CDC's Global AIDS Program GAP

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Laboratory Quality and its role in the
fight against AIDS in Africa
Building Laboratory Quality Systems A
Route to Reliable Laboratory Data
Gaborone, Botswana July 2003
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Adult HIV seroprevalence worldwide 2002
Sub-Saharan Africa 29.4 million living with
HIV/AIDS 2.4 million child and adult deaths
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Goal of CDC Global AIDS Program (GAP)1999 -
2003

• Assist in reducing HIV transmission and
• improving HIV/AIDS care and support
• in partnership with resource-poor
• countries.

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GAP Countries 2002
China
India
Haiti
Vietnam
Nigeria
Senegal
Ethiopia
Guyana
Cambodia
Thailand
Côte dIvoire
Uganda
D.R. Congo
Kenya
Rwanda
Angola
Tanzania
Zambia
Zimbabwe
Brazil
Namibia
Malawi
Botswana
Mozambique
South Africa
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Major assistance requests from our partners are
for

• Surveillance support
• Training
• Strengthening laboratory capacity
• Information systems
• Voluntary counseling and testing
• Prevention of mother-to-child transmission
• Improving care of persons living with HIV

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GAP Budget History
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Prevention of Mother to Child Transmission
Photo Robert Mulder
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Outputs for the Initiative

• Reach up to 1 million women annually
• Reduce mother-to-child HIV transmission by up to
  40 among women treated

WHO/P. Virot
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Presidents Emergency Plan for AIDS Relief (EPAR)

• Prevent 7 million new infections
• (60 of the projected new infections)
• Treat 2 million HIV-infected people
• Care for 10 million HIV-infected individuals and
  AIDS orphans.
• Funding proposed 15 billion

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HIV/AIDS Prevention Treatment and the
Laboratory in Africa
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Voluntary Counselling and HIV Testing
Prevention
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• Stigma
• Cultural acceptability
• Community mobilization
• Ethical issues
• Continuity of care
• Laboratory quality
• Use of rapid tests
• Information systems
• Training and supervision

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Voluntary Counseling and Testing
Commitment Community
mobilization Partnerships
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Care and Treatment
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Anti viral treatment ?
Prevention

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BRASIL number of AIDS cases reported
Total cases reported (03/06/00) 190,949
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Affordable prices ?
Annual cost per person for triple therapy in
Africa (US)
12,000 10,000 8,000 6,000 4,000 2,000 0
1991 1993 1995 1997 1999 2001 2003
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(No Transcript)
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Laboratory Quality ?
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Factors Influencing Laboratory Quality

• Cost
• Equipment and Maintenance
• Reagent Procurement and Distribution
• Personnel Training
• Simplicity and Accuracy of Algorithms
• Information Systems for Care Monitoring

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Expected AIDS treatment costs as a share of
government health spending
70
of MOH Budget
60
50
40
30
20
10
0
Ethiopia, 2014
Kenya, 2005
Zimbabwe, 2005
Costs
Source Stover Bollinger, 1999
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Equipment and Maintenance
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Personnel Training
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Lab Testing Monitoring Algorithms

• CD4 counts
• Viral load
• Opp. infections
• Toxicity
• Compliance
• Viral resistance

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Diagnosis and Treatment algorithms

• Cotrimoxazole
• TB treatment
• ARV regimens
• Delivery systems

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Information Systems
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Challenges for Laboratories Care Providers

• Improving communication with each other
• Determining the appropriate tests for
• - individual clients (rapid tests)
• - programs (surveill, screening, treatment)
• Providing testing in remote locations
• Appropriately trained staff (Diag. Care)
• Scaling up for population coverage
• Maintaining quality

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Prevention