ASCP's HIV Initiative

PEPFAR countries include: Barbados, Botswana, Cambodia, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Jamaica, Kazakhstan, Kenya, Kyrgyz Republic, Lesotho, Malawi, Mozambique, Myanmar, Namibia, Nigeria, Rwanda, Sierra Leone, South Africa, Suriname, Swaziland, Tajikistan, Tanzania, Trinidad and Tobago, Ukraine, Vietnam, and Zambia

In 2003, the US government launched the President’s Emergency Plan for AIDS Relief (PEPFAR) program. Implemented by US government agencies (including the Centers for Disease Control and Prevention [CDC], United States Agency for International Development, Department of Defense, and others) and hundreds of partner organizations, PEPFAR supports HIV diagnosis, care, and treatment in the countries most impacted by the HIV epidemic. Thanks to PEPFAR interventions in 2017, 85.5 million people received HIV testing services, and 13.3 million men, women, and children are receiving life-saving antiretroviral therapy.¹ These incredible achievements were made possible by dedicated healthcare workers, including laboratory professionals, who provide high-quality laboratory testing for HIV diagnosis and treatment.

When PEPFAR began, health systems in countries most heavily affected by HIV were underdeveloped and often unable to treat those in need. Capacity for rapid testing, let alone immunology or molecular methods, was limited, and training and certification programs for laboratory professionals were weak or nonexistent. In 2004, the CDC reached out to the American Society for Clinical Pathology (ASCP) to address these gaps and help build the next generation of laboratory workers to lead the fight against HIV.

ASCP’s Contribution
ASCP is firmly established as one of the leading organizations supporting laboratory quality improvement around the world. Over the years, ASCP’s global efforts have shifted as health systems have improved, and PEPFAR priorities have shifted from an emergency response to building sustainable healthcare delivery systems.

The Society has been a leading provider of technical assistance to hospital laboratories and ministries of health as they adopt new technology and methods. When PEPFAR first began, the initial work focused on HIV confirmatory testing with rapid and serologic testing, and ASCP provided training and planned validation studies as countries implemented improved diagnostic algorithms.

ASCP's Center for Global Health staff visited the molecular biology laboratory in Nampula, Mozambique, to provide technical assistance with their HIV viral load testing program. 

In the following years, ASCP assisted several countries as they rolled out CD4 testing for patient monitoring. Clinical chemistry, hematology, and biosafety training programs have also been delivered.

On the laboratory workforce front, ASCP was one of the organizations that spearheaded the Strengthening Laboratory Management Toward Accreditation (SLMTA) program, an in-service training program designed to empower laboratory managers in low- and middle-income countries to improve the quality of their labs. On the preservice side, ASCP has worked with medical technology schools in 12 countries, including Cote d’Ivoire, Mozambique, Tanzania and Vietnam, to modernize and strengthen the laboratory training curricula.

Recent Developments
In 2014, the Joint United Nations Programme on HIV/AIDS set the lofty “90-90-90” goal, which calls on all countries to reach the following targets by 2020:²

• 90% of all people living with HIV know their status
• 90% of those people receive sustained antiretroviral treatment
• 90% of those on therapy have viral suppression

As countries work towards the “third 90” (ie, viral suppression), scale-up of routine viral load monitoring has become one of the highest priorities. Once considered too technically challenging and expensive to use in Africa, viral load testing is expanding rapidly now thanks to the work of PEPFAR, CDC, and their partners.

The ASCP Center for Global Health has been leading the effort to expand access to viral load testing in Mozambique. Over the past year, ASCP has brought together member volunteers, consultants, international experts, and a team of dedicated local scientists to provide on-site mentorship and training to Mozambique’s nine viral load testing laboratories. Spending between two to six weeks at each laboratory, they have helped improve the quality of testing, implemented changes to laboratory processing and workflow to increase efficiency, and provided input to policymakers on the national viral load plan. In Xai-Xai, the capital of Gaza province, the province with the highest HIV prevalence in Mozambique at 25.1%, a supply chain issue led to a critical backlog of samples with thousands of samples piling up over the course of several weeks. Once the ASCP team arrived, a plan was developed to institute a 24-hour workday, increasing the lab’s testing volume from 200 tests per day to over 500.

In the year ahead, the ASCP team will continue supporting the viral load testing labs in Mozambique and provide mentorship to the laboratory team as they continue to improve their efficiency and quality in the pursuit of accreditation. In 2018, ASCP is also partnering with the Mozambique National Institute of Health to bring genotyping capacity to the country. This service will be launched for HIV drug resistance surveillance as well as patient testing in select cases of treatment failure.

In addition to the work in Mozambique, the ASCP Center for Global Health continues to support HIV laboratory strengthening activities in Ukraine, Tanzania, Vietnam, and Myanmar, and will begin a new project in the Caribbean region in April (including Jamaica, Suriname, Trinidad and Tobago, and Barbados).

References:

1. 2017 PEPFAR Global Results. PEPFAR. https://www.pepfar.gov/documents/organization/276322.pdf 
2. 90-90-90 - An ambitious treatment target to help end the AIDS epidemic. UN AIDS. http://www.unaids.org/en/resources/­documents/2017/90-90-90. January 1, 2017. Mr. Landgraf is the Director of the Center for Global Health at ASCP.

The ASCP Center for Global Health is looking for medical laboratory scientists and technicians with advanced experience in molecular biology and viral load testing to support our work in Ukraine and Mozambique.

If you are interested in getting involved and giving back, go to www.ascp.org/content/get-involved to apply as a volunteer, and send an email to globalhealth@ascp.org with your CV.