The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

This activity is linked to Columbia University, Chest Diseases Laboratory, CDC Lab TA, ASM, ComForce,

and SCMS.

Since 2004, the Tropical Diseases Research Center's (TDRC) tuberculosis (TB) Regional Reference

Laboratory has provided acid fast bacilli (AFB) smear microscopy services for the Ndola area. However, in

2004/5 the United States Government provided funding to upgrade the laboratory to a "state-of-the-art"

facility to support the scale-up of HIV/TB activities. The renovation is complete and the center, which was

opened in May 2005, now provides TB fluorescent microscopy and expanded TB culture services for

People Living with HIV/AIDS (PLWHA) in the northern region of the country. TDRC supports TB cultures

from five provinces encompassing 42 districts. In addition to renovation, this activity has provided training

to personnel for TB laboratory support, basic laboratory equipment, reagents and supplies for liquid TB

culture, DNA probe identification and drug susceptibility testing capacity. Training was provided to ten

laboratory staff on the use of the bio-safety cabinets, reagent preparation, and culture media. Equipment

provided includes a BACTEC MGIT TB culture and Gen Probe DNA Mycobacteria identification system, in

addition to a water tank and generator for electricity backup.

The diagnosis of TB in HIV-positive cases is often difficult in rural settings without specialized equipment. In

FY 2007 a courier system for TB specimen transport from 12 chest clinics within five provinces was

established in Copperbelt, Northern, Northwestern, Luapula, and Central provinces. The regional laboratory

works in collaboration with the National TB Reference Laboratory to improve rapid culture and drugs

susceptibility diagnostic testing services and provides support to the Arthur Davison's Children's Hospital

(ADH), which is the national Pediatric Hospital located a few kilometers from the TDRC. The TB Country

Assistance Program (TBCAP) supports training and external quality assurance activities for acid fast smear

microscopy in three of the five Northern provinces including the Copperbelt, Northern, and Luapula

provinces.

In FY 2008, the TDRC laboratory staff will be dedicated to expanding and improving detection of drug

resistant TB cases using liquid culture technology as well as supporting external quality assurance services

in local and rural settings for AFB smear microscopy. These services will include training, proficiency

testing, AFB smear microscopy rechecking, and feedback to the laboratories. Training will be provided to

two technologists from each of the five provinces to expand capacity for supervision and monitoring of

TB/HIV support in the district hospitals. The ten technologists are currently government staff who will

receive further training to expand their laboratory technical role. Those trained at the provincial level will

share skills with district staff during supervisory visits to ensure laboratory skills are expanded and

sustained at all levels health facilities.

The funding level for this activity in FY 2008 has increased since FY 2007. Narrative changes include

updates on progress made and expansion of activities.

This activity relates to Ministry of Health (MOH), and Centers for Disease Control and Prevention (CDC).

This cooperative agreement with the Tropical Diseases Research Centre (TDRC) was established with the

following objectives: (1) to expand the use of quality program data for policy development and program

management; (2) to support and increase TDRC expertise in the surveillance of HIV/AIDS/STI/TB; (3) to

improve information and communication technology (ICT) infrastructure; (4) to improve human resource

capacity for monitoring and evaluation (M&E); and (5) to strengthen capacity in scientific research methods,

data management and statistical analysis, and reporting. Centers for Disease Control and Prevention

(CDC)-Zambia will continue to provide technical assistance and other support to strengthen the TDRC and

its infrastructure as a key partner in HIV/AIDS/STI/TB surveillance, laboratory and strategic information

quality control and assurance, and strategic information. In FY 2007, CDC-Zambia will place special

emphasis on training in ICT and data management/statistical analysis in order to strengthen TDRC

expertise in these areas for sustainability of all above activities.

This activity will continue to maintain support of a local area network (LAN) established during FY 2004. FY

2007 funding will allow increased bandwidth and the expansion of LAN coverage to the new tuberculosis

(TB) laboratory supported by CDC-Zambia. FY 2007 funding will also help to procure ICT equipment,

enable TDRC to continue the employment of personnel skilled in ICT to maintain the infrastructure, to

provide in-house ICT expertise and training capability, and to train TDRC staff in data management.

TDRC will support the Government of the Republic of Zambia (GRZ) in HIV/AIDS, Sexually Transmitted

Infections, and TB surveillance activities, including the Zambia Antenatal Clinic Sentinel Surveillance (SS)

survey and the Zambia Demographic and Health Survey (ZDHS). While the Ministry of Health is the

authorizing institution for national surveys and other surveillance activities, TDRC and the University

Teaching Hospital (UTH) Virology Laboratory serve as the implementing institutions and regional reference

laboratories. FY 2008 funding will support the TDRC and UTH in implementing the national surveys,

laboratory testing, supervision of sentinel sites, and data analysis and reporting. Additional laboratory

testing using existing biospecimens are planned. TDRC laboratory and data processing personnel have

participated in multiple CDC-Zambia-sponsored training in SI and laboratory methods, and work closely with

CDC-Zambia staff in data management, analysis, and reporting. TDRC laboratory staff was trained to

perform the BED-CEIA assay and testing is currently ongoing to identify recent HIV infections to estimate

HIV incidence. Laboratory staff will perform HIV incidence testing, confirm HIV and syphilis testing, perform

testing for other important viruses, including HSV2 testing on specimens collected for the Nakambala

Migrant Workers Health Project.

Funding to the TDRC will cover travel and transportation needs for national surveillance activities,

procurement of consumables in the immunology and data processing units, procurement of -70 freezers for

storage of samples from national surveys, and expenses to cover the coordination, implementation, and

dissemination of survey results.

In addition, the TDRC would like to establish a central electronic specimen tracking and repository system.

Numerous research projects, including large national surveys, that involve collection and storage of

biological samples, are conducted each year at the TDRC. A much more efficient process is required, not

only to enable the scientists to track their specimens as they work, but also enable them to retrieve samples

that have been stored for a period of time. Novel techniques for the detection of different diseases are being

developed continuously; the existence of an efficient repository system will ensure easy retrieval of

samples, and safe archival of biologic specimens. Because Zambia has had a well developed sentinel

surveillance system since the early 1990's, there is a wealth of historic data and biologic specimens that

require careful archiving.

In FY 2008, TDRC intends to continue with all ongoing surveillance activities in HIV/AIDS/STI/TB. Timely

implementation of the National Sentinel Surveillance of HIV/Syphilis in ANC attendees will be key. Apart

from existing laboratory analysis for HIV and syphilis from this population, other laboratory analyses will be

conducted, including BED testing to estimate HIV incidence and testing for prevalence of other viruses that

cause significant mortality and morbidity among HIV infected persons. Additional training will be given to

sentinel site staff to collect Dried Blood Spots (DBS) in the same population for estimation of the prevalence

of transmitted HIV drug resistance in the ANC population. TDRC proposes to conduct a separate survey in

the same sites to determine HIV prevalence and incidence in children attending under-five clinic in these

sentinel sites. TDRC will also participate in the surveillance of HIV/AIDS in prison populations in Zambia.

M&E activities for TDRC will focus on: (1) continued operation of the LAN and extension of LAN coverage

to the newly completed TB laboratory; (2) the number of TDRC, UTH, and District Health Center staff

trained in SI; (3) the successful design and implementation of the 2008 sentinel surveillance survey, and

successful analysis, reporting, and dissemination of the 2006/2007 SS and ZDHS; (4) the successful

collection, storage, and management of demographic information and biologic specimens; (5) additional

laboratory testing required for surveillance activities and focused studies such as the Nakambala Migrant

Workers Health Study; (6) the appropriate analysis and reporting of HIV prevalence and incidence data in

relation to socio-demographic data; and (7) the dissemination of surveillance information for GRZ planning,

making of policy decisions, and design of community-level interventions.

This activity relates to activities in counseling and testing activity, laboratory infrastructure, palliative care,

basic health support activity, and HVTB activities.

Targets set for this activity cover a period ending September 30, 2009.