The goals of this TBD's PEPFAR program will be: 1) To improve patient care through improved and reliable HIV and HIV-related testing. 2) To increase awareness of Quality Systems among laboratory professionals. 3) To show the importance of good quality laboratory testing and introduce methods of measuring the quality of laboratory testing.

The program objectives will be: 1) Maintain quality assurance services in order to monitor, improve and maintain high quality testing in support of HIV prevention, surveillance, care and treatment programs. 2) Maintain accreditation of Proficiency Testing (PT) schemes that are already accredited. 3) Prepare laboratories in Zimbabwe for WHO accreditation. 4) Provide emergency equipment & reagents to avoid stock gaps in HIV & HIV related testing in Zimbabwe. 6) Strengthen the biomedical service centre set up with PEPFAR support in FY09 for the cost effective service and repair of medical laboratory equipment in Zimbabwe. 7) Strengthen the public health laboratory network in Zimbabwe. 8) Evaluate the impact of implementing quality assurance in laboratories and testing sites performing HIV and related testing. 9) Collaborate with the Health Professions Authority in order to strengthen its position as the regulatory body for laboratories and implement the Zimbabwe Medical Laboratory Standards/Guidelines. 10) Offer a comprehensive External Quality Assurance program in order to monitor, improve and maintain high HIV/AIDS related testing in support of HIV prevention, surveillance, care and treatment programs. 11) Continue to provide an internationally accredited Proficiency Testing program in HIV and related confidentiality testing. 12) Coordinate the routine review, printing & distribution of laboratory standard operating procedures. 13) Train laboratory personnel in laboratory techniques and quality systems.

The activities of this TBD should support the HIV/AIDS National Strategy and Plan through monitoring the quality of testing provided by laboratory and testing sites. Training laboratory personnel in quality systems of key tests such as CD4/CD8 testing, monitoring of liver function tests and others. Supporting provision of reagents and laboratory consumables in cases of stock-outs to allow uninterrupted provision of laboratory services. Providing technical support to provincial and district laboratories in the development and implementation of quality systems in preparation for WHO accreditation.

The coverage of the activities of this TBD should be national with particular focus in supporting development and quality systems at the National Microbiology Reference Lab and the National Tuberculosis Reference Lab.

Key contributions of this TBD's program to health systems strengthening will be accreditation of Zimbabwean laboratories in quality systems and thus providing confidence in the quality of results produced. Ability to sustain and expand the biomedical service center set up in FY09 through PEPFAR support for the maintenance and repairs of equipment required for testing throughout the country. This service center minimizes equipment down-time and ensures continuous provision of laboratory services in Zimbabwe.

Cross-cutting funding of this program will be in Human Resources for Health for significant in-service-training of laboratory personnel, performance assessment/ quality improvement, management and leadership development, and retention of key staff at the National Microbiology Reference Laboratory (NMRL). REDACTED

A number of Key PEPFAR issues that this program will address include Malaria, for proficiency testing to be carried out together with the HIV proficiency testing, and, TB to account for commodity procurement and training at the National TB reference lab.

Cost-efficiency strategies of this TBD will be based on bulk procurement of reagents and consumables for TB and HIV-related monitoring tests. Application of good inventory management practices like first-in-first-out (FIFO) to avoid expiration of reagents. Continuation of lab refurbishments based on the National Lab assessment by USG in 2009 to procure only the necessary items for service provision. Resources that are already in place should be utilized as much as possible. The biomedical service center set up in FY09 with PEPFAR resources should allow this TBD to support the MOHCW in its regular maintenance and/or repair of laboratory equipment at the national level more cost-effectively than outsourcing the services from private companies. Cost savings should be done by conducting integrated site visits (covering quality assurance issues on HIV, TB and Malaria within the same visit) to sites within close vicinity to minimize traveling costs and time.

Monitoring and evaluation of activities should be done through quarterly progress reports based on a detailed implementation plan that includes targets and indicators. Site visit reports, Proficiency Testing shipment reports and training reports.

In FY2010, this TBD will support emergency procurement of CD4, Biochemistry and Hematology reagents for HIV monitoring of patients on ART within the National OI/ART program. This is to ensure equitable, uninterrupted provision of laboratory services in support of the National ART program.

In FY2010, this TBD will strengthen the national biomedical service center initiated with FEPFAR funding in FY09, which is designed to provide maintenance and repair of lab equipment in public laboratories. This unit consists of two equipment engineers provided with the necessary equipment and transport means to manage and repair standardized chemistry, hematology and CD4 analyzers in Zimbabwe. They attend to requests done through the National lab logistician and after consolidation of this small team the center should grow up to 8 engineers to be able to cover all provinces of the country.

In FY2010, this TBD will: 1) Continue the process of refurbishment of district laboratories initiated with PEPFAR resources in FY09 ; 2) Consolidate the quality assurance program at national level in the testing areas of Hematology (CD4 count), clinical chemistry, microbiology and serology; 3) Conduct training of laboratory personnel in quality systems and lab techniques; 4) Conduct on-site assessments of selected sites to assess the implementation of laboratory quality systems on the ground; 5) Roll out the standardized HIV rapid testing log book to improve the quality of the data currently collected. 6) Provide technical support to provincial and districts laboratories in the country for the accreditation process with WHO Afro.

In FY2010, this TBD will support the procurement of reagents and consumables for TB microscopy, culture and Drug Sensitivity Testing for the national TB program. REDACTED