The American Society for Clinical Pathology (ASCP) is a CDC central multi-country PEPFAR cooperative agreement partnered with CDC to improve laboratory training and implement laboratory quality improvement initiatives. In Ukraine, ASCP's goal is to strengthen the HIV laboratory system and overall laboratory system, especially in human capacity. In stakeholders meetings, ASCP developed a plan for 1) training courses for national/regional laboratory personnel in key clinical laboratory techniques and quality control; and 2) a process to improve pre-service curricula.

MOH approval of full implementation of the plan has been delayed due to restructuring of the MOH and AIDS control program. Recent steps by ASCP included review of two recent laboratory curricula from the Kiev laboratory pre-service training institute.

ASCP contributes to goals 2 and 3 of Ukraines Partnership Framework related to improved quality/ cost effectiveness of HIV services for MARPs; and strengthened national/local ability to achieve Ukraines AIDS Program objectives. These activities support the goals in the MOH strategy on counseling, testing and laboratory diagnosis of 2009.

ASCPs cost efficiency includes coordination with and leverage of GF Rd 10 grant resources for lab strengthening and advocacy with the GOU to increase funding for laboratory strengthening. All ASCP activities are designed to increase national capacity and ownership. For example, training plans include a 'train-the-trainer' component to allow national staff to conduct future trainings.

Monitoring and evaluation activities for this activity will include tracking of trainees by the National Reference Laboratory to ensure that all appropriate staff and a cadre of trainers receive the required courses.

ASCP FY12 funds will be used to continue the Curriculum development process in Clinical Chemistry/Hematology/CD4. This activity will take place at national and regional academies of postgraduate education which provide the preservice training for higher level laboratory workers (advanced degree equivalent). In addition, initial discussions are occurring in February 2012 with MOH and medical institutes that train laboratory technologist equivalent workers on curricula improvement .

Funds will be used to support the HIV National Reference Laboratory and the Ukrainian Reference Center (UkRC) in the development and implementation of external quality assurance (EQA) programs for CD4. (The UkRC has been made responsible for initiating/coordinating EQA in Ukraine and began these operations in 2009 has recently begun EQA programs. EQA in HIV assays has been limited to small-scale EQA of HIV serology in 2010.) ASCP will also continue implementing laboratory best practices within the HIV laboratory network. This cooperation will be primarily at the central level - the NRL and the UkRC, which will develop national regulations. Further assistance will be provided for the implementation of these documents in the local laboratories (support training for local laboratory staff). ASCP will conduct an evaluation of additional changes within HIV laboratory services made possible/necessary by health care reform legislation being drafted in the Ukraine parliament.

PEPFAR II indicators: These indicators (no. of testing laboratories and number of accredited laboratories) provide limited information for programming laboratory support in Ukraine. Currently, the number of testing laboratories in the HIV laboratory system is sufficient; however, quantitative capacity in some assays needs to be augmented and the qualitative capacity, especially human, of all laboratories needs to be strengthened. All laboratories in the system are nationally accredited except for the HIV National Reference Laboratory (due to its lack of adequate physical facilities); however, numerous gaps exist in quality management. ASCP activities are addressing these gaps.

Coverage: Currently coverage with laboratory testing is adequate nationwide with the exception of prison populations. CDC is participating in planning for laboratory capacity augmentation under the GF Round 10 funding to cope with anticipated growth in needs and to extend coverage to prison populations; however, addl laboratories are not planned. As additional capacity is developed, ASCP activities will include them into training and human resource development planning.

Training in management and quality assurance: these trainings are a major part of ASCP laboratory trainings and pre-service curricula.

All CDC-supported laboratory activities in Ukraine target enhancing the capacity of the MOH laboratory system.