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. No funding is requested in the COP08

submission; activities will be carried out through the COP08 program period with funds provided in late

COP07 reprogramming.

ASCP will 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 (Power Point (PP) presentations),

participant's manual including 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.

ASCP will 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 "teach back" 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.

ASCP will work toward laboratory accreditation for Nigerian laboratories: 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.

ASCP will improve in-service training curriculum to medical laboratory scientist provided by MLSCN: ASCP

will work closely with the MLSCN to develop HIV related, week-long training courses directed at medical

laboratory scientist currently working in the field. MLSCN offers these courses on a yearly basis to a limited

number of scientists. ASCP will work to improve the curriculum and support delivery to a wider group of

scientist (from both PEPFAR and non-PEPFAR supported sites. IP developed training labs will also be

utilized to add a lab practical component to the curriculum (currently only didactic lectures are provided).

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, developing a national

approach to quality systems, implementing comprehensive laboratory quality services with the goal of

accrediting laboratories in Nigeria. 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. The two

accredited demonstration labs will serve as a model for 4 additional tertiary labs in Nigeria.

LINKS TO OTHER ACTIVITIES:

Strong clinical labs support 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.

EMPHASIS AREAS:

The emphasis of this activity is local organizational capacity development through training and on

Activity Narrative: infrastructure and quality assurance as detailed in the activity description above.