Strengthening High Quality Laboratory Services Scale-Up for HIV Diagnosis, Care, Treatment, and Monitoring in Malawi under PEPFAR (CDC-Malawi)

The Challenge

Malawi is a landlocked country surrounded by Tanzania, Zambia, and Mozambique with an estimated population of 17 million people. It is among the countries worst affected by the HIV and AIDS epidemic, with 10% infection rate amongst the adults aged 15 to 49. With more than 1 million people living with HIV, Malawi has adopted the UNAIDS 90-90-90 targets: by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people diagnosed with HIV infection will be on antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. 

Overview and Objectives

URC with funding from CDC, worked closely with the Malawi Ministry of Health (MOH) Diagnostic Department and other partners from April 2015 implementing the URC-Malawi Laboratory Project whose main objective was strengthening High Quality Laboratory Care, Treatment and Monitoring in Malawi under PEPFAR. URC worked with the MOH to achieve these goals by strengthening the laboratory system to ensure rapid, accurate diagnostic services are available for the entire population. URC focused on diagnostic services, sample transportation, training lab technicians and laboratory capacity building for Malawi to achieve its UNAIDS 90-90-90 targets.

Project objectives were to:

1. Increase the quality of HIV laboratory services through the strengthening of quality management, control and assurance systems
2. Increase access to quality HIV laboratory services through improved laboratory capacities
3. Strengthen the collection and use of laboratory strategic information to improve organizational performance
4. Strengthen the availability of trained laboratory human resources
5. Improve the national sample transportation system

Focus Areas

• Viral Load scale up
• Early Infant Diagnosis scale-up
• External Quality Assurance
• M&E and Strategic Information Systems
• Strengthening Laboratory Management Toward Accreditation
• Sample Transportation

Achievements

• The project has embedded seven mentors in 48 facilities to work directly with laboratory technicians and clerks on quality improvement projects. Through this mentorship program, the project is working to achieve laboratory accreditation through the African Society of Laboratory Medicine (ASLM). Mentors train lab technicians to conduct internal audits to find and fix nonconformities such as outdated SOPs or equipment that needs servicing. Once most of the nonconformities are addressed, the project will have ASLM do an external audit to accredit each laboratory.
• 414,622 Viral Load samples tested in Project Year 4, representing 110.8% of the annual goal. This is a substantial increase since the project’s first year, which ended with 146,199 tests performed.
• 44,544 Early Infant Diagnosis samples tested in Project Year 4
• 83.4% Viral Load Suppression Rate
• 100% of Molecular Laboratories passed Viral Load External Quality Assurance testing in November 2018
• Established a National Transportation System network through Riders for Health, one of the project’s sub-recipients. Riders for Health connects 658 health facilities across the country to offer quality sample transportation services replacing the previous segmented sample transportation system. In the project’s fourth year, 431,769 samples and 397,761 results were transported.
• 150+ laboratory personnel trained in Project Year 4 on internal laboratory audits, EID/VL testing, and method validation
• The project renovated Nsanje Molecular Laboratory in July 2017 to increase the country’s viral load testing capacity. Several other renovations are planned for 2019.
• 29 diploma students supported for Medical Laboratory Technician program at Malamulo College of Health Sciences graduated
• 73/77 graduated students supported for Medical Laboratory Assistant program at Malawi College of Health Sciences are now employed by Malawi Ministry of Health and Christian Health Association of Malawi