1. 11 Laboratory Quality Improvement for clinical HIV/AIDS Services in the Uniformed Forces Mwaibako, J, Shija, L; Haverkamp, G; van den Hombergh; Katebalila, M; Shekalaghe, A; Rwezaura, J; Msuya, S; Malewa, 2 nd NQIF 21-22 November 2012 Dar es Salaam

2. 2 Background Laboratory services are essential for improved HIV/AIDS services Yet, poor lab conditions remain a problem, not only for HIV/AIDS services but also for management of other disease conditions In 2006, PharmAccess received funding from DOD/USAID/PEPFAR to improve the health systems of the uniformed forces in Tanzania through a workplace HIV/AIDS intervention An assessment of status of health facilities was conducted which showed that health care system was poor and below minimum standards to deliver HIV/AIDS services Major challenges include: dilapidated infrastructure, lack of human resource capacity and equipment, frequent stock out of reagents etc

3. 3 Background The laboratory services and systems in the forces did not have the capacity to provide timely and reliably diagnostic support services for HIV/AIDS treatment Clinical lab monitoring was not implemented to effectively support HIV/AIDS treatment Facilities had inadequate resources and as a consequence few HIV and other Lab tests were performed and few patients were on treatment The factors above all together compromised the quality of test results and impacted patient management

4. 4 Program objectives Improve capacity to provide quality HIV prevention, HTC, care and treatment services including laboratory support Improve knowledge and skills of staff, linkage with other institutions and communities to ensure continuum of care and support Improve laboratory services of the Uniformed Forces and monitor test and treatment services according to standards of the MOHSW

5. 5 Labs before improvements

6. 6 Methodology 103 laboratories were refurbished and equipped using MOHSW standard list of equipment, laboratory reagents and supplies About 268 laboratory staff were trained in Laboratory Quality Management System (LQMS), stock management, Laboratory diagnosis of TB and HIV and Laboratory equipment application and methodology All sites were provided with equipment maintenance contracts and are participating in various external quality assurance schemes In country and external laboratory experts provide technical assistance through quarterly supportive supervision visits and when needed

7. 7 Results Improved laboratory services contributed to recognition of Uniformed Forces health facilities as Testing & Counselling (n=103), PMTCT (n=74), CTCs (n=53) and TB Program (53) sites by the Ministry of Health. In one year over 80,000 persons have been tested for HIV; over 20,000 pregnant women tested for PMTCT; over 14,000 persons screened for TB; over 3,500 patients treated for TB; and over 15,000 persons were kept on monitoring tests and enrolled on ARVs treatment. Scaling-up of laboratory services has resulted in improved HIV/AIDS services thus contributing substantially to the National Care and Treatment Program

8. 8 Number of CD4 tests recorded 2006-2012

9. 9 Lab after improvements

10. 10 Conclusion and Recommendation The limited number of qualified staff and frequent transfers are challenging. LQMS and preventive maintenance services need further strengthening. A Laboratory Quality Manual should be available for the uniformed forces in order to be prepared for the process of accreditaion Supportive supervision and on the job training, with an increasingly important role for the laboratory specialists from R/CHMTs is to be provided once per 3-6 months Contribution of Improved Laboratory services to the HIV/AIDS Care and treatment in the uniformed forces is a means towards quality of services delivery

11. 11 Thank you for listening……………….

12. 12 Appreciation PEPFAR/USAID/DOD for financial support MOHSW, NACP and R/CHMT for guidelines and facilitating the trainings, supportive supervision and mentorship Thanks to TPDF&TPPI leadership and staff for accepting the program, participating in planning and implementation