In the global effort to address the AIDS crisis in Africa, accurate test results are critical to determine who gets to free drug treatment. While widely publicized rapid tests for HIV serve as an initial screening tool, sophisticated laboratory test methods are necessary to confirm diagnosis and monitor the effectiveness of treatment therapies on individuals.

Through a cooperative agreement with the U.S. Centers for Disease Control and Prevention as part of the President’s Emergency Plan for AIDS Relief (PEPFAR), the American Society for Clinical Pathology (ASCP) in Chicago is assessing the needs of laboratories in select African nations and conducting customized training sessions for laboratory professionals in the specialty areas of hematology, clinical chemistry, and flow cytometry.

From May 22 through June 2, 2006, a team of ASCP-member medical technologists will conduct a two-week, train-the-trainer session in Arusha, Tanzania, for 35 laboratory professionals from laboratories throughout the country. The program involves one week of intensive didactic and hands-on training in one of the specialty areas and another week learning to conduct training sessions back in their home laboratories.

In April and May, Gonfa Ayana of the Ethiopian Health and Nutrition Research Institute (EHNRI) and Teferi Mekonen, MSc, of the Centers for Disease Control and Prevention (CDC) in Ethiopia underwent 150 hours of didactic and practical training in quality laboratory management at Howard University Hospital (HUH) in Washington, DC, under the direction of HUH Laboratory Manager Michele L. Best, MT(ASCP). Upon their return to Ethiopia, Ayana and Mekonen will train laboratory managers who work in facilities that are approved to provide free antiretroviral therapy (ART) throughout the country. Approved facilities receive new flow cytometers, as well as new hematology and clinical chemistry analyzers.

Of the more than 1150 laboratories in Ethiopia, 59 laboratories are involved in the free treatment program, Ayana said. By the end of 2006, 89 laboratories are expected to be in the program, with 100,000 people receiving treatment. With funding from numerous international organizations, free treatment became available in January 2005. The Ethiopian Ministry of Health estimates that about 1.6 million people in the country are HIV-positive, and nearly 1.2 million people have already died of AIDS.

Implementing standard operating procedures and improving record-keeping and documentation systems are top priorities. A computerized laboratory information system is being piloted in a handful of facilities—a first step toward electronic recordkeeping. In addition, accuracy of test results is of paramount importance due to the lives at stake and the appropriate allocation of resources to people who need it most.

“HIV patients whose CD4 counts (T-cells counted using a cell-surface marker protein called CD4) are above 200 are not eligible for treatment—below 200, eligible—so accuracy is critical to determining whether one has treatment or not,” said Ayana. “Secondly, in the course of the treatment, certain regimens are not helpful for some patients, or there are contraindications with renal problems, and these change over the course of time. To have the effect, one has to have real, exact, accurate lab results.”

Ayana said the global effort to address the AIDS crisis in Africa is improving “the overall structure and service quality of the health system in the country, because all these services—quality laboratory management—are done in a facility where general services are conducted. There is no difference in liver function testing in the ART patient and in the normal liver disease patient.” AIDS, Ayana added, is not a one-country issue. “It’s a worldwide issue, even though we are bitten hard by the problem,” he said. “With all of the international support we have on our side, we hope we can do something of value to the society.”

In addition to Ethiopia and Tanzania, ASCP training is planned for Kenya, Lesotho, South Africa, and Swaziland. Guyana, Namibia and Rwanda have also expressed interest.