Section 11 -

The American Society for Clinical Pathology (ASCP) and the President's Emergency Plan for AIDS Relief (PEPFAR) Lee H. Hilborne

Background: The President's Emergency Program for AIDS Relief (PEPFAR) is an initiative to identify and treat people living with HIV/AIDS in resource poor countries. The PEPFAR initiative began in 2003, with funding of US$15 billion committed over five years; it focuses on the most afflicted countries in Africa, the Caribbean and Southeast Asia. ASCP and its members and staff have been significantly involved for two years in developing and presenting educational materials in countries identified in the PEPFAR program through a cooperative agreement with the United States' Centers for Disease Control and Prevention's (CDC) Global AIDS Program (GAP). Purpose ASCP, through its cooperative agreements with CDC, supports laboratory training and quality improvement for diagnosis and laboratory monitoring of HIV/AIDS patients in resource-limited countries that are part of PEPFAR. ASCP's has developed educational modules to provide laboratory support and assistance in building human resource capacity and laboratory infrastructure for diagnostic testing in clinical laboratories within PEPFAR countries. One of the important elements in health care delivery is the use of laboratory test results. Laboratory test results are an integral part of a treatment plan as they monitor HIV progression and provide information to the clinician in making decisions about a treatment regimen. A commitment to regularly monitor patients using the clinical laboratory is an important way to enhance the health care delivery system. Ultimately this program will serve to augment laboratory testing practices and enhance the quality of laboratory testing services in order to improve the effectiveness of HIV/AIDS prevention, care and treatment services and interventions. The ASCP has presented laboratory education programs on Clinical Chemistry, CD4 Count and Hematology in Ethiopia, Tanzania and Malawi. ASCP's approach includes needs assessment, training programs and evaluation visits. The programs are presented and administered by professionals from ASCP membership and staff. Program Goal The overall goal of the project includes the development of training packages for laboratory testing essential for accurate diagnosis and monitoring of HIV-AIDS patients; deployment of training packages and training the trainers by ASCP consultants, traveling to host countries; and measuring effectiveness of training programs, (immediate and short term) and sustaining the education and knowledge transfer to in country laboratory personnel. These strategies are intended to assist countries in scaling up the capacity of PEPFAR countries by addressing care and treatment of individuals with HIV/AIDS, ensuring consistency and quality in the implementation of training goals, and assisting technologists in the technical procedures in performing different tests related to HIV/AIDS treatment. The most immediate need is to provide well designed training programs for chemistry, hematology, and CD4 to assure accuracy of testing. Follow-up will consist of on-site visits to hospitals and reference laboratories to ensure the development of appropriate laboratory policies and procedures, implementation of these policies and procedures, and competency assessment/improvement of laboratory staff. The successful implementation of these goals will require a significant strengthening and expansion of laboratory systems and services in each PEPFAR country. Under the terms of this cooperative agreement, the ASCP collaborates with in-country CDC offices and CDC-Atlanta as well as other organizations and institutions as appropriate. Outcomes Enhancing the capacity of laboratories in countries with high burdens of HIV to rapidly diagnose and monitor the health of HIV/AIDS patients will more effectively confront the global HIV epidemic according to the goals set forth by the US government, and result in more effective and systematic laboratory systems in resource limited countries. Outcomes for this program include a variety of qualitative and quantitative measures including pre and post test results and ultimately a six month post intervention longitudinal evaluation assessing the programs affects on clinical practice in each country. The findings from ASCP's evaluation of the effectiveness of initial training will be an important component of the overall effectiveness of the Global AIDS Program.