In line with WHO recommendations, the Zambian government has recommended ART for all infected infants. Infected infants will need to be identified, treated, monitored and be tested for the presence of ART resistant viruses at follow up to guide treatment options. Such monitoring will include not only CD4 count but viral load and genotyping for drug resistant viruses, which will guide treatment for FY12 and beyond. The Zambian efforts to diagnose and treat HIV/AIDS remain largely hampered by a lack of infrastructure, resources, and trained personnel.The overall objective and goal is to continuous our ongoing activities to support the UTH pediatric care and treatment program to: perform HIV viral load testing, PCR diagnosis of infected infants; provide pre-assessment service before commencement of ART; perform HIV genotyping to monitor drug resistant viruses; train laboratory personnel and; to develop human resources. This is essential to support the scale up and implementation of the anti-retroviral program in Zambia. We are anticipating a higher demand of the genotyping tests as more patients are being treated and more drug failure cases will be observed. To enhance cost-efficiency, cheaper in-house viral load and genotyping tests will need to be developed and adapted to reduce future cost, since these tests are essential for the guidance of clinical care.

M&E: There will be established standard operating procedures, documentation, data base and instrument calibration procedures and preventive maintenance. Our plan has been daily monitoring by our project director and laboratory manager. There will be internal QC checks and data validation. In addition, there will be a semi-annual evaluation of performance and system audits by US personnel.

Early diagnosis and treatment of HIV infected infants and children are keys to successful pediatric care and support. Infected infants need to be identified, treated, and tested for ART resistant viruses at follow up to guide treatment for FY 2012 and beyond. In FY 2012, funds will continued to be used to support PCR diagnosis, viral load and genotype for Pediatric Centre of Excellence. Currently five laboratory technicians are trained in PCR technology and engaged in these activities. Three of these are also trained in viral load testing and genotyping. Supervision and oversight are provided from the laboratory Manager and Director to ensure daily monitoring and quality assurance. Nebraska budget will continue to support the salaries of two laboratory technicians, a data entry personnel and the Director Genotyping is now available for monitoring of treated individuals with clinical and immunological failures. Over 120 cases have been successfully genotyped in the current funding period, and a number of additional cases are currently being analyzed. We are anticipating a higher demand of the tests as more patients are being treated and more drug failure observed. The laboratory is expected to perform about 800 PCR diagnosis, 100 viral load tests and 20 genotyping per month. It will start seeking accreditation through a recognized international institution.

Much of the limitations on viral load and genotyping are due to reagent costs. Therefore, an additional activity is to adapt in-house viral load and genotyping tests to reduce the cost to enable larger number of tests to be done, especially when there is a continued scale up of the treatment program and more demand on viral load and genotyping. In addition, technical expertise from this activity will be used to train laboratory personnel from UTH and other facilities (at least 20, including students from the Department of Biomedical Sciences), and to support laboratory infrastructure development of other sites in Zambia. Under this activity Zambians trained in FY 2012 will work with facilities in other provincial hospitals and the Ministry of Health to transfer to them knowledge and skills on viral load and resistance monitoring activities so more children can access treatment as well as build a sustainable pediatric treatment at the provincial levels such as the Arthur Davisons Childrens Hospital in Ndola.

This is a continuation of a new activity initiated in FY2010. There is critical shortage of trained human resource, even at the BSc level, such as those with a degree in Biomedical Science to support the HLAB technical area. UNL, UNZA, and UTH have a history of successful training and research collaboration, and through several projects have established considerable in-country research and training project and infrastructure (these projects and facilities are staffed by former Nebraska Fogarty Program trainees). A total of 48 Zambians have been trained through the Nebraska training program in the US and many more have undergone in-country training through this program since 2000 (including one trained in Nebraska and at CDC-Atlanta). However, the project teams experience with HIV/AIDS-related work in Zambia indicates there is still a pressing need to increase the number of well-trained healthcare personnel and laboratory workers, and to build additional infrastructure to support Zambias response to the HIV/AIDS epidemic, including there is a need for those with BSc degree in Biomedical Sciences or those with Med Tech equivalent training. The proposed human resource development program is modeled after the successful Nebraska Fogarty training program and since a memorandum of agreement between UNL and the University of Zambia to facilitate Nebraska-Zambia collaboration training and technical assistance projects has already been signed, this can be expanded to including training towards a BSc and or MedTech degree. This is important because of a need for a more vigorous curriculum for the degree than what is currently available at UNZA. Since such curriculum and courses are already available in Nebraska, The proposal is to provide short term training of UNZA lecturers at UNL, develop a more vigorous BSc curriculum at UNZA, as well as to select several students from UNZA who have been accepted into the Biomedical Sciences degree program to take the needed courses in Nebraska and through distance learning when appropriate, where the students will be awarded the BSc degree by UNZA. This will also be accomplished through US lecturer who will be stationing in Zambia to engage in teaching and training.

In the current year, we have sponsored workshops to revise and strengthened the curriculum of the BSc in Biomedical Sciences, we have a US lecturer who is engaged in teaching of students in Biomedical Sciences at both undergraduate and graduate levels. We have also three Zambian students from UNZA currently enrolled in our MSc program, one in public health and two in Microbiology. We are proposing to continue with the current training activities, and will identify at least one more US lecturer to station in UNZA to teach and strengthen the training of students and laboratory personnel. We are also proposing to identify at least two Zambian lecturers to attend relevant classes on our campus in Nebraska for 6 months to bring their freshly acquired knowledge and skills back to Zambia to be used in their teaching activities. We will also identify US faculty who will conduct in-country workshops for Zambian lecturers, focusing on teaching skills and course delivery technology. This proposed activity has been endorsed by the Ministry of Health, UNZA and University of Nebraska administrations. In addition, we will procure educational materials, books, and audiovisual items as needs arise.