IMPACT: This investment is designed to directly contribute to high quality scale up of HIV treatment and PMTCT services through health care worker salary support, space and refurbishment and essential laboratory programs for delivering these HIV services. The Malawi College of Medicine HIV/AIDS Laboratory Capacity Consortium is made up of four institutions with a long-standing history of work in Malawi: College of Medicine, University of North Carolina (UNC) Project, Loma Linda University-Malawi Adventist Health Services, and Johns Hopkins University-College of Medicine Research Project collaborating with the Malawi Ministry of Health (MOH). The overall goal of this CDC support is to collaborate and empower MOH in its efforts to implement a comprehensive plan to strengthen the national HIV care and treatment program in the areas identified in the Partnership Framework (PF) and the National Strategic Laboratory Plan. The program supports human resource development by: training medical laboratory technology students and currently-deployed laboratory professionals; supporting the MOH, Christian Hospital Association of Malawi (CHAM) and other partners to deliver high quality HIV diagnostic and disease monitoring services; improving the referral linkages from HIV testing to treatment and treatment monitoring sites; strengthening systems that provide quality ART services; and assisting in collecting and using data to improve HIV prevention and treatment outcomes. This program will contribute significantly to the PEPFAR-Malawi PF goals of strengthening: HIV treatment and support; laboratory systems; health information systems; and human resource development closely working with CDC, Howard University, CHAM, Malawi Defense Forces, and John Snow Inc.

COM will support the development and implementation of national laboratory quality assurance standards and national laboratory standard operating procedures (SOPs). The newly developed national laboratory quality manual and national laboratory standard operating procedures documents will be printed and distributed, and training will be offered to all testing facilities to standardize laboratory practices in Malawi. Through the current mentoring program, guidance will be provided to mentored sites on customization of the quality manual and SOPs as required by Strengthening Laboratory Management toward Accreditation (SLMTA) program. This support will provide monitoring and mentoring in implementation of corrective action plans, ensuring that recommended improvement projects are implemented to make progress towards accreditation.

COM will provide in-service training support in laboratory management and technical skills in FY 2012 through:Conducting training workshops for implementation of SLMTA laboratory accreditation programAfter publication of the National Laboratory Quality Manual and National Standardized SOPs, clinical laboratory tutors from Malawi College of Health Sciences and 40 laboratory managers and deputy managers will be trained on their contents.These programs allow technicians in Mentoring Laboratories to exchange benches with technicians working at UNC Project and JHU/COM Research Project, giving MOH and CHAM lab staff the opportunity to experience firsthand of the quality culture and advanced diagnostic techniques offered at these clinical research labs, while the JHU/COM and UNC Project technicians share skills with their colleagues in the Mentoring Laboratories.Providing training in inventory control and specimen management for newly selected laboratories.Support MOH to develop performance indicators to measure the effectiveness of the referral system.COM Laboratory Mentors will work with staff in mentored labs to ensure effective implementation of the new referral system, prioritizing the improvement of turn-around-time for lab results.Treatment Scale-up: USD 150,000

Through a subgrant with UNC,COM will support a technical advisor in the Reproductive Health Unit to support RH surveillance capacity and activitiesCOM will support MOH and partners in collection and analysis of laboratory service delivery data. COM will also continue to support MOH in the monitoring and evaluation of the implementation of the National Laboratory Strategic Plan to assess laboratory services performance and inform further programmatic development. COM will continue to support MOH in the development and implementation of the Laboratory Information Management System. In preparation for implementation of the LIMS, laboratory data collection and reporting tools will be standardized nationally, in partnership with MOH, HUTAP and other USG partners. Once the automated LIMS is finalized, College of Medicine will support MOH in the rollout of the system through training.

The COM Lab Consortium will continue to support MOH, CHAM, HUTAP and other partners to increase the quality and number of graduates from pre-service training institutions for laboratory staff in Malawi through the following activities:Assisting HUTAP in printing and distribution of the new curriculum.Providing technical assistance to integrate the updated laboratory pre-service training curriculum developed in previous fiscal years into the diploma and certificate programs at Malamulo College of Health Sciences, contributing to the number of new health care workers graduating from a pre-service training institution.Providing training for key staff nationally on implementation of the new curriculum will be supported.The COM Lab Consortium will also support laboratory management and technical skills of currently deployed laboratory staff through in-service training, including the following activities:Conduct training workshops for implementation of SLMTA laboratory accreditation program.After publication of the National Laboratory Quality Manual and National Standardized SOPs, clinical laboratory tutors from Malawi College of Health Sciences and laboratory managers and deputy managers will be trained on the new documents.Continuing to implement the technician exchange & rotation programs will continue to be implemented.o Technicians in the Mentoring Laboratories will exchange benches with technicians working at UNC Project and JHU/COM Research Project, giving MOH and CHAM lab staff the opportunity to experience firsthand of the quality culture and advanced diagnostic techniques offered at these clinical research labs, while the JHU/COM and UNC Project technicians share skills with their colleagues in the Mentoring Laboratories.Providing training in inventory control, safety, quality assurance and specimen management for newly selected laboratories.Through a subgrant to UNC, COM will also support emergency obstetrics training and the development of an Obstetrics Residency Program

COM will support to MOH to develop, implement, and monitor a comprehensive HIV rapid testing quality assurance program for the following PMTCT activities:Support for Community Health Sciences Unit (CHSU) to strengthen its national HIV Rapid Testing Proficiency Testing Program, and to strengthen and fully implement its national HIV Rapid Testing sample retesting program.Support to train PMTCT program supervisors in enhanced documentation, reporting, and quality assurance measures at ANC level.Support the National HIV Reference Laboratory to participate in the Strengthening Laboratory Management towards Accreditation (SLMTA) accreditation program for the laboratory to reach accreditation.In partnership with Ministry of Health COM will provide PIMA Point of Care CD4 analyzers in district and CHAM hospital PMTCT clinics and supporting operational costs.Assist the Malawi Ministry of Health with Reproductive Health strategic information needs.Train active providers of Obstetric services in Emergency Obstetrics (EmOC)Develop the first post-graduate residency training program in obstetrics and Gynecology in Malawi at COM, with competency in public health measures.Staff members of QECH and COM will be trained on the new national ART/PMTCT guidelines.Staff members from health centers involved in the Blantyre ART network will also be trained in the new ART/PMTCT guidelines.Health centre staff will be organized on an exchange program with the QECH ART clinic on PMTCT issues in an effort to build capacity for health centers and decentralize PMTCT activities.

COM will strengthen adult treatment at the QECH ART clinic by:Providing General ART training of untrained staff at ART clinic.Providing training-of-trainers new national ART curriculum in adult treatment.Providing a training-of-trainer course for QECH ART staff in adult aspects of HIV and ART.Providing training to staff of Health Centers in adult aspects of HIV and ART.Developing training materials for Health Centre staff to the QECH ART clinic on new techniques in adult HIV and ART.Supporting research projects at Umodzi Family Clinic (an academic training institution), as outlined in a joint research policy issued in 2011 by the HIV Department at MOH and NAC.Providing counseling for ART(including non-adherence, toxicity, nutrition, couple counseling and reproductive health)Integrating STI management into HIV/ART services through training of health center staff.Treatment Scale-up: USD 150,000

COM will support pediatric treatment at the QECH ART clinic through:Providing pediatric ART training of untrained staff at ART clinic.Training of trainers in the new national ART curriculum in pediatric treatment.Training of trainer course for QECH ART staff in pediatric aspects of HIV and ART.Train staff of Health Centers in pediatric aspects of HIV and ART.Developing training materials for Health Centre staff to the QECH ART clinic for them to be acquainted with new techniques in pediatric HIV and ART.Providing adolescent HIV-ART training for health centre staff on implementing adolescent programs to improve teen adherence to ART.Integration of research on HIV and ART in children into service programs.Providing training on nutrition, ART and food supplementation for ART staff in QECH , including a session on nutritional counseling.Developing a nutrition unit within the ART clinic, this will integrate the provision of food supplements (acquired in the local market) into the ART package. COM will support palliative care at the Tiyanjane ANC clinic, which provides services to in- and outpatients in QECH, including HIV and ART patients, with a particular focus on care for patients with Kaposi's sarcoma.