The high prevalence of HIV/AIDS of 14.3% in general population and Tuberculosis (TB) case notification rate of 545/100,000 with 50-70% HIV/TB co-infection are a great public health challenge causing high morbidity and mortality in Zambia. The situation calls for immediate, comprehensive, and evidence based interventions to reverse the trend threatening the very existence of the nation. The target provinces with 2010 projected populations are: Copperbelt with 2,088,146, Luapula with 1,064,422, North-Western with 808,046 and Northern Provinces with 1,662,240 populations. TDRC will perform a target of 4578 TB/HIV/STI diagnostic tests by end of 2010.

In FY 2009 TDRC played a significant role in the implementation of HIV/STI/TB surveillance in different populations of interest. The following are the objectives of the 2010 TDRC cooperative agreement: (1) to expand the use of quality program data to inform policy and program management; (2) to support and enhance TDRC expertise in the surveillance of HIV/AIDS/STI/TB as well as implementing the biannual ANC National HIV/Syphilis sentinel surveillance survey; (3) to expand the information communication technology (ICT) infrastructure; (4) to improve human resource capacity for monitoring and evaluation (M & E) and to enhance scientific research methods, data management and statistical analysis, and reporting. TDRC will seek technical assistance (TA) from the CDC-Zambia in protocol development, surveillance training, as well implementation of the survey, data processing and analysis, report writing activities.

In FY 2010, TDRC seeks to continue implementing different surveillance activities in HIV/AIDS/STI/TB important in enhancing GRZ's response to the HIV/AIDS/TB pandemic. HIV prevalence and incidence data are critical in assuring that the program activities are responding to state of the epidemic, as well as informing and guiding policy and interventions. In FY 2010 TDRC plans to hold a workshop for the dissemination of the 2008 ANC HIV sentinel surveillance data to stakeholders; timely implementation of the 2010 National sentinel surveillance of HIV/Syphilis in Antenatal (ANC) attendees on the Copperbelt, Northern, Luapula, and North-Western Provinces aimed at estimating HIV prevalence in this population. TDRC will seek to estimate the HIV incidence for recent infection using the BED-CEIA testing strategy. TDRC will develop the survey protocol for estimating the prevalence of HIV in children less than five years old. HAART has been scaled up to most health centers in Zambia. It is important that surveillance and monitoring of HIV Drug resistance (HIV DR) is part of HAART programs. TDRC will seek to use specimens from the 2010 HIV SS in ANC to evaluate the burden and extent of transmitted HIV drug resistance in Zambia.

TDRC plans to expand and strengthen ICT Infrastructure aimed at supporting the surveillance and laboratory activities in HIV/AIDS/TB/STI, and other related epidemiologic and public health programs: TDRC ICT will seek to strengthen (1) ICT/Informatics infrastructure, within TDRC and across selected sentinel surveillance sites to improve networking with the sites.

TDRC will implement monitoring and evaluation activities at critical operational units to ensure that the planned activities are implemented successfully. The monitoring and evaluation plans will subsequently provide information that will feed into the new generation of indicators provided by CDC. Timely data on HIV prevalence and incidence is important in informing policy and guiding interventions. TDRC seeks to continue supporting the GRZ in the implementation of the various HIV surveillance and information system activities across the country.

The United States Government (USG) has since 2004, supported the strengthening and expansion of Tropical Diseases Research Centre (TDRC) infrastructure and expertise in surveillance of HIV/AIDS/STI/TB, and improved ICT infrastructure, in order to provide quality evidence based data for program management and policy development by the Government of the Republic of Zambia (GRZ).

Further, the USG responded to GRZ and supported upgrading and renovations of TB infrastructure to 'state-of-art' of TDRC Regional TB Reference Laboratory. Since then, TDRC has been key in supporting the scale-up of TB diagnostic activities in Northern region in order to combat the challenges of TB/HIV burden. TDRC TB Reference Laboratory will continue providing TB diagnostics and External Quality Assurance (EQA) services in the northern region of Zambia;

In FY 2010, TDRC TB Regional Reference Laboratory will strengthen and expand its TB diagnostic services and provide external oversight to ensure provision of high quality TB diagnostic testing in the northern region of Zambia. This objective will be achieved by providing all components of EQA in AFB smear microscopy. TDRC will seek TA from CDC in new specialized TB diagnostics, and EQA system implementation.

In FY 2010, TDRC seeks to continue implementing HIV surveillance activities, and expanding the laboratory capacity in the following areas: (1) Dissemination of information from the 2008 HIV sentinel surveillance (HIV SS); (2) Implementation of the 2010 HIV SS survey in the 27 sentinel sites; Training field staff, sample analysis, data management, analysis and report writing; (3) Estimation the HIV incidence using the BED-CEIA testing strategy; (4) TDRC will provide training to field staff on the preparation of dried blood spots (DBS) samples for estimating the extent of the emergence of transmitted HIV drug resistant strain. The 2010 HIV SS DBS will be used for estimating the prevalence of transmitted HIV drug resistance in the ANC population; (5) TDRC will continue strengthening the specimen repository system for storing survey specimens, to assure an efficient specimen tracking. (6) HIV prevalence data among children is lacking. TDRC plans to develop, and finalize a protocol for estimating the prevalence of HIV in this category, and implementation in selected sites. (7) In FY 2010 TDRC will seek to strengthen ICT infrastructure with a view to supporting the HIV/AIDS/TB/STI surveillance and laboratory activities. These activities will require sustaining a well functioning and efficient LAN and server maintenance services, and developing an offsite data backup system for TDRC as well as improving Internet link and resource access by TDRC Regional Tuberculosis Reference and HIV Laboratories. TDRC will set-up basic Internet infrastructure at selected TB/HIV sentinel sites to improve networking in HIV surveillance and TB EQA activities. TDRC plans to continue maintaining and upgrading its LAN infrastructure by acquiring updated hardware and software to sustain an efficient LAN. TDRC will seek TA support from the CDC in the upgrading and deployment of new technology. Further, as new technology will be acquired, TDRC plans to provide training support to ICT staff to enable them meet the challenges of the new technology. In turn, ICT staff at TDRC will provide in-house training on new ICT advancements to the TDRC staff.

TDRC Regional TB Reference Laboratory receives TB samples referred from 77 diagnostic centers in the northern region of Zambia for TB laboratory diagnostic services. To provide a comprehensive diagnostic package for these samples, TDRC will procure reagents and supplies to perform fluorescent TB smear microscopy, expanded rapid TB culture complemented by solid L-J culture, Gen probe identification, and drug sensitivity testing. TDRC will strengthen safety transportation of sputum specimens from peripheral sites to TDRC. They will include packaging, transportation, tracking and information system, which is essential for feedback reports and networking with TB/HIV diagnostic centers in the northern region. Eleven TDRC laboratory personnel will be trained and supported in the provision of TB/HIV laboratory related activities by end of 2010. In addition, TDRC will train 50 microscopists from the five northern provinces for TB smear microscopy.

In FY2010, TDRC will need USG support to continue to strengthen and expand provision of all the three components of EQA activity at provincial and central hospital TB diagnostic centers in the northern region. The three components of EQA are: on-site evaluation of TB diagnostic centers; blinded rechecking of collected TB smears; and proficiency testing of laboratory personnel in AFB smear microscopy. TDRC will seek to conduct two on-site evaluation visits to TB diagnostic centers on Copperbelt, Luapula and North-Western provinces, quarterly supervisory visits for collection of slides for blinded rechecking, and once perform TB smear proficiency testing of laboratory technicians by end of 2010. TDRC will strengthen feedback to TB diagnostic centers for corrective measures through on-site visit and group trainings. TDRC will continue participating in local (Chest Diseases Laboratory-National Tuberculosis Reference Laboratory) and international (WHO/NICD and CDC MPEP) external quality assurance activities in TB smear microscopy and culture. In addition, TDRC TB laboratory will seek assistance from a national or international institution to start up accreditation process.