Opportunistic infections are common in HIV populations and are a major threat to People Living with HIV/AIDS (PLWHA) both prior to diagnosis as well as during care and treatment programs. Global efforts toward detection of tuberculosis are currently in place. However, basic microbiology laboratory services for blood stream and other infections, which have high morbidity in the HIV infected patients, are limited and lack quality.

The goals of the American Society for Microbiology's (ASM) program are to address microbiological laboratory capacity-building needs in PEPFAR countries by strengthening laboratory organizational and technical infrastructure, especially as it relates to training of personnel and development of processes of Quality Management (QM) Systems in the laboratory setting; and assuring the quality of laboratory testing for tuberculosis (TB) and other opportunistic infections (OIs), by instituting systematic approaches to delivering clinical microbiology services to HIV/AIDS, TB, and OI, prevention, treatment and care programs. ASM's objectives are to:

1. Build human capacity at national and regional/provincial laboratories through the provision of technical assistance in the form of mentoring Zambian laboratory workers to improve the quality and delivery of clinical microbiology services and strengthen local leadership in testing, training, supervision, and quality assurance for sustainability purposes.

2. Strengthen the capacity of regional/provincial, district, and primary laboratories to perform laboratory testing essential for accurate diagnosis of HIV/AIDS-related OIs through the development, customization, and roll out of country specific training packages and integrating the curriculum into pre-service training when appropriate.

3. Develop and strengthen national external quality assurance (EQA) programs for TB and bacteriology diagnostics, enabling laboratories at the national, regional/provincial, and district level to accurately assess and improve the knowledge base and resource availability of the laboratory network, and develop linkages with international EQA programs.

4. Provide technical guidance on laboratory physical infrastructure and procurement of laboratory equipment and supplies to enable high quality, rapid, and affordable diagnostic testing of HIV/AIDS-related OIs for the tiered, integrated laboratory network.

5. Contribute technical input to country laboratory strategic plans to strengthen and enhance the planning, management, and microbiology service capacity of the national laboratory network and promote an indigenous, sustainable response to infectious disease epidemics.

In FY 2010, ASM will continue to provide in-country support for microbiology and opportunistic infections, laboratory systems and strategic planning, standardization of protocols for cost effective testing, antibiotic utilization, infection control and good laboratory and clinical practice. ASM's major emphasis area will continue to be human capacity development. Activities conducted will include training on the most common bacterial infections and cost-effective diagnostic techniques, improvements in rapid TB culture, and drug susceptibility testing at the national and regional TB reference laboratories. Rapid cost effective diagnostics to improve quality and human resource capacity in the laboratory will be implemented.

ASM will address Human Resources for Health areas pre-service education, in-service training, and quality improvement. It will seek to strengthen the training network throughout Zambia to build a sustainable training mechanism by building a team of indigenous trainers and master trainers through the support of external ASM mentors. With the assistance of the mentor, the team will deploy basic microbiology training workshops to provincial and district laboratories over the next year. ASM will coordinate training activities with local partners to maximize resources available for training and ensure integration of activities. ASM will also provide technical assistance for strengthening of quality systems and support laboratories seeking WHO/AFRO accreditation.

ASM will prioritize monitoring and evaluation as a means of routinely tracking the key elements of program performance and proposes to optimize efforts by developing more standardized and harmonized tools for data collection and reporting. Data will support real-time project monitoring to identify best practices and course corrections needed through input, process, and output indicators, as well as ASM's overall contribution to improving laboratory diagnostic testing of HIV/AIDS-related OIs via increased OI case detection and treatment success.

ASM will continue to send technical experts to provide support to CDC-Zambia laboratory staff and local laboratories for strengthening microbiology services and treatment of opportunistic infections. During multiple consultations of approximately one month, the experts will continue to provide onsite consultation/supervision for routine microbiology diagnostics and antimicrobial susceptibility testing in the form of mentoring; training for laboratorians in basic microbiology techniques, and develop quality standards for microbiology diagnostics.

They will continue to implement a QM Program within microbiology laboratories, to include workflow plans, lab safety, recording and reporting of results, media and reagents quality control (QC), instrument maintenance, and specimen and record management; write the supporting SOPs; prepare the supporting forms, flowcharts, checklists, and worksheets; customize the details of the QM SOPs to the laboratory's needs and procedures; and develop SOPs for QA programs, training and competency, and internal QC