The American Society for Microbiology (ASM) will continue to work in coordination with the MOH and the USG in Mozambique to carry out laboratory capacity building activities, with primary emphasis on clinical microbiology laboratory strengthening for HIV-related Opportunistic Infections (OIs).

ASM's goals are in alignment with the Partnership Framework objective to strengthen laboratory support services for HIV diagnosis and management, and with MOH Strategic Plan. Significant contribution will be made to strengthening human resource capacity and the national commodity procurement system. In FY 2010, ASM will: 1) Create regional centers of excellence for microbiology diagnosis to serve as referral microbiology laboratories; 2) Strengthen TB diagnosis in central (regional) laboratories and increase access to TB culture; 3) Strengthen forecasting and planning for equipment and reagents for microbiology by ensuring the updating of microbiology reagent catalogue with the correct products and product specifications; 4) Strengthen pre-service training for microbiology through the revision of pre-service microbiology curriculum (Human Resources for Health) 5) Strengthen the diagnosis of sexually transmitted infections.

ASM will develop/improve training programs provided to laboratory technicians working in clinical health care facilities for improved diagnosis of TB and OIs and will be focused at the Central Hospital Laboratories. Basic microbiology workshops will be conducted for 6 district level laboratories, 2 in each region, south, central and north. ASM will improve pre-service curriculum that will be used at the Health Science Institutes across the nation for basic and medium level laboratory training as well as at Superior Level Training Institutes in Mozambique.

The laboratory is an integral component of national health systems. ASM activities are aimed at building diagnostic and management capacity of the individuals being trained and mentored. Apart from that,

significant contribution will be made to improving pre-service training through revision of the microbiology component of the pre-service curriculum. This will be done in collaboration with ASCP that will be revising the entire pre-service curriculum for laboratory training

ASM looks to synergize its activities with other USG partners by dialoguing with them and integrating microbiology components into their efforts, thus better leveraging resources. Furthermore, ASM places great emphasis on gathering information on other donor support, in order to prevent duplicating efforts and uses already-developed resources when applicable such as training materials and guidance documents that ASM later customizes to better fit the environment and context.

In FY 2009, ASM employed an M&E Specialist to develop program-specific quality indicators to better measure program impact. These same indicators will be shared with the Mozambicans, and they will be instructed on how to use them to continue to monitor the quality of microbiological testing in Mozambique.

One of the key drivers of the HIV epidemic is sexually transmitted infections (STI). STI screening, diagnosis and treatment is therefore important in the reduction of the compounded risk of HIV transmission because of an increased rate of (STI). ASM will support the strengthening of diagnosis of STIs in Mozambique.

In FY 2009, ASM technical experts conducted an assessment of existing STI diagnostic services at central and provincial laboratories providing HIV care and treatment services. A report from the assessment will include identification of gaps in equipment, reagents and supplies, training and monitoring, and evaluation needs. Recommendations and a plan with timeline for next steps will be developed.

In FY 2010 funds allocated to ASM will go towards implementation of the recommended strategies to strengthen the diagnosis of STIs, with emphasis on the central hospital laboratories, which serve as referral hospitals for their respective regions. In addition, curricula will be developed to include an STI diagnosis module in the planned regional microbiology workshops for Beira and Nampula. This will include the introduction and roll out of simple testing methodologies for STIs of importance in Mozambique. Support will include inclusion of STIs in the microbiology EQA scheme to ensure quality laboratory testing.

American Society for Microbiology (ASM) will continue to work in coordination with the MOH and USG in Mozambique to carry out microbiology laboratory capacity building activities. ASM will implement the following activities:

1) Portuguese or Spanish speaking mentors will provide on the job training in standard techniques, new technologies and an introduction to mycology and higher level parasitology. Proposed laboratories are located at central hospitals in Maputo, Beira, and Nampula. Mentoring will include onsite supervision and training as needed. Mentors will work with MOH counterparts to develop and implement an External Quality Assurance Program (EQA) for routine clinical microbiology procedures and aim to integrate this with other existing EQA programs.

2) Five day regional workshops will be held for provincial lab personnel that will provide practical and didactic training in basic bacteriology and roll-out new standard operating procedures (SOPs) and standardized training materials. Workshops will be held regionally with 40 microbiology staff trained. A reference set of positive, negative or indeterminate gram stained slides for the most frequently observed bacterial pathogens will be developed and provided to laboratories to utilize as quality controls and ongoing proficiency testing of staff.

3)ASM will work jointly with the American Society of Clinical Pathologists to revise pre-service microbiology curriculum to improve microbiology training in Health Science Training Institutes across the country.

Through training and mentoring, the end goal of ASM's efforts is to achieve sustained results and formulate a strong cadre of local Mozambican mentors to carry forward mentoring/training efforts post program completion. Transfer of expertise to local Mozambican microbiologists will eventually eliminate the dependence on external experts. PEPFAR II indicators, including number of laboratories moving towards accreditation, will measure the impact of laboratory systems strengthening activities and quality improvement investments.

ASM will work in coordination with the MOH and USG in Mozambique to carry out laboratory capacity building activities to strengthen tuberculosis (TB) diagnostics. In FY 2010 ASM will implement the following activities:

1) Conduct a training of trainers (TOT) for TB smear microscopy: An Acid-fast Direct Smear Microscopy training package has been developed by USG working together with WHO,APHL, and The Research Institute of Tuberculosis, Japan (RIT). This package was translated into Portuguese in FY 2008 with USG funding. FY 2010 funding requested for ASM will be to conduct a TOT for TB reference laboratory staff to roll out smear microscopy training in the country. Participants will receive concise training in the material presented in the package and hands-on practical training. These "Master Trainers" will go on to facilitate roll-out of the curriculum in four provinces in FY 2010 with a total of 80 people trained. Roll-out will be funded through Global Fund Round 7 funds for TB. Through TOTs, training skills are passed on to local trainers ensuring program sustainability and cost savings in the long run.

2) Support the strengthening of the National External Quality Assessment (EQA) system for TB diagnostics: ASM will review the existing EQA system operational in the TB laboratory network and strengthen supervision and blind re-checking of slides. The EQA will be expanded to include proficiency testing (PT) panels and ASM will facilitate training of the TB reference laboratory in preparation of PT panels for distribution first to the provincial hospital laboratories in the first round then to district level hospitals. A system will be set up for analysis and review of results and follow up for poorly performing sites.

3) ASM will develop a plan for the implementation of the TB Culture training package (translated into Portuguese by CDC Atlanta) for the three regional TB culture laboratories.