicians who are working at HUTAP supported laboratories and from other laboratories

linked to HIV service delivery sites. The new funding will allow HUTAP to build on its achievements in FY

2007 where 82 lab technicians received knowledge and skills updates in Infection Prevention/Lab Safety,

HIV testing including CD4 and PCR, Lab Management, and Effective Teaching Skills.

Activity 2: Strengthen and update laboratory pre-service curriculum in HIV diagnosis, disease monitoring,

and opportunistic infections (OI)

In 2005, HUTAP along with a core team of laboratory tutors, technicians, and curriculum development

experts, developed an HIV testing pre-service learning package. The competency-based curriculum was

designed to address gaps that were identified in the HIV content in the pre-service curriculum. The core

competencies (HIV testing, Lab Management, Safety and Ethics) were integrated into existing courses in

which the content was taught.

With new funding, the learning package will be expanded to include theoretical and hands-on applications

along with reference materials and assessment tools for CD4, PCR, and OIs . HUTAP will continue to

procure the necessary equipment and supplies to support the practical training component. Prior to the

implementation of the updated curriculum, HUTAP will conduct a training of trainers and clinical instructors

on new HIV curriculum content, educational methodology and curricular implementation.

Activity 3: Employ High-level Managerial and Lab Technical Staff

An HIV epidemiologist, HIV reference laboratory manager, and supervisor were hired through a MoH/CDC

subcontract in an effort to strengthen the National HIV/AIDS Reference Laboratory at CHSU under the

MoH. Through the existing contract, they will continue to provide adequate management and supervision of

the HIV reference lab and HIV surveillance activities, and assist in the development and implementation of

the national quality assurance programs for HIV testing.

Through the previous CDC-UTAP COAG, HUTAP has hired two laboratory tutors at the Malawi College of

Health Sciences to assist with the implementation of the HIV pre-service curriculum and to provide

supervision and training of students at designated clinical training sites. Through this funding mechanism,

HUTAP also recruited three lab technicians, one laboratory coordinator, and one Project Manager to assist

the MoH with the scale-up of the pediatric treatment and care program. This one year demonstration project

will advise the Malawi national scale-up plan for pediatric ART care and treatment.

HUTAP will request EP funds to extend these positions through FY 2009 based on results from program

Activity Narrative: assessments and staffing needs. Where vacancies exist, HUTAP in collaboration with the MoH and USG,

will recruit personnel from sub-Saharan region, including Malawi, to fill the positions.

Activity 4: Implement and Monitor QA programs for HIV-related Testing

Using FY 2008 Emergency Plan (EP) funds, HUTAP will increase the capacity at government and mission

hospital laboratories to carry out quality HIV diagnosis and disease monitoring by establishing national

quality assurance programs for HIV, CD4, and PCR testing.

Activity 5: Provide Mentoring and Training for Laboratory Supervisors

HUTAP will provide training and mentorship to laboratory supervisors and managers from central and

district hospitals. Through this training and mentorship, supervisors will be able to manage the laboratory

more efficiently and to assure accuracy and quality in testing results. Supervisors will be trained to oversee

quality assurance programs instituted for HIV testing. This will be a collaborative effort between HUTAP and

the EMLS-MoH since the EMLS is mandated to provide management/supervision and training to laboratory

staff in the district hospitals.

Activity 6: Refurbish Laboratories at Central and District Hospitals

During FY 2008, HUTAP will complete the refurbishment of the Malamulo Hospital laboratories with EP

funding. All laboratories will be supplied with high quality laboratory furnishing, equipment, supplies, and

reagents. Service contracts will be provided for all major equipment. HUTAP will provide support to

laboratories that presently have the greatest capacity to carry out quality testing including trained staff,

supervisory structure, and those that will participate in the national quality assurance program. These

laboratories are closely linked to ARV and PMTCT service delivery.

Activity 7: Support or build laboratory Centers of Excellence (COE)

HUTAP will target the following sites as COEs: Kamuzu Central Hospital - KCH, Mzuzu Central Hospital,

Thyolo District Hospital, Queen Elizabeth Central Hospital (QECH), Malamulo Mission Hospital, and

Mzimba District Hospital. These sites will provide HIV testing services and will be linked to ARV and PMTCT

referral sites. All laboratories will be refurbished by HUTAP in partnership with the MoH through the Sector

Wide Approach (SWAp). Though USG funds are not pooled in Malawi, USG partakes in the Program of

Work for the MoH by supporting earmarked activities in the SWAp plan. Critical equipment will be

upgraded, training provided, and systems for ensuring consistent stock of reagents and supplies will be

established. They will be enrolled in national and international QA programs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21083

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21083 21083.08 HHS/Centers for Howard University 9208 9208.08 Howard GHCS $536,000

Disease Control & (State)

Prevention

Table 3.3.16:

NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

This activity has split funding and is the same activity narative as HVSI#10859.

Summary

Activities under this program area include planning, designing, and coordinating all HIV activities within the

Ministry of Health's (MoH) Epidemiology unit, including HIV Drug Resistance surveillance, and Integrated

Disease Surveillance. Other activities involve the development of lab protocols and coordination of data

collection and data entry; the analysis and interpretation of data; and the dissemination of findings.

Background

Howard University was funded by USG to strengthen the HIV testing capacity in Malawi through pre-service

and in-service training. The funds were used to strengthen the knowledge and skills of laboratory tutors and

clinical instructors in HIV testing through workshops and practical training. In FY 2007, Howard University

updated and strengthened the laboratory science curriculum in HIV testing, Laboratory Management,

Quality Assurance, Ethics, and Laboratory Safety. Laboratories were refurbished, supplies and equipment

were purchased, and HIV testing standards to improve the quality of testing and training at the clinical

training site were implemented. The project utilized regional and local contractors to assist with project

implementation. All of this work was done in collaboration with the MoH, USG and other donor partners. It

was based on a needs assessment that identified the training needs and resources required to build the

capacity for HIV testing training at Malamulo and Malawi College of Health Sciences, and to prepare

laboratory technicians working in government and private laboratories for expanded roles in HIV/AIDS

testing.

Our efforts strengthened the laboratory infrastructure to support HIV diagnosis, monitoring of treatment

effectiveness and surveillance. Since much of the equipment was outdated or malfunctioning, supplies and

reagents were in short supply, and there was a great need to upgrade the knowledge and skills of

laboratory personnel, HUTAP addressed critical needs for building the laboratory infrastructure in Malawi.

HUTAP supported the MoH in addressing the shortage of laboratory personnel through recruiting and hiring

laboratory technicians, lab supervisors a laboratory manager, and lecturers for the laboratory training

schools. These efforts have assisted in building the capacity of Malawians to conduct laboratory testing in

support of the scale-up of the antiretroviral therapy program.

In FY 2007, through a sub-contractual agreement with the MoH, HUTAP employed a Sr. HIV Epidemiologist

to assist in the implementation and management of HIV/AIDS surveillance activities within the Epidemiology

Unit at the Community Health Sciences Unit (CHSU) in the MoH. The hiring of an HIV epidemiologist has

contributed greatly to the commencement of activities for the national HIV epidemiological surveillance

system in the MoH. Through the guidance and supervision of the HIV epidemiologist, several achievements

have been made in this program area. For example, in only 19 antenatal clinics was surveillance conducted

since 1994. During FY 2007, the number of sites increased to 53 and now covers 26 districts through USG

funding. Over 50 individuals including lab technicians and nurses have received training in surveillance

procedures, documentation, and in the collection and processing of blood samples.

With FY 2008 funds, HUTAP will continue to support the Epidemiologist within CHSU's Epidemiology Unit,

thus the following activity narratives are directly related to CHSU's SI narrative.

Activity 1: HIV Drug Resistance Surveillance

With FY 2008 EP funding, HUTAP will support the HIV Epidemiologist position in the MoH. More

specifically, the epidemiologist will play a critical role in HIV Drug Resistance (HIVDR) Monitoring, including

in FY2007 the HIVDR Threshold Survey to look at the transmission of HIVDR; generation of early warning

indicator reports to monitor programmatic factors that have been linked to the development of HIVDR; and

the HIVDR Retrospective Monitoring Survey to look at the development of drug resistance in patients that

have been on treatment for one year.

With FY2008 funds, HUTAP will support the Epidemiologist within the CHSU Epidemiology Unit to

implement the prospective HIVDR monitoring survey with the support of PEPFAR funds Funding from the

USG will support the site training, site preparation and supervision. The activity develops local capacity

through training site members in surveillance methodology and specifically the implementation of the

monitoring survey. Four sites are selected to serve as sentinel sites for Malawi in Mzuzu, Lilongwe,

Blantyre and Thyolo. CHSU will mobilize other funding to support the generation of the Early Warning

Indicator (EWI) report, and the next threshold survey will occur in FY 2009.

Activity 2: Techncial Assistance for Data Analysis, Interpretation, and Use

The Epidemiologist will help develop protocols; coordinate data collection, data entry and data analysis; will

disseminate findings and respond to the MoH and other key stakeholders. The epidemiologist will take part

in HIV surveillance activities, including an inpatient survey for HIV cases, and interpret findings for program

planning. The epidemiologist will actively participate in data triangulation activities that are coordinated by

NAC.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21084

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

21084 21084.08 HHS/Centers for Howard University 9208 9208.08 Howard GHCS $24,000

Disease Control & (State)

Prevention

Table 3.3.17: