Mechanism uddated from TBD to APHL during August 2009 reprograming. APHL Capabilities Meet PEPFAR Supported Countries Needs. APHL is a membership organization comprised of public health laboratories. Its member organizations, with approximately 5,000 professionals, provide a readily available resource of training laboratories and experienced experts to assist and support others in completing diverse tasks to support HHS/CDC including strategic planning for national laboratory networks, implementing training programs, planning and managing renovation projects, implementing laboratory management information systems, procuring equipment and supplies, and providing US-based and in-country advanced training for laboratory professionals. APHL has extensive experience in PEPFAR supported countries that includes a 3-year cooperative agreement (CA) with CDC's Global AIDS Program which preceded the current 5-year CDC/GAP CA to support PEPFAR initiatives. APHL gained valuable experience early in the global HIV/AIDS response, having led an effort in 1991 with funding support from the World AIDS Foundation and USAID to India to provide training in HIV antibody assays (EIA, WB) in 5 states of India. During its early work in the PEPFAR focus countries, APHL not only provided technical assistance for laboratory strengthening but also assisted in procurement of supplies, reagents, and equipment and hiring and supervising long-term consultants to provide technical assistance in countries including training-of-trainer activities. APHL has developed quality training tools such as External Quality Assessment for AFB Smear Microscopy and Basic Laboratory Equipment Maintenance and provided technical assistance in thirty countries during its eighteen years of experience in laboratory capacity building. We are able to draw on these resources to provide comprehensive training and technical assistance in areas including implementing test methods such as drug sensitivity testing for TB, quality management systems, laboratory safety and policy development, and providing practical experiences in public health laboratories in the core functions of public health laboratory systems. Examples of APHL training tools developed for HHS/CDC to support PEPFAR are a one-week laboratory management workshop curriculum, a two-week seminar program in collaboration with GWU SPHHS for senior laboratory professionals, a biosafety curriculum, a strategic planning training curriculum and a guideline for implementation of laboratory information systems in resource-poor settings.

The 5-year strategic plan for APHL activities to support PEPFAR country projects has three major components:

1. Core training initiatives that support laboratory strengthening

2. Country-specific action plans

3. Strategic partnerships

APHL implements specific short-term best practices to strengthen laboratory services while working systematically to gain long-term improvements in quality management and infrastructure of laboratories. Activities are coordinated with HHS/CDC Country Operational Plans (COP) in annual work plans for each country. APHL adapts its work plans and training materials to meet the specific needs and outcome objectives of each country plan. Once the set of activities are identified for the year, APHL organizes technical assistance (TA) teams and logistical support to complete the activities successfully. Groups of members as well as staff have received training in core activity curricula such as laboratory management so that we can respond in a timely and effective manner to TA requests. A hallmark of APHL performance has been flexibility in response to changing schedules and responding to unexpected events.

Core Training Initiatives. APHL provides training and technical assistance, much of which directly addresses what is widely considered the weakest area of laboratory capacity- workforce- and all of which strengthen key areas of laboratory capabilities and capacities. These include: 1) Laboratory management training provides supervisors and directors with the knowledge, skills and abilities to be more effective in their jobs. This is a comprehensive one-week curriculum that has been developed and continually improved with user input. Mentored follow-up projects enable participants to gain competency and confidence. Outputs of this training and follow-up include SWOT analyses, organizational improvements and coaching initiatives; 2) Strategic and operational planning workshops provide laboratory professionals with knowledge, skills and tools to develop effective strategic plans that support national health goals and guide development of annual operational plans for systematic, sustainable improvements in laboratory services. Outputs include strategic and operational plans; 3) Twinning agreements between major US public health laboratories and national referral laboratories cultivate close working relationships, learning opportunities and information sharing. Outputs include technology transfer and competency in new test methods and long-term affiliations; 4) Implementation of laboratory information management systems provides increased efficiency of testing, better monitoring of quality control, supply and equipment management, and data for surveillance, trend monitoring and evidence-based decisions. Outputs are operating local area networks in national and provincial laboratories with automated equipment interfaces and capability for electronic transfer of test information; 5) Technical assistance in the development, implementation, and management of quality assurance and external quality assurance (EQA) programs using the experience of US state operated QA and EQA programs to provide internships for QA managers at public health laboratories and technical assistance in needs assessment, development of technical and analytical capabilities and logistical infrastructure, training of personnel and implementation; and 6) Technical assistance in laboratory design and safety in collaboration with an APHL laboratory design partner and using APHL training materials for laboratory biosafety and biosecurity.

In FY 2010, APHL will conduct the following activities

1. Support the development of a one year national laboratory operational plan. This activity is a continuation of support in developing a national 5 years laboratory strategic plan in FY 2009.

2. Deliver one laboratory management training in Zambia. Thirty mid-level laboratory personnel will be trained.

3. Establish a twinning relationship between the Zambia national TB laboratory and a state public health laboratory to support national TB initiatives.

4. Provide in-service refresher practical training for provincial/district level technicians in all specialities of chemistry, hematology and CD4.

5. Technical assistance to the MOH Zambia and CDC in establishing and implementing the national QA program for CD4, hematology, and chemistry.

6. Provide technical assistance to the MOH and partners on energy issues by hiring an in-country energy specialist.

7. Train twenty healthcare workers (technicians, admin and maintenance staff) on energy, load, design, and maintenance of energy systems.

8. Work with a local company to retrofit and support up to 6 small health centers to improve and maintain their energy systems.

9. Provide technical assistance or laboratory-related training courses as needed.