TITLE: Strengthening Laboratory Capacity to Support HIV/AIDS Prevention, Care and Treatment

NEED and COMPARATIVE ADVANTAGE: The National HIV/AIDS Care and Treatment Plan for 2003-2008

targets expansion of care and treatment centers to 200 sites located in public, private, and faith-based

organization health facilities countrywide. The plan set to provide ART to approximately 440,000 people by

2008. With a 7% HIV prevalence in the general population, and assuming 20% would be treatment-ready,

five million people will need to be tested to find 100,000 ARV treatment-ready individuals. At many of these

entry points, HIV rapid testing will be performed by non-laboratory health workers to scale up identification

of HIV positive individuals. Laboratory personnel will supervise testing at key ART entry sites. AMREF,

winner of the 1999 Conrad N. Hilton Humanitarian Award and the 2005 Gates Award for Global Health, has

technical expertise in HIV/AIDS and health training. AMREF, through the ANGAZA Voluntary Counseling

and Testing (VCT) and Prevention of Mother-to-Child Transmission (PMTCT) programs, took the lead in the

training of non-laboratory health workers for HIV rapid testing, a model now scaled up nationwide, and an

integral component of the recent National Testing Campaign launched by The President on July 14, 2007.

AMREF will use their experience in training laboratory personnel to support the Ministry of Health with

logistics in the roll out to lower level facilities for training on CD4, Chemistry and Hematology testing.

ACCOMPLISHMENTS: AMREF facilitated the zonal-level training of 746 health workers - 336 (45%)

laboratory staff and 410 (55%) non-laboratory staff - in HIV rapid testing and the new National HIV rapid

testing algorithms, with the assistance of trained trainers, and support from the MOHSW and the National

Training Team .

ACTIVITIES: The activities for FY 2008 will focus on continued training and quality assurance on the HIV

rapid test, collaboration with MOHSW, laboratory partners and the National Laboratory Training Team to

facilitate training of laboratory and non-laboratory health workers in HIV rapid testing to meet the set target

of 1000. AMREF will undertake retraining of laboratory and non-laboratory health care workers, including

additional requirements at National level training using trained zonal trainers for rapid HIV testing and will

procure test kits and supplies needed to support the on-going laboratory-training program in HIV rapid

testing, and CD4, Chemistry and Heamatology testing to cater for expansion to additional care and

treatment sites.

AMREF will support HIV rapid testing quality assurance activities to monitor performance of trainees at their

places of work to ensure compliance to programme and MOHSW set standards. Existing supervision

matrix and tools will be applied to two selected laboratories and Counseling and Testing (CT) sites per

region. The activities include quality assurance of sample testing and competency assessment of those

performing the tests. This will involve on-site retesting of the first 50-100 samples performed by the testers,

conducting remedial and/or corrective actions, and performing continuous site quality assessments. At

these visits proficiency panel testing will also be conducted. AMREF willl support on-site support

supervision and training at testing sites to assess competency and to certify that trainees are using the

standard operational procedures according to the MOHSW training curriculum and CDC/WHO criteria;

convene program review meetings, and support attendances for laboratory personnel to conferences and

study tours, as appropriate. Lesson learned will be shared with MOHSW, the sites and stakeholders and

will be used to modify project implementation. Rapid testing training and monitoring of trained staff will be

a continued activity. AMREF will work with the MOHSW to continue to ensure that these activities remain

effective in responding to their goals. These activities are geared to ensure accessible, accurate and

reliable diagnosis of HIV by rapid testing and availability of reliable monitoring testing for HIV/ AIDS care

and treatment.

LINKAGES: AMREF works closely with the MOHSW and Care and Treatment, other non USG development

partners. To ensure development of sustainable laboratory services, avoid duplication of activities, and

maximize resources, AMREF attends the MOHSW quarterly meetings in which laboratory partners present

their progress, achievements, challenges, and a way forward. Regular meetings convened by CDC for the

PEPFAR laboratory partners are another link to ensure that efforts are coordinated and not duplicated in

supporting MOHSW to implement activities. The project links its activities with the National Care and

Treatment programmes, such as PMTCT, VCT, TB, STI, Home-based care and palliative care programme

through training of in-services providers. AMREF will work under the national guidelines and plans for

implementation.

CHECK BOXES: The overall strategy of the project is to train both laboratory and non-laboratory personnel

to improve the quality of HIV rapid diagnostics laboratory tests; train the health management team in a

supervisory system for effective monitoring and strengthening of rapid HIV testing services, and increase

identification of HIV positive individuals in order to meet the national targets for ART These will be achieved

through training, quality assurance and supportive supervision. About 1000 laboratory and non - laboratory

health care workers will be trained to perform tests according to standards will be trained to perform rapid

HIV testing.

M&E: A project monitoring and evaluation framework will be used to monitor the project's outputs and

expected outcomes during the project lifetime.

The M&E tool to capture data on whether the project is achieving desired goal for training as the number

trained, percentage sites demonstrating quality indicators, number and category of service providers

trained, competent testers certified, types of supplies procured; number of laboratorians trained on CD4,

chemistry and hematology testing, external quality assessment results for sites trained, number of

supervisions conducted.

SUSTAINAIBLITY: AMREF works with the Diagnostic Services section of the MOHSW and is a member of

the National training team which implements the in-service training strategy. Training of trainers and

supervisors ensures local capacity and roll out plans and will enable quick adoption of best practices.

Inclusion of PMTCT, CT, TB/HIV and other programs will ensure comprehensive planning, standardization

of training and inclusion of laboratory training in program specific training. To enable replication of the model

elsewhere, AMREF will work with MOHSW and partners on agreed criteria for identification of best

practices.