ACTIVITY DESCRIPTION The American Society for Clinical Pathology (ASCP) has successfully provided laboratory support to other PEPFAR countries in Africa. For Nigeria ASCP will carry out 3 separate activities related to laboratory, these included an initial assessment of laboratory training needs, delivery of Train the Trainer (TOT) in the area of CD4 determination, hematology, clinical chemistry and improvement of laboratory infrastructure and practices at two model sites for eventual laboratory accreditation.

I. Develop Baseline Needs Assessment for Nigeria / Standardized Training Packages Currently in Use in Nigeria: In collaboration with USG-Nigeria, a team of 3 ASCP consultants/staff will work with the Government of Nigeria (GON) and Implementing Partners (IP's) to assess the current laboratory situation in Nigeria. During this initial visit ASCP will assess onsite logistics for the subsequent training session and technical assistance. ASCP consultants and staff will meet with in-country USG leadership, representatives from the Federal Ministry of Health and IP's (those supporting clinical monitoring labs) to perform baseline needs assessment of training. This initial visit will help to determine the specific needs of Nigeria and assist in the development of a strategy addressing those needs. In coordination with the USG team, IP's, and the GON, using the in-country Laboratory Working Group as a vehicle, the ASCP will establish a country specific scope of work, deliverables and outcomes. This will include bring together all training packages currently used in Nigeria (for hematology, chemistry and CD4 determination) and harmonizing/standardizing them into a single package. All training modules will be reviewed by ASCP consultants and lab technical staff from the GON, such as Nigeria AIDS and STI Control Program (NASCP) and Medical Laboratory Council of Nigeria (MLCN)), implementing partners and the USG.

ASCP laboratory training packages typically consist of didactic lectures with Microsoft Power Point (PP) presentations, participant's manual with copies of the PP slides, participant supplementary materials (i.e. procedures, atlases, job aids), instructor's version of the PP presentation, instructor's guide with support notes for each PP slide and a CD-ROM with aforementioned materials.

II. Deliver Laboratory Training of Trainers Programs in Chemistry, Hematology and CD4: Upon completion of the assessment of Nigeria, ASCP trainers will provide a TOT workshop for 30 Nigerian trainers (including lab staff from USG, IPs and GON). The TOT format is designed for a high level technologist who will be designated to provide laboratory training in their clinical setting at a future date thereby scaling up the training to the rest of technologists in their region. The projected length of time for TOT is 2 weeks and will include didactic presentations and "teachback" methodology. The program faculty working with implementing partners will administer the pre-tests, provide didactic as well as hands-on training, administer the post-tests, and administer the satisfaction survey. The trainers employ participatory methods for interactive learning and promotion of teamwork. Plenary sessions are encouraged for the exchange of experiences, group interaction and peer assessment. There may be variations in training durations depending on the level of trainees.

III. Laboratory Accreditation: Laboratory physical infrastructure must be strengthened to meet international quality standards and processes need to be in place to assure that those standards are maintained. At the same time, efforts must be taken to strengthen the skills of in-country laboratorians, develop strategies to assess initial competency and then provide strategies to assure quality practices. The Laboratory Accreditation Project is designed in five phases; each has a set of specific objective and a series of connected activities. The goal is to create a process by which key components can be replicated in various settings. Those five phases are: Create awareness and build consensus for national accreditation with the appropriate GON institutions. Assess standards and adapt as necessary for local laboratories with input from GON institutions; develop training materials; select participating sites for the initial pilot. Train participating sites and implement the project in those locations. Evaluate the pilot project and revise standards based on evaluation and feedback. Review with stakeholders. Create plans for a national roll out of revised standards. ASCP will work in conjunction with Joint Commission International (JCI) for the accreditation of two model/demonstration labs.

Indirect Targets

ASCP activities in Nigeria will indirectly support other labs and laboratorians. All training provided by ASCP will include GON lab staff and be in a TOT format. Trained individuals will go on to each train 4 laboratorians from non-EP supported labs. The two accredited demonstration labs will serve as a model for 4 additional tertiary labs in Nigeria.

CONTRIBUTIONS TO OVERALL PROGRAM AREA Currently the clinical and hospital laboratories within Nigeria are challenged to provide laboratory services to support HIV/AIDS care and treatment. The successful implementation of PEPFAR goals requires a significant strengthening and expansion of laboratory services. As antiretroviral therapies are made available there is an immediate need for expanded patient monitoring in clinical chemistry, hematology and CD4. To this end, ASCP plans to enhance the laboratory system in Nigeria by providing assistance in the development of a national approach to quality systems. ASCP and the USG team, working together, will enhance laboratory systems in Nigeria by conducting integrated laboratory training. ASCP will enhance the laboratory system in Nigeria by developing a national approach to quality systems, the implementing comprehensive laboratory quality services with the goal of accrediting laboratories in Nigeria and providing continuing education. These strategies are intended to assist countries in scaling up the capacity of Nigeria by addressing care and treatment of individuals with HIV/AIDS, ensuring consistency and quality in the implementation of training goals, and familiarizing technologists in the technical procedures necessary to perform laboratory analysis of tests related to HIV/AIDS.

LINKS TO OTHER ACTIVITIES Having a sufficient number of highly qualified laboratorians allows for the correct identification of HIV positive individuals in the VCT setting (HVCT-3.3.09). While having strong clinical labs supports the monitoring and treatment of HIV infected individuals and palliative care (HBHC-3.3.06 and HVTB-3.3.07).

POPULATIONS BEING TARGETED This activity targets clinical laboratory workers for diagnostic training.

KEY LEGISLATIVE ISSUES ADDRESSED N/A

EMPHASIS AREAS The major emphasis of this activity is training. There is minor emphasis on infrastructure and quality assurance as detailed in the activity description above.