CEO SUMMARY: With new Congressional authorization and funding of $48 billion, PEPFAR II—a second five-year initiative to help targeted countries battle HIV, AIDs, tuberculosis, and malaria—is about to get under way. To better support diagnosis and management of HIV/AIDs patients, some PEPFAR funds are designated to expand laboratory testing services in countries with high prevalence rates of HIV/AIDS. ASCP’s funding award will support laboratory training events and technical assistance to labs in 12 PEPFAR countries.
LABORATORY TESTING SERVICES continue to play an essential role in supporting patient treatments under PEPFAR (President’s Emergency Plan for AIDS Relief ). One of the first laboratory organizations to receive funding in the current budget cycle is the American Society of Clinical Pathology (ASCP).
ASCP was awarded $3.9 million in PEPFAR funding this fall by the U.S. Centers for Disease Control and Prevention (CDC). The funding is for the first year of the nation’s second five-year PEPFAR initiative. Last year, ASCP received $2.8 million in PEPFAR funding to develop and implement laboratory training programs in 12 of 15 PEPFAR countries, mostly in Africa.
Many Lab Groups Involved
Other lab associations that received funding under PEPFAR include the Association of Public Health Laboratories (APHL), the American Society for Microbiology (ASM), and the Clinical Laboratory and Standards Institute (CLSI).
In the first five-year PEPFAR cycle, the United States spent $15 billion. For this second five-year cycle, called PEPFAR II, Congress allocated $48 billion to treat patients who have AIDS, malaria, and tuberculosis. Of the total allocated, $39 billion is going for AIDS-related treatment and prevention efforts.
Since 2004, ASCP and its volunteers have trained more than 1,400 laboratorians in such areas as laboratory management, phlebotomy, hematology, chemistry, and CD4 testing. These newly trained laboratory professionals then serve in laboratories which provide monitoring services to HIV/AIDS patients in PEPFAR countries.
The CDC’s new funding award for PEPFAR II allows ASCP members and staff to continue these training programs. The emphasis is on providing laboratorians in PEPFAR countries with best practices that will result in quality testing. One cornerstone of this effort is to emphasize the importance of quality control and quality assurance. Both are fundamental elements critical in moving a laboratory toward accreditation.
“ASCP’s scope of work under PEPFAR has grown in the last few years,” said Barbara Hoffman, ASCP’s Director of Global Outreach. The objective is to build laboratory services capable of high quality laboratory testing to support the diagnosis and monitoring of patients with HIV/AIDS in resource-limited countries.”
U.S. Labs And PEPFAR
Laboratory testing support for PEPFAR activities is a little-known story in the United States. The CDC supervises a program to develop and support lab testing services within PEPFAR countries. Volunteers from laboratory groups, including ASCP, travel to countries in Africa, South America, and the Caribbean to train laboratory staff and help laboratory organizations achieve accreditation under international standards. The goal is to build a laboratory infrastructure that will provide reliable, accurate laboratory testing that supports the diagnosis and monitoring of patients with HIV/AIDS in resource-limited countries.
PEPFAR II (www.PEPFAR.org) has ambitious goals. It intends to: 1) support treatment of two million HIV-infected patients; 2) nurture programs that will pre- vent an estimated 12 million new infections, and, 3) contribute to the care of 10 million patients infected or affected by HIV/AIDS. The PEPFAR program is operating in 15 countries, most of which are in Africa.
Significance of Funding
There is positive news for the laboratory profession in the Congressional authorization of the PEPFAR II. When PEPFAR I was initially conceived and launched in 2003, funding for laboratory testing was meager, at best. As a consequence, health care professionals in these developing countries—lacking more sophisticated laboratory testing capabilities available to clinicians in developed healthcare systems—had difficulty identifying the patients who were HIV positive and managing the care of these patients.
About 18 months after the program began, PEPFAR leadership recognized that laboratory standards in these countries needed to be enhanced and capable of operating the instrumentation used in monitoring HIV/AIDS patients. “In July 2004, the CDC approached ASCP and asked for assistance developing training materials for laboratorians in PEPFAR countries and providing training in country,” recalled Hoffman. “It was envisioned that the training would enhance basic laboratory operations, which would ulti- mately improve the quality and reliability of the HIV/AIDS patients’ results, a goal to which every laboratorian aspires. ASCP was honored to be considered for this project and has been involved since 2004.”
Since then, ASCP members and staff have travelled extensively throughout Africa, Guyana, and Haiti to support the training and technical assistance programs under PEPFAR. “This training and support has produced substantial improvements in the practice of laboratory medicine in these countries,” commented Hoffman. “It has provided these laboratorians with information and access to lab expertise to which they previously had little or no access.
90 Laboratory Consultants
“ASCP supports a pool of 90 consultants in laboratory services who are members of ASCP. These individuals travel regularly to PEPFAR countries in Africa and elsewhere,” noted Hoffman. “There are three project managers who each travel six to eight times a year to Africa, Guyana, and Haiti.”
For PEPFAR II, ASCP volunteers will provide assistance to laboratorians in Botswana, Ethiopia, Kenya, South Africa, Lesotho, Côte d’Ivoire, Guyana, Haiti, Mozambique, Namibia, Rwanda, Swaziland, and Tanzania. Experienced lab- oratory professionals wishing to participate in these activities should contact the ASCP or other laboratory associations involved in PEPFAR activities.