The funding level for this activity in FY 2008 will remain the same as in FY 2007. Only minor narrative

updates have been made to highlight progress and achievements.

This activity is linked to UTH Virology, Columbia University and ART in Lusaka.

Reliable laboratory support continues to be critical for treatment and care of HIV/AIDS patients. This activity

has provided the University Teaching Hospital (UTH) Department of Pediatrics, and the Kalingalinga-

Lusaka Health District with training of laboratory personnel and the equipment needed to perform

Polymerase Chain Reaction (PCR) diagnosis of HIV-exposed infants, viral load, and HIV genotyping for the

monitoring of drug resistance. To date, six lab technicians have been trained from the two facilities and are

now performing deoxyribonucleic acid (DNA) PCR for early infant HIV diagnosis. Through United States

government (USG) funding, UTH and Kalingalinga now have the needed equipment and regularly perform

PCR for early infant diagnosis. Antiretroviral (ARV) drug resistance testing (i.e. genotyping) and viral load

tests were set up at UTH by July 2007.

PCR testing on whole blood or dried blood spots (DBS) is critically important for scaling-up early pediatric

ARV treatment in Zambia. Early infant diagnosis is now enabling early intervention so the infected infants

receive specific appropriate treatment and/or other preventive measures such as cotrimoxazole prophylaxis.

CDC has placed one full-time laboratory technologist with expertise in molecular biology and diagnostic

laboratory testing who is assigned to support the activity at the UTH Department of Pediatrics, in addition to

five trained technologists. With the scale-up of screening, children on therapy are now regularly monitored

for CD4 analysis, full blood count, kidney, and liver function testing. An additional benefit of this activity is

the ability to monitor ‘missed opportunities' for HIV prevention in children and the impact of prevention of

mother to child transmission of HIV (PMTCT) interventions in reducing HIV transmission.

In FY 2008, funds will be used to scale-up the availability of early infant DNA PCR testing by using DBS

collection. In addition, viral load and genotype testing will be made available at UTH and Kalingalinga

Laboratories. It is anticipated that two additional technologists and one data entry clerk will need to be hired

and trained to support the scale-up of PCR and the additional new activities. Technical expertise from this

center will support infrastructure development of a third national PCR site in the Arthur Davison's Children's

Hospital (ADH) in Ndola (in close collaboration with the Zambia Prevention, Care and Treatment

Partnership [ZPCT]). Lessons learned from this activity in FY 2007 will be applied to expand the PCR and

genotyping activities to the ADH in Ndola. In addition, six staff will be trained in Ndola to perform PCR and

HIV genotyping for ARV drug resistance monitoring and about 7,000 tests will be performed. Working with

CDC, the Ministry of Health (MOH), Provincial Health Offices (PHO's), and other stakeholders such as the

University of Nebraska-Lincoln, Health Services and Systems Program, and the World Health Organization

(WHO), UTH will formulate an optimal strategy for conducting ARV drug resistance monitoring in Zambia.

Initiating and scaling-up PCR and ARV drug resistance monitoring at the government hospitals, in

collaboration with the MOH, is allowing these government institutions to build national capacity through

acquiring skills and equipment necessary to scale-up and maintain high standards of pediatric ART care.

PCR training has been provided to Zambian nationals so that the skills are retained in the country. Under

this activity, Zambians trained in FY 2007 will work with facilities in other provincial hospitals to transfer their

knowledge and skills on PCR and resistance monitoring activities so more children can access treatment as

well as build sustainable pediatric treatment at the provincial levels.

Another area proposing to be developed is that of acquiring a mobile pediatric medical/laboratory unit,

staffed with clinical and laboratory personnel that can be stationed in different regions of the country at

different times so that counseling and testing, clinical care, diagnosis, and laboratory tests can be done on-

site. This type of unit, based at the UTH Pediatric Center of Excellence (PCOE), will be essential for

reaching out to children and their families, even in the most remote areas of the country such that clinical

and laboratory services can be provided in a timely manner.