Foreword 5 Background 7-8 - Ghana Health Service€¦ · 2 Ghana Viral Load Scale Up and...

September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 1

2017 – 2020

September 2017

Ghana Viral Load Scale Up and Operational Plan

September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 20202

Acknowledgements 4

Foreword 5

Glossary 6

A. INTRODUCTION 7

Background 7-8

Current Status of VL Testing Programme in Ghana 9

SWOT Analysis of VL Testing Programme 10-13

VL Testing Programme 2020 Targets and Projections 13-15

Programme Needs to Meet 2020 VL Testing Programme Goals 15

• Test Equipment 15

• Equipment Maintenance System 17

• Supply Chain 17

• Human Resources 17

• Specimen Referral and Result Delivery System 17

• Information Management 18

• Quality Assurance 18

• Monitoring and Evaluation 18

Table Of Contents

Pg No.


B. GOAL, OBJECTIVES AND STRATEGIES OF VL SCALE UP PLAN 19

Goal of Scale Up Plan 19

General Objectives of Scale up Plan 19

Overview 20

Specific Objectives and Strategies 21

Objective 1: Programme Management 21

Objective 2: Test Equipment 21

Objective 3: Supply Chain Management and Logistics 22

Objective 4: Human Resources and Training 22

Objective 5: Specimen Referral and Result Transmission 22

Objective 6: Quality Assurance Programme 23

Objective 7: Laboratory Information Management 23

Objective 8: Monitoring and Evaluation 24

C. ACTIVITIES OF VL SCALE UP PLAN 25-47

D. APPENDICES 48-51

Pg No.


Dr. Stephen Ayisi Addo NACP, GHSDr. Bernard Dornoo NACP, GHSMr. Kenneth Danso NACP, GHSMr. Kwadwo K. Owusu NACP, GHSMrs. Veronica Bekoe NACP, GHSMr. Rowland Adukpo NACP, GHSMs. Berenice Botchwey NACP, GHSMs. Doris Awudi NACP, GHSMrs. Naana Yawson MOHMr. Bernard Nkrumah CDC, GhanaMr. Silas Quaye CDC, GhanaMr. Frank Amoyaw CDC, GhanaDr. Nicholas Adjabu Clinical Engineering Unit-GHSMr. Festus Sroda Regional Health Directorate, AshantiMr. Anthony Addo Brong Ahafo Regional Hospital, Sunyani Mr. Albert Dompreh Komfo Anokye Teaching HospitalMr. Augustine Sagoe Korle Bu Teaching HospitalDr. David Mills Consultant, APHLMs. Kim Lewis Consultant, APHL

Dr. Stephen Ayisi AddoProgramme Manager, National AIDS/STI Control Programme.

AcknowledgementsThe Ghana Health Service acknowledges the leadership provided by the National AIDS/STI Control Programme (NACP) and contributions from the following organisations and individuals: Centres for Disease Control and Prevention (CDC) for financial and

technical support, the Association of Public Health Laboratories (APHL) for technical assistance and the under listed individuals from Ghana Health Service (GHS) and the Teaching Hospitals who constituted the technical team for putting this plan together.


ForewordHIV prevalence in Antenatal care clients in 2016 was 2.4% (C.I: 2.18% – 2.62%)1 and 1.62% (C.I: 1.3% – 2.0%) in the general population. In 2016, there were an estimated 293,804 Persons Living with HIV (PLHIV), nearly 60% of whom are women and 15% are children below 15 years.2

The provision of comprehensive care for Persons Living with HIV using Highly Active Antiretroviral Therapy (HAART) in Ghana over a decade now has impacted greatly on the lives of many. At the end of 2016 there were 245 Antiretroviral Therapy (ART) sites in the ten regions across the country. As at end of December 2016 there were 100,665 clients on ART out of the cumulative number of PLHIV ever enrolled in ART care. With a relatively lower Paediatric ART coverage of ~30%, the total unmet need for ART is approximately 65%.

With emerging new evidence in therapeutic outcomes world-wide and changing trends in the management of PLHIV, Ghana has made a major shift from ART initiation criteria using the World Health Organization (WHO) clinical stage 3&4 and or CD4 count of <500cells/mm3 to “Treat All” policy in line with 2015 WHO recommendations for the comprehensive care of PLHIVs. Ghana has also adopted the global UNAIDS 90/90/90 aspirational targets in order to sustain the progress being made in the area of care for PLHIV towards ending the AIDS epidemic by 2030.

The recent WHO consolidated guidelines for ART in 2016 reinforced the need for a shift from the use of CD4 testing to the use of Viral Load (VL) testing for the routine monitoring of PLHIVs on ART. Due to the previous policy where viral load testing was mainly to guide decisions on treatment failure, Ghana’s Viral Load coverage was very low and the existing 9 functional VL equipment were grossly underutilized.

Due to the anticipated significant rise in VL testing occasioned by Ghana’s adaptation of 2016 ART guidelines, it has become necessary to develop this VL scale-up and operational plan to assure complete client access to laboratory monitoring towards the achievement of the third 90 of the HIV care cascade. The plan will enhance VL testing, monitoring whilst improving the clinical and laboratory interface for improved client care. This document has been developed for use by all levels of health care facilities; and will assist to provide high quality, effective and standardized VL testing to monitor patients on ART as part of quality health care service delivery in the country.

Dr. Anthony Nsiah-AsareDirector GeneralGhana Health Service

1 2016 HIV Sentinel Survey Report, National AIDS/STI Control Programme, Ghana Health Service2 2016 National HIV Prevalence & AIDS Estimates report (SPECTRUM), Ghana AIDS Commission


AIDS Acquired Immunodeficiency Syndrome APHL Association of Public Health LaboratoriesAR Ashanti RegionART Anti-retroviral therapyASLM African Society for Laboratory MedicineBAR Brong Ahafo RegionCDC Centers for Disease Control and PreventionCR Central RegionEID Early Infant DiagnosisEQA External Quality AssessmentER Eastern RegionGAR Greater Accra RegionGIS Geographic Information SystemHIV Human Immunodeficiency VirusHTS HIV Testing ServicesHVAC Heating, Ventilation and Air Conditioning Control SystemIQC Internal Quality ControlM&E Monitoring and evaluationMLS Medical Laboratory ScientistNACP National AIDS/STI Control ProgrammeNR Northern RegionPCR Polymerase Chain ReactionPLHIV Persons living with HIVPMTCT Prevention of mother-to-child transmission QMS Quality Management SystemSLIPTA Stepwise Laboratory Quality improvement Towards AccreditationSLMTA Strengthening Laboratory Management Toward AccreditationSOPs Standard Operating ProceduresSTI Sexually Transmitted InfectionsSWOT Strengths - Weaknesses -Opportunities -ThreatsUER Upper East RegionUWR Upper West RegionVL Viral loadVLMS Viral Load Management SystemVLSUP Viral Load Scale Up PlanVR Volta RegionWHO World Health OrganizationWR Western Region

Glossary


The Human Immunodeficiency Virus (HIV) was first identified in Ghana about three decades ago. Since then, there have been many developments in the response to the epidemic. At the end of 2016, the national prevalence of HIV in Ghana was 1.62% and 2.4% among pregnant women; there was an estimated 293,804 persons living with HIV whilst new infections were 20,418 annually3 . Also, there were 245 Anti-Retroviral Therapy (ART) and 2,325 Prevention of Mother-To-Child transmission of HIV Testing Sites (PMTCT/HTS) with a total of 100,665 persons living with HIV (PLHIV) on ART4 .

With new data on therapeutic outcomes world-wide and changing trends in the management of PLHIV, Ghana is moving away from using the ART initiation criteria of WHO clinical stages 3 and 4, and/or CD4 count of ≤500 cells/mm3 to offering treatment for all persons with confirmed diagnosis of HIV in accordance with the World Health Organization (WHO) Recommendations (November 2015). The new recommendations also requires the use of VL testing rather than CD4 count to routinely monitor clients on ART. Ghana adopted these recommendations in the newly revised 2015 Guidelines for ART delivery. Hitherto, VL testing was used to monitor treatment failure and was not a universal basic requirement for monitoring clients on ART in Ghana. Although there may be considerations for VL testing prior to initiation of therapy, it is still not a requirement for initiation of ART. In line with the current WHO recommendations, VL testing is to be conducted in all clients 6 months after initiation of therapy, 12 months after initiation of therapy and, subsequently, at least once yearly thereafter, as a routine way of monitoring clients on ART in order to assess management outcome, disease progression, and drug resistance emergence6 .

While Ghana currently has 9 functional Roche COBAS AmpliPrep/Taqman Polymerase Chain Reaction (PCR) machines for HIV VL testing, the uptake of VL testing in Ghana has to date been low. In 2016, only 17,044 of the estimated 100,665 clients on ART had at least one VL test done (Table 1).

a. INTRODUCTION

Background

3 National HIV Prevalence and AIDS Estimates &Projections Report. 2016.4 2016 Annual Report. NACP, GHS5 Guideline for Antiretroviral Therapy in Ghana. 2016. NACP, GHS6 WHO 2015. Consolidated Guideline for treatment of Persons Living with HIV


Table 1: Viral Load Tests Conducted per Region in 2015 and 2016

RegionsOn

treatment in 2015

VL Tests Done

(2015)

VL Tests Done

(2016)

On treatment

(2016)

Ashanti Region (AR)

Brong Ahafo Region (BAR)

Eastern Region (ER)

Greater Accra Region (GAR)

Western Region (WR)

Northern Region (NR)

Upper East Region (UER)

Upper West Region (UWR)

Volta Region (VR)

Central Region (CR)

Totals

21882

11304

11942

18836

7545

2900

2865

2106

6740

2993

89,113

739

571

1097

5952

120

487

61

No data

22

567

9,616

4072

1372

1859

6605

893

407

No data

No data

500

1336

17,044

18,706

13,206

14,584

23,771

7,210

3,514

3,537

2,788

8,080

5,269

100,665

The low uptake of VL testing to date is attributable to multiple factors such as the poor utilization of VL by clinicians, poor co-ordination of VL testing services, lack of a structured sample referral and results transmission system, workload and competing demands on laboratory personnel, weak clinical monitoring and evaluation of patients on ART, weak laboratory clinical interface, equipment malfunction, power fluctuations, reagent stock-outs and the absence of a VL scale up plan.

To effectively improve VL testing in Ghana, these multiple challenges must be addressed in a comprehensive and concerted manner. The current lack of a structured sample referral and results transmission system must, of necessity, be rectified and proper coordination of systems and range of activities that will culminate in the success of VL testing put in place. The procedures for collection, processing and transportation of samples to the regional and National centers for testing, must be clearly defined, tracked, monitored and appropriately supervised, while a framework is established to enable patient results to be sent back for clinical decision and patient monitoring in a timely manner. To make the VL testing system more robust and efficient, instances of laboratory reagent stock outs must be reduced to the barest minimum, and on-going equipment care and maintenance schedules are strictly being adhered to. The Ministry of Health and the GHS, in collaboration with their development partners, are of the common understanding that developing a VL load Scale Up and Operational Plan is required to improve the overall uptake and utilization


of VL testing services in Ghana. This Plan will provide the base and reference point of a well-coordinated and efficient VL testing scale up, align with the National Strategic Plan and 90-90-90 Roadmap, and reflect the VL testing algorithm adopted by Ghana for the attainment of its goals for HIV management. The National AIDS/STI Control Programme recognizes the need for VL testing expansion in order to achieve the 90-90-90 target and improve the utilization of HIV services for the benefit of all PLHIV.

Current Status of VL Testing Programme in Ghana

At present, the VL testing programme for ART delivery in Ghana is being administered through the use of 9 Roche CobasAmpliPrep/Taqman 48 PCR (Taqman 48) machines located in 9 of the 10 regions of the country namely Brong Ahafo, Greater Accra, Central, Volta, Eastern, Northern, Ashanti, Western and Upper East. Some of machines were procured in early 2010 and are also used for HIV DNA-PCR Early Infant Diagnosis (EID) testing. Together, they can perform a total of 64,512 VL tests per year when operating optimally. However, by virtue of aging and ‘wear & tear’, their efficiency is fast diminishing. Prolonged equipment malfunction due to challenges with maintenance and repair support, electrical power interruptions, lack of sample referral and results transmission systems have hindered the capacity of the VL testing programme. By the year 2020, four of the units are likely to be permanently non-functional.

VL testing capacity has also been adversely affected by shortages, stock-outs and expiration of reagents associated with logistical issues in the reagent supply chain due to limited use of tools for forecasting and quantification of laboratory reagents at the national level. Currently, commodities are distributed using a push system and not strictly based on reported consumption reports.

There are currently 18 trained laboratory staff, on average 2 per testing site, conducting VL testing. But in order to provide VL testing at full instrument capacity and without service interruption, 3 laboratory personnel are required per site. While all existing staff have received technical training in VL testing currently, there is no standardized established technical training and competency assessment programme for newly hired and continuing staff.

Ghana has implemented a laboratory quality management system in 15 laboratories using the Strengthening Laboratory Management Toward Accreditation (SLMTA) tool. Of the 9 operational VL testing laboratories, 7 have completed the SLMTA training and were assessed by African Society for Laboratory Medicine (ASLM) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist with star ratings ranging from 2 to 4 (out of 5). However, since the SLMTA programme ended in 2015 these laboratories have not been assessed and their level of implementation of quality


management systems have fallen back.

Also, the 9 VL testing laboratories are registered for an external proficiency testing programme with AfriQuaLab, a CDC supported laboratory based in Senegal, in which they perform satisfactorily. However, there is no inter-laboratory comparison testing system in place in the country.

Information management gaps also limit the VL testing programme. VL test requisition is done using general laboratory request forms that exclude VL specific data needed for patient monitoring, programme monitoring and evaluation. In addition, there are neither standardized VL registers at referring facilities nor laboratory registers for VL result entry. In addition, reporting of VL test results are not standardized across the system. The National AIDS/STI Control Programme, in collaboration with CDC, has implemented Basic Laboratory Information System (BLIS) as a tool for laboratory data management for VL and EID to feed information into the District Health Information Management System-II (DHIMS-II) and E-tracker, which are national monitoring and evaluation platforms.

A poor utilization of VL by clinicians and poor co-ordination of VL testing services also contributes to the low VL coverage of ART patients. The VL testing programme is managed as part of an integrated system of the comprehensive care for PLHIV from the national level through to the peripheral level. At the facility level, clinicians review the patient and make a request for the test. The patient is then assisted by nurses and caregivers to locate the testing laboratory where the sample is collected and either tested or referred for testing. The district level and regional coordination teams of the NACP/GHS are only involved when there is a challenge with the testing laboratory and clients are in need of assistance.

Ghana currently does not have a VL scale up plan. Likewise, there is no standardized VL Monitoring and Evaluation (M&E) plan to monitor and track key indicators, including viral suppression, which is the third 90 of the UNAIDS 90-90-90 aspirational targets. The available plans are insufficient for tracking key outcomes of the 90-90-90, thus concentrating more on above site level activities and indicators. This does not address facility level gaps and challenges within the systems.

SWOT Analysis of VL Testing Programme

A SWOT analysis of the VL testing programme (Table 2) reveals a number of key challenges and gaps that must be bridged with an intervention that is capable of achieving 2020 VL testing Programme goals.


1. There is currently no VL testing scale up plan to achieve these goals. The development of a plan will need to address a number of issues relating to testing capacity. These include insufficient numbers of functional VL testing platforms, service interruptions due to equipment malfunction and reagents stock-outs, insufficient testing staff, inadequate training of staff and high rates of attrition among these staff. Remediation of these issues is complicated by the lack of a continuous quality improvement scheme and a weak monitoring and evaluation programme.

2. There is a lack of logistics and transportation support from facilities as well as district and regional health directorates and no structured specimen referral system and results transmission system in place.

3. There is weak coordination between various service delivery facility levels and non-adherence to VL testing policy by clinicians and other clinical care providers.

Table 2: SWOT Analysis of VL Testing Programme

Equipment• Nine (9) functional Taqman 48 PCR machines located in Nine regions.• Service contract available at the national level.

Human Resource• Technical personnel available to operate the machines. • Roche Engineering personnel available to service the equipment.

Equipment• Non-availability of structured maintenance schedule.• Slow response to service calls (Roche).• Unstable power supply.• Frequent breakdown of the equipment.• Servicing parts are not readily available in- country.• Poor humidity and temperature control

Human Resource• Lack of continuous training to cater for attrition of staff.• Laboratory Staff attrition.• Poor coordination among caregivers for VL testing.• GHS Engineering staff not trained to troubleshoot or service equipment.

STRENGTHS WEAKNESSES


Logistics• Availability of reagents and consumables. • Good reagents and consumables storage facilities available.

Specimen referral and results transmission• Good inter-town road network.• Good communication means.• Good laboratory network.

Quality AssuranceExternal quality assessment programme in place.

OPPORTUNITIES

• Commitment from development partners to support Laboratory strengthening and capacity building.• Establishment of AIDS fund under the new GAC Act 938 is a potential source of future funding for national HIV strategic plan.

Logistics • Poor Logistics Management Information System (requisition, transportation, storage, disposal and reporting) resulting in occasional stock-out and expiry of reagents.

Specimen referral and results transmission• No structured specimen referral system and results transmission system in place. • Lack of systems that connect the laboratory information system with clinical sites for site and patient VL test monitoring and targeted identification of patients with virologic failure.• Lack of existing site level data utilization for clinical mentoring efforts directed at site level VL performance and follow up of patients with virologic failure.• Poor co-ordination of the VL testing system and processes within clinics and between clinics and laboratories• No VL testing Scale-up plan to match national strategic plan.

Quality Assurance• Lack of VL testing Monitoring and Evaluation plan.• Limited clinical guidelines, SOPs and job aids for routine viral load monitoring. • Lack of accreditation for VL testing laboratories.

THREATS

• Unstable power supply (electrical wiring audits at all sites).• Dwindling donor funding support coupled with inadequate Government budgetary allocation for national HIV strategic plan. • Non-adherence to policy guidelines for Viral Load testing by service providers.


• Possibility of using GeneXpert and other Point of Care equipment at district and sub-district levels. • Training and research support.• Significant momentum catalyzed from global, regional and local demand for action on routine viral load monitoring.

• Non-prioritization of transfer of technology for equipment management.

VL Testing Programme 2020 Targets and Projections

With the adoption of the 2020 global UNAIDS 90-90-90 aspirational targets by Ghana, the need for an effective VL measurement of ART patients becomes not only relevant for patient monitoring, but also a vital means of measuring the overall treatment interventional outcomes. The targets set out under this new global drive, which aims at eliminating AIDS by 2030 are: (a) 90% of people living with HIV should know their HIV status by 2020 (b) 90% of people who know their HIV status are to be on ART by 2020 and (c) 90% of people receiving ARV treatment to achieve viral suppression within 12 months of initiation of therapy by 2020.

These targets form part of the basis of the current drive towards immediate ART enrollment following HIV diagnosis and using VL as the primary means of monitoring clients on ART. This therefore imposes a greater responsibility on Ghana to significantly improve VL testing capacity, testing systems and uptake. Only 9,616 of the 89,113 PLHIV on ART by end of 2015, received VL testing within the year. In 2016, a total of 20,497 new clients were initiated on ART, bringing the total cumulative number of clients on ART to 100,665. During the period of 2016, however, only 17,044 (16.9%) VL tests were conducted on both old and newly initiated clients7 .

The estimated prevalence of HIV amongst the general population for 2016 was 1.6% with an estimated number of persons living with HIV being approximately 290,0008 . Based on the 2016 Spectrum Outputs of National HIV Prevalence and AIDS Estimates & Projections, the HIV population was projected to experience slight increase from 293,805 in 2016 to 316,994 in 2020, as per Table 3 below.

7 NACP Service Data, 20168 2016 National HIV Prevalence and AIDS Estimates & Projections Report


Table 3: Estimated and Projected PLHIV, ART Patients and VL Test Volumes

Estimated Number of PLHIV

90% who know HIV status

90% who know status to be on ART

VL testing for New Clients up to 1 year (2x48,285)

VL testing for Clients beyond 1 year on therapy

Total Number of VL tests per year

274,562

81,988

9,616

293,805

100,665

17,044

299,110

100,665+48,285=148,950

96,570

148,950

197,235

304,459

148,950+48,285=197,235

96,570

197,235

293,805

310,514

197,235+48,285=245,520

96,570

245,520

342,090

316,994

285,295

245,520+48,285=293,805

96,570

293,805

390,375

YEAR 2015 2016 2017 2018 2019 2020

Taking the 2016 National HIV Prevalence and AIDS Estimates & Projections and the 90-90-90 targets into consideration, there are anticipated to be 316,994 PLHIVs in 2020, of which 390,375 are expected to be on ART. Considering that the actual number of PLHIVs on ART at end of 2016 was 100,665, it is anticipated that there will be the need to enroll and retain 193,140 new clients on ART in Ghana, as well as the need to improve on the numbers of lost to follow-ups and deaths between 2017 and end of 2020. This will require enrolling an annual average of 48,285 new clients on ART over the next four years, as well as putting measures in place to minimize loss-to-follow up and death. As per Ghana’s National ART Guidelines, each newly enrolled client will require two VL tests within the first year of initiation at 6 months intervals; the first test being done 6 months after initiation. With the estimated new ART enrollment of 48, 285, it is expected that an average of 96,570VL tests will be conducted each year only for


newly enrolled ART clients. Clients who have also been on treatment for more than 12 months will be required to have at least one VL test done per year.

Based upon these projections, the annual volume of VL tests that will need to be performed 2017-2020 are 197,235 in 2017; 293,805 in 2018, 342,090 in 2019 and 390,375 in 2020 (Table 3). This implies that a total of 1,223,505VL tests will need to be conducted between 2017 and 2020 to meet Ghana’s programmatic goals. Based upon these projections, the annual number of VL tests to be conducted for the next 4 years will increase significantly from current levels given that 80% of the total testing capacity of the current 9 Taqman 48 instruments is dedicated to VL testing and the remaining 20% taken up by EID testing, the testing capacity of Ghana’s current equipment will be significantly inadequate for this dramatic expansion of testing services.

Programme Needs to Meet 2020 VL Testing Programmatic Goals

The National VL testing goal is to attain 95% coverage ART patients by 2020. Forecasted needs to bridge existing programmatic gaps to meet this goal include:

1. VL Demand CreationTo meet the 2020 VL targets, demand creation for clinicians and other health care cadres such as Nurse Prescribers, primary counselors, community health care workers, expert patients and PLHIV. Demand creation activities such as orientation, stakeholder meetings, trainings and refresher courses will be provided.

2. Test EquipmentThe annual testing capacity of Roche testing platforms is illustrated in Table 4. To meet the 2020 VL programme goals of 95% coverage of ART patients, the country-wide system will require an annual capacity of 390,375 VL tests. It is planned that this testing will be performed using twelve (12) Roche PCR platforms (4

Taqman 48 and 8 Taqman 96 Platforms) distributed across 12 test sites in 10 regions (Table 5) providing a total testing capacity of 258,048 VL samples /year (32,256 + 225,792 as per Table 4). Three of these centers namely; Korle Bu Teaching hospital, Komfo Anokye Teaching hospital and the Sunyani Regional hospital laboratories covering the southern, middle and the northern belts respectively of the country will be equipped to serve as centres of excellence in viral load and DNA PCR (EID) testing and ultimately take up the entire testing needs of the country. If needed, additional capacity may be added using GeneXpert.


Table 4: Annual Test Capacity of Planned Roche COBAS Taqman 48 and 96 (147 test) Platforms

Table 5: Current and Planned Distribution of Roche Taqman VL Test Platforms

Tests/day/platform

Tests/week/platform (4 Days)

Tests/month/platform (4 weeks)

Test/year/platform (12 months)

Total test capacity of 4 Taqman 48 and 8 Taqman 96(147 test) platforms

Roche Cobas Taqman 48Roche Cobas

Taqman 96 (147 tests)

Tests (Test + Controls)

48

192

768

9216

36,864

Tests (Tests only)

42

168

672

8064

32,256

Tests (Tests only)

147

588

2352

28224

225,792

REGION

Greater Accra

Ashanti

Brong Ahafo

Eastern

Volta

Western

Upper East

Upper West

Northern

Central

Total

2017 (current)

1 Taqman 48

1 Taqman 48

1 Taqman 48

1 Taqman 48

1 Taqman 48

1 Taqman 48

1 Taqman 48

0

1 Taqman 48

1 Taqman 48

9 (Taqman 48)

2020

2 Taqman 96

2 Taqman 96

1 Taqman 96

1 Taqman 96

1 Taqman 96

1 Taqman 96

1 Taqman 48

1 Taqman 48

1 Taqman 48

1 Taqman 48

12 (8 Taqman 96; 4 Taqman 48)


3. Equipment Maintenance SystemIn order to meet 2020 annual VL testing targets, it will be essential that all nine test platforms are supported by a reliable maintenance programme. It is intended that the remaining 4 Taqman 48 platforms to be owned by Ghana Health Service in 2020 will be supported by a maintenance contract with the vendor. The new 9 Taqman 96 instruments, will be acquired through lease/placement agreements and will be supported by the vendor through the terms of the lease/placement agreements.

Equipment performance is affected by environmental conditions such as high humidity, temperature and dust. VL laboratories will be supported to ensure laboratory environmental conditions are maintained to ensure optimal performance.

4. Supply ChainCurrently laboratory supplies are distributed through a parallel system. Laboratory reagents stored at the central level are allocated and distributed to the Regional Medical Stores (RMSs) or directly to the testing facilities.

Due to inadequate cold chain storage facilities at some Regional Medical Stores (RMS), they are unable to store commodities and so to prevent damage of these commodities, they are sent directly to the testing sites using available means. Even though there is the availability of a logistics tool for collection of consumption data this is not utilized. As a result, there are challenges in the reporting

of consumption data from the testing sites to the region and then the central level.

By 2020, a supply chain and logistics operation will be required that is capable of providing supplies and reagents necessary for the performance of 390,375 VL tests annually (across 12 testing sites using Taqman platforms and 130 sites using the GeneXpert platforms) with minimal interruption of testing or disruption of turnaround times for specimens due to shortages and stock-outs.

5. Human ResourcesBy year 2020, 36 well trained and competent laboratory personnel (3 per test site) will be required to support the VL load testing targets for the country; this will be achieved by the hiring and training to competency of 18 additional lab VL testing staff, to support 12 test sites by 2018 (Table 6). To support these 36 testing personnel, a standardized training programme for re-assigned personnel and a continuing education/refresher training programme for existing personnel will be developed and implemented throughout the system.

6. Specimen Referral and Result Delivery System By 2020 a standard specimen and result delivery system must be in place for all 10 regions (including the 3 Teaching hospitals: Komfo Anokye Teaching Hospital, Korle-Bu Teaching Hospital and Cape Coast Teaching Hospital) in the country to


support the VL testing programme. This will require an initial and continuing on-going training in courier services.

Table 6: Projected Lab Testing Staff Needs per Region

Western Region

Greater Accra Region

Korle-Bu Teaching Hospital

Komfo Anokye Teaching Hospital

Ashanti Region

Northern Region

Brong Ahafo Region

Eastern Region

Cape Coast Teaching Hospital

Volta Region

Upper East Region

Upper West Region

TOTAL

2

0

2

2

0

2

2

2

2

2

2

0

18

1

3

1

1

3

1

1

1

1

1

1

3

18

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

3

3

3

3

3

3

3

3

3

3

3

36

VL Testing Site

Current VL Load testing

staff

Additional staff needed

2018 2019 2020

TOTAL VL Load Testing

Personnel (2020)

7. Information ManagementPCR test machines will need to be interfaced with the BLIS data management system. In addition, standardized paper forms are required to support the VL testing data management (test request forms, lab data sheets, VL register, and test report forms).

8. Monitoring and EvaluationEffective monitoring and evaluating tools are required to provide ongoing monitoring of targets and indicators used to measure progress and success of the scale-up plan as well as the performance of the 12 testing sites. Analyzed data are needed for identification of challenges and implementation of appropriate improvements.


Goal of Viral Load Scale-Up PlanThe goal of the VLSUP is to ensure that all HIV clients on ART have access to routine VL testing in line with programmatic guidelines and national Strategic Plans by 2020.

Objectives of the Scale up PlanThe objectives of this plan are to:

1. To ensure a coordinated VL testing scale-up in Ghana from the current 16.9% to 60% by the end of 2018 and universal access (>95% coverage) by 2020.

2. To support resource mobilization for VL Scale-up through highlighting the funding and systemic gaps that need to be closed in order to make this plan a success.

3. To ensure all laboratory staff assigned for VL testing are properly trained and deemed competent to perform their duties with respect to specimen handling, processing, testing, transporting, data management and reporting.

4. To select appropriate technology for VL and adequate and continuous supplies and reagents.

5. To develop and implement an effective M&E framework and plan.

b. GOAL, OBJECTIVES AND STRATEGIES OF VL SCALE-UP PLAN (VLSUP)


OverviewConsidering the current state of under-performance of VL testing in the country coupled with the need to scale up services to reach all clients accessing treatment at all ART sites across the country it is particularly critical that 1) strategies are put in place to address the current inherent weaknesses in the existing VL testing system, 2) to initiate new approaches to surmount challenges preventing the optimal utilization of existing VL machines and 3) to develop a scale-up plan to provide guidance and protocol for overall improvement in the universal provision and utilization of VL testing services across the country with a robust co-ordination and M&E framework.

A phased approach would be adopted for this scale up as outlined below:

Phase 1 (2017)• Finalize and approve the VLSUP.• Map out and implement an effective sample referral and results delivery system.• Develop Standard Operating Procedures (SOPs) and other guidelines for VL testing.• Build capacity of laboratory personnel on SOPs and guidelines.• Replace and/or add equipment for four (4) regions [GAR, AR, ER, WR].• Establish M&E system.• Initiate and sustain VL testing demand Creation.

Phase 2 (2018)• Build capacity for all care providers on all implementation strategies. • Improve on data management and M&E systems.• Replace equipment for three (3) regions [UER, BA, NR].• Establish Quality Management System (QMS) and VL accreditation.• Establish the concept of VL centres of excellence.

• Evaluate addition of GeneXpert platform for VL testing.• Start setting priorities and themes for operational research.

Phase 3 (2019)• Equipment replacement for two (2) regions [VR, CR].• Develop and implement a plan for using GeneXpert for VL testing. • Disseminate lessons and Carry out new operational research.• Continue capacity building of service providers to fill new gaps.

Phase 4 (2020)• Evaluate performance of systems.• Disseminate research findings and share best practices through well established country dialogue platforms.• Revise the VL Scale-up plan for the post 2020 period.


SPECIFIC OBJECTIVES AND STRATEGIES

Objective 1: Programme ManagementTo establish an effective programme management system that includes task teams at all levels to effectively oversee the implementation of the plan which will be linked to an overarching technical working group (TWG).

Strategies

• Strategy 1.1: Form VL Task Teams, which will comprise the Regional HIV coordinator, Regional Laboratory Focal Point, Medical laboratory scientist (MLS) at Testing Lab, and the Data Officer’s Representative. This team is to ensure logistics are in place and requests for the tests are made. It shall address immediate issues and perform monitoring of activities.

• Strategy 1.2: Establish a TWG: Programme Officer at NACP (preferably the National Laboratory Focal Person), 3 MLSs representing three (3) zones in the country [Northern, Middle, and South], Regional Coordinators Representative, Procurement and Supply Representative, and M&E Representative. The TWG will meet quarterly to review progress of implementation in the first year and bi-annually in subsequent years. The TWG will define roles and responsibilities of all caregivers through the capacity system to ensure a smooth scale up of VL testing.

Objective 2: Install EquipmentTo install twelve (12) functional and well-maintained Roche Taqman machines and, if needed, 130 GeneXpert machines will support the VL load testing programme targets by 2020.

Strategies

• Strategy 2.1: Acquire 4 new PCR machines to replace existing Taqman 48 platforms in a phased manner: In phase one (2017), four Taqman 96 (147 test) platforms will be acquired for the 4 priority regions (2 in Greater Accra and 2 in Ashanti regions) to replace the current units. The current two existing machines that are freed up will then be moved to the Upper West Region and Kumasi Public Health Laboratory in 2017, providing testing sites in all ten regions. In phase two (2018), four more Roche Taqman 96 platforms will be acquired to replace the older, smaller units in 4 regions.

• Strategy 2.2: Utilize maintenance contracts for the Taqman 48 platforms and lease agreements (that include maintenance) for Taqman 96 to ensure that the machines are well maintained and functioning optimally.

• Strategy 2.3: Train and assess competency of laboratory staff.


• Strategy 2.4: Develop SOPs for GeneXpert platforms to provide VL testing, as needed

• Strategy 2.5: Develop a decommission strategy for old, unusable platforms.

Objective 3: Supply Chain Management and LogisticsEnsure that sufficient supplies and reagents are available at all testing sites to permit the testing of 390,375 VL specimens in 2020, meeting established turnaround time (TAT) (14 days) for 90% of specimens.

Strategies

• Strategy 3.1: Establish a system to ensure regular supply of reagents to meet the testing needs of the country.

• Strategy 3.2: Build the capacity of personnel handling laboratory commodities in logistics management and information system.

• Strategy 3.3: Develop a system to support the in-country distribution of commodities from the central level to the regional medical stores and then to the testing sites.

• Strategy 3.4: Collaborate with the Food and Drugs Authority (FDA) to establish a system for post-market surveillance testing of commodities in order to assure the

quality of products being used.

Objective 4: Human Resources and TrainingTo have 36 VL testing staff employed at the 12 test sites by the end of 2020 and have a structured annual continuous training programme in place for all VL testing staff and all specimen courier staff.

Strategies

• Strategy 4.1: Develop standardized annual and continuous training programme for all VL testing staff

• Strategy 4.2: Reassign 18 new VL testing staff to be placed in testing sites as indicated in table 1.

• Strategy 4.3: Implement training of laboratory staff, assess and maintain staff competence.

• Strategy 4.4: Training of ART staff on sample collection, processing and transportation techniques.

Objective 5: Specimen Referral and Result TransmissionTo implement a specimen referral and results transmission system for VL testing that will support an increase in annual test volume from 17,044 specimens in 2016 to 390,375 specimens by 2020, meet specimen handling requirements and reduce specimen turnaround time to less than


or equal to 14 days by 2020.

Strategies

• Strategy 5.1: Conduct an assessment of all VL testing sites using the VL score card.

• Strategy 5.2: Develop Geographic Information System (GIS) maps and demarcate sample transportation routes of all 245 ART centers in Ghana.

• Strategy 5.3: Pilot two modes of sample referral and result submission transmission system for 6 months in WR and ER using two modes of transport: a courier system and local transportation system.

• Strategy 5.4: Use lessons learnt from pilot to review and modify the sample referral and results transmission system.

• Strategy 5.5: Scale up the sample referral and result submission system in a stepwise approach.

Objective 6: Quality Assurance ProgrammeTo establish an effective quality assurance system across all VL testing laboratories to assure the quality of patient test results.

Strategies

• Strategy 6.1: Perform baseline quality assessment

in all the VL testing labs.

• Strategy 6.2: Implement and monitor Internal Quality Control (IQC) and External Quality Assessment Scheme (EQA).

• Strategy 6.3: All laboratories to monitor quality indicators.

• Strategy 6.4: Train all staff at all laboratories in QMS.

Objective 7: Laboratory Information ManagementTo establish a robust, standardized and fully operational laboratory information system for VL testing services in all VL testing laboratories to feed information into DHIMS and E-tracker systems by December, 2020.

Strategies

• Strategy 7.1: Incorporate Viral Load Management System (VLMS) into BLIS.

• Strategy 7.2: Interface all PCR VL test instruments with BLIS, DHIMS-2 and e tracker.

• Strategy 7.3: Develop standardized paper-based forms and registers (lab request forms, VL sample referral register, lab register, test report form).


Objective 8: Monitoring and EvaluationTo provide an effective M&E framework and tools to evaluate the success of implementation of the VL scale-up plan through quarterly reporting.

Strategies

• Strategy 8.1: Develop programme indicators and tools to monitor and access implementation targets set in the scale up plan.

• Strategy 8.2: Monitor indicators of VL testing monthly.

• Collate and analyze data and write quarterly reports.• Report shared with MOH/GHS and stakeholders/partners.• Review reports at bi-annual meetings.• Develop and implement improvement strategies as appropriate.• Strengthening BLIS to include all laboratory associated indicators.• Train testers on monitoring indicators and taking corrective actions.• M&E focal persons trained to produce monthly summary reports.• Monthly review and follow-up of summary reports.

Evaluation• Annual/multiple year evaluation.• Data Quality Analysis.• Cohort Analysis.• Quality of Service Assessment.

Programme-based indicators• Number of HIV patients (patients on ART).• Proportion of VL test done on newly diagnosed / long term ART clients.• Number of facilities doing VL testing for clients on ART.• Number of clients with viral suppression at 6 months after ART initiation.• Number of clients with viral suppression at 12 months after ART initiation.• Total Number virally suppressed.

Lab-based indicators• Number of VL test conducted per month per site.• Number of results returned to requesting facilities.• Turn-Around-Time from sample collection to receipt of results.• Number of rejected samples.• Number of days of equipment breakdown.• Number of preventive maintenance sessions conducted.• Number of days QC failed.• Proficiency Testing: acceptable or not acceptable.• Number of days of stock-outs of VL testing commodities.


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men

t ag

ent G

F

Pro

cure

men

t ag

ent,

NA

CP

,

NA

CP

, MO

H

Dec

om

mis

sio

n

pla

n a

nd

SO

P

dev

elo

ped

4 p

latf

orm

s id

entifi

ed fo

r d

eco

mm

issi

on

4 p

latf

orm

s d

e-co

mm

issi

on

ed

Nu

mb

er o

f si

tes

with

S

OP

s

Nu

mb

er o

f p

latf

orm

s id

entifi

ed

Nu

mb

er o

f p

latf

orm

s d

eco

mm

is-

sio

ned

NA

CP

L

abo

rato

ry

foca

l per

son

x

x

x x xx

x

20

17

20

18

20

19

20

20

2.5

2.5

.1

2.5

.2

2.5

.3

3.1

3.1

.1

3.1

.2

3.1

.3

AC

TIV

ITY

OU

TP

UT

/P

RO

DU

CT

IND

ICA

TO

R/

VE

RIF

ICA

TIO

NR

ES

PO

NS

IBL

EP

AR

TN

ER

S

COST

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4


Str

ate

gy

3.2

Co

nd

uc

t tra

inin

g in

20

17

for

all

lab

ora

tory

pe

rso

nn

el i

n lo

gis

tic

s m

an

ag

em

en

t

Str

ate

gy

3.3

: Su

pp

ort

10

Re

gio

na

l Me

dic

al S

tore

s (R

MS

) to

dis

trib

ute

c

om

mo

dit

ies

to te

stin

g s

ite

s

Ord

ers

are

del

iver

ed o

n a

q

uar

terl

y b

asis

to

the

Cen

tral

w

areh

ou

se

Dev

elo

p

con

sum

ptio

n

form

s to

be

com

ple

ted

by

test

ing

site

s b

i-mo

nth

ly a

nd

b

i-mo

nth

ly re

po

rts

com

pile

d

Wri

te a

nn

ual

co

nsu

mp

tion

re

po

rt

To tr

ain

36

la

bo

rato

ry

per

son

nel

(3

per

son

s p

er s

ite)

Dev

elo

p a

nd

su

bm

it d

istr

ibu

tion

p

lan

for r

eag

ents

fr

om

the

RM

S to

te

stin

g s

ites

ord

ers

rece

ived

at

the

war

e-h

ou

ses

Bi-m

on

thly

re

po

rts

fro

m

test

ing

site

s an

d c

om

pile

d

rep

ort

co

m-

ple

ted

Rep

ort

wri

tten

36

trai

ned

lab

ora

-to

ry p

erso

nn

el

Dis

trib

utio

n p

lan

ap

pro

ved

Nu

mb

er

of o

rder

s re

ceiv

ed

Nu

mb

er

of s

ites

pro

vid

ing

m

on

thly

co

nsu

mp

tion

d

ata

rep

ort

s

Rep

ort

av

aila

ble

Nu

mb

er o

f la

bo

rato

ry

per

son

nel

tr

ain

ed p

er

site

Dis

trib

utio

n

pla

n

imp

lem

ente

d

by

RM

S.

Site

s re

ceiv

e re

qu

este

d

sup

plie

s

PS

M fo

cal

per

son

, N

AC

P

Lab

ora

tory

fo

cal p

erso

n,

NA

CP

PS

M fo

cal

per

son

, N

AC

P

Lab

foca

l p

erso

n,

NA

CP

RM

S

man

ager

sN

AC

P-

coo

rdin

atio

n

MO

H

GF

JS

I D

eliv

er,

US

AID

G

HS

C P

SM

xx

x

xx

xx

x

x x x

x x x

x x x

xx x x

x x x

x x x

x x x

x x xx

x x x

x x x

x x x

x x xx

20

17

20

17

20

18

20

18

20

19

20

19

20

20

20

20

3.1

.4

3.1

.5

3.1

.6

3.2

3.2

.1

3.3

3.3

.1

20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4


Str

ate

gy

3.4

: Un

de

rta

ke

po

st m

ark

et s

urv

eil

lan

ce

test

ing

of c

om

mo

dit

ies

to

ass

ure

qu

ali

ty o

f pro

du

cts

Pro

vid

e fin

anci

al

sup

po

rt to

th

e 1

0 R

MS

to

ensu

re o

ng

oin

g

dis

trib

utio

n o

f su

pp

lies

Del

iver

co

mm

od

ities

fro

m

the

10

RM

S to

12

te

stin

g s

ites

ever

y 2

mo

nth

s

Dev

elo

p

Po

st M

arke

t S

urv

eilla

nce

Pla

n

and

SO

Ps

for V

L

reag

ents

Trai

n s

taff

on

SO

Ps

Po

st M

arke

t S

urv

eilla

nce

p

roce

du

res

imp

lem

ente

d a

s p

er p

lan

Wri

te a

nn

ual

re

po

rt

Fin

anci

al s

up

-p

ort

pro

vid

ed

Co

mm

od

ities

d

eliv

ered

to te

st-

ing

site

s ev

ery

2

mo

nth

s

Pla

n a

nd

SO

Ps

dev

elo

ped

Sta

ff tr

ain

ed

Pla

n im

ple

men

t-ed A

nn

ual

rep

ort

av

aila

ble

an

d

revi

ewed

Nu

mb

er

of R

MS

re

ceiv

ing

fin

anci

al

sup

po

rt

Nu

mb

er o

f si

tes

rece

ivin

g

com

mo

diti

es

as p

er s

ite

req

ues

ts

Pla

n im

ple

-m

ente

d

Nu

mb

er o

f st

aff t

rain

ed

On

go

ing

im-

ple

men

tatio

n

and

reco

rd

keep

ing

An

nu

al re

po

rt

avai

lab

le

PS

M fo

cal

per

son

, NA

CP

PS

M fo

cal

per

son

, NA

CP

PS

M fo

cal

per

son

, NA

CP

PS

M fo

cal

per

son

, NA

CP

Acc

ou

nts

u

nit

hea

d,

NA

CP

10

RM

S

man

ager

sR

MS

- sen

d

com

mo

di-

ties

to S

DP

s

xx

x x x

xx x

x

x x x

x x x

x x x

x x x x

x x x

x x x

x x x

x x x x

x x x

x x x

x x x

x x x x

20

17

20

18

20

19

20

20

3.3

.2

3.3

.3

3.4

3.4

.1

3.4

.2

3.4

.3

3.4

.4

20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4


OB

JE

CT

IVE

4: T

rain

36

VL

lab

sta

ff, d

ev

elo

p a

nd

imp

lem

en

t a s

tru

ctu

red

c

on

tin

uo

us

tra

inin

g p

rog

ram

for

VL

sc

ale

up

by

20

20

Str

ate

gy

4.1

: De

ve

lop

an

an

nu

al c

on

tin

uo

us

tra

inin

g p

rog

ram

for

all

vir

al l

oa

d

test

ing

sit

es

20

17

20

18

20

19

20

20

AC

TIV

ITY

OU

TP

UT

/P

RO

DU

CT

IND

ICA

TO

R/

VE

RIF

ICA

TIO

NR

ES

PO

NS

IBL

EP

AR

TN

ER

S

COST

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Str

ate

gy

4.2

: Re

cru

itm

en

t of L

ab

Sta

ff

Rev

iew

an

d re

vise

tr

ain

ing

mat

eria

ls.

Trai

n 3

6 la

b

staf

f (1

8 n

ewly

as

sig

ned

an

d 1

8

refr

esh

er s

taff

) u

sin

g th

e ap

pro

ved

cu

rric

ulu

m

Dev

elo

p jo

b

des

crip

tion

for V

L

test

er

Req

ues

t fo

r ap

pro

val f

or

add

itio

nal

18

lab

st

aff V

L te

stin

g s

ites

Iden

tify

and

ass

ign

1

8 la

b s

taff

18

req

ues

t gra

nte

d

for l

ab s

taff

to b

e re

-des

ign

ated

18

lab

sta

ff

assi

gn

ed

nu

mb

er

of s

taff

d

esig

nat

ed

nu

mb

er o

f st

aff i

n p

ost

Ro

wla

nd

A

du

kpo

VL

site

s la

b

Hea

ds

GH

S/M

OH

/T

Hs/

NA

CP

ho

spita

l M

anag

e-m

ent/

Hea

ds

of L

abs

NA

A T

rain

ing

cu

rric

-u

lum

dev

elo

ped

36

sta

ff tr

ain

ed

Job

des

crip

tion

d

evel

op

ed

Cu

rric

ulu

m

avai

lab

le

Nu

mb

er s

taff

tr

ain

ed

Nu

mb

er o

f V

L te

ster

s w

ith jo

b

des

crip

tion

s

Ro

che/

NA

CP

NA

CP

Lab

F

oca

l per

son

NA

CP

Lab

F

oca

l per

son

NA

CP

/R

och

e

NA

CP

/R

och

e

ho

spita

l M

anag

e-m

ent/

Hea

ds

of L

abs

x

x

x

x

20

17

20

18

20

19

20

20

4.1

4.1

.1

4.1

.2

4.1

.3

4.2

4.2

.1

4.2

.2


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Str

ate

gy

4.3

: To

tra

in la

bo

rato

ry s

taff

, ass

ess

an

d m

ain

tain

co

mp

ete

nc

e

Trai

n 3

lab

sta

ffs

fro

m e

ach

of t

he

12

site

s o

n V

L

test

ing

Trai

n 3

lab

st

affs

fro

m e

ach

o

f th

e 1

2 s

ites

on

eq

uip

men

t m

ain

ten

ance

Trai

n 3

lab

st

affs

fro

m e

ach

o

f th

e 1

2 s

ites

on

log

istic

s m

anag

emen

t

Trai

n 3

lab

sta

ff o

n

spec

imen

refe

rral

Trai

n 3

lab

sta

ff o

n

use

of B

LIS

Trai

n 3

sta

ff fr

om

ea

ch s

ite o

n Q

MS

36

Tra

ined

lab

st

aff a

t 12

site

s

36

Tra

ined

lab

st

aff a

t 12

site

s

36

Tra

ined

lab

st

aff a

t 12

site

s

36

Tra

ined

lab

st

aff a

t 12

site

s

36

Tra

ined

lab

st

aff a

t 12

site

s

37

Tra

ined

lab

st

aff a

t 12

site

s

Nu

mb

er s

taff

tr

ain

ed

Nu

mb

er s

taff

tr

ain

ed

Nu

mb

er s

taff

tr

ain

ed

Nu

mb

er o

f st

aff t

rain

ed

Nu

mb

er o

f st

aff t

rain

ed

Nu

mb

er o

f st

aff t

rain

ed

Lab

foca

l p

erso

n

Lab

foca

l p

erso

n

Lab

foca

l p

erso

n

Lab

foca

l p

erso

n

Lab

foca

l p

erso

n

Lab

foca

l p

erso

n

CD

C, N

AC

P

GF

, Ro

che

CD

C, N

AC

P

GF

, Ro

che

CD

C, N

AC

P

GF

, Ro

che

CD

C; N

AC

P

CD

C; N

AC

P

CD

C, N

AC

P

GF

x

x x

x

x

x

4.3

4.3

.1

4.3

.2

4.3

.3

4.3

.4

4.3

.5

4.3

.6


OB

JE

CT

IVE

5: I

mp

lem

en

t a s

am

ple

Re

ferr

al a

nd

re

sult

s tr

an

smis

sio

n s

yst

em

Str

ate

gy

5.1

: Co

nd

uc

t ba

seli

ne

ass

ess

me

nt f

or

9 V

L T

est

ing

La

bs

20

17

20

18

20

19

20

20

AC

TIV

ITY

OU

TP

UT

/P

RO

DU

CT

IND

ICA

TO

RR

ES

PO

NS

IBL

EP

AR

TN

ER

S

COST

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Str

ate

gy

5.2

: Co

nd

uc

t GIS

Ma

pp

ing

for

all

24

5 A

RT

sit

es

Sel

ect 6

ass

esso

rs

and

co

nd

uct

a 3

d

ays

trai

nin

g o

n th

e u

se o

f th

e ex

istin

g

asse

ssm

ent t

oo

l

No

tify

12

site

s an

d

con

du

ct b

asel

ine

asse

ssm

ent a

t all

site

s. 2

day

s p

er

site

.

Dev

elo

p fi

nal

as

sess

men

t rep

ort

Sel

ectio

n o

f a 1

0

mem

ber

co

re te

am

for G

IS m

app

ing

. T

hes

e te

am w

ou

ld

be

sup

po

rted

by

Dat

a O

ffice

rs a

cro

ss

all 2

45

AR

T s

ites

GIS

map

pin

g c

ore

te

am s

elec

ted

Nu

mb

er

of p

eop

le

sele

cted

Lab

Fo

cal

Per

son

sN

AC

P, C

DC

, C

HIM

6 a

sses

sors

tr

ain

ed o

n u

se

of t

oo

l

Co

mp

lete

d

asse

ssm

ent

for

each

site

Fin

al a

sses

s-m

ent R

epo

rt

Nu

mb

er o

f as

sess

ors

tr

ain

ed

Nu

mb

er o

f si

te a

sses

s-m

ent r

epo

rts

Dis

sem

ina-

tion

of R

epo

rt

Lab

Fo

cal

Per

son

s

Ass

esso

rs,

Lab

Fo

cal

Per

son

s

Ass

esso

rs,

Lab

Fo

cal

Per

son

s

NA

CP

, CD

C

NA

CP

, CD

C

NA

CP

, CD

C

xx x x 20

17

20

18

20

19

20

20

5.1

5.1

.1

5.1

.2

5.1

.3

5.2

5.2

.1

20,000


Str

ate

gy

5.3

: Pil

ot t

wo

me

tho

ds

of s

am

ple

tra

nsp

ort

ati

on

an

d r

esu

lt s

ub

mis

sio

n

at E

R a

nd

WR

3 D

ay tr

ain

ing

an

d d

evel

op

men

t o

f act

ivity

, w

ork

shee

ts a

nd

tr

avel

pla

n

GIS

Map

pin

g a

t 2

45

AR

T s

ites

Dev

elo

p

dat

abas

e w

ith G

IS

coo

rdin

ates

for a

ll 2

45

AR

T s

ites

and

d

evel

op

map

s

Dev

elo

p fi

nal

ac

tivity

rep

ort

Dev

elo

p tr

ain

ing

m

ater

ials

(fo

r co

uri

ers,

dri

vers

, la

b s

taff

, nu

rses

, et

c.),

SO

Ps

and

sa

mp

le tr

ansp

ort

fo

rms.

MO

U b

etw

een

M

oH

/GH

S/N

AC

P,

EM

S a

nd

Lo

cal

tran

spo

rt U

nio

ns

(GP

RT

U, P

RO

TIA

, V

IP, S

TC

)

Trai

nin

g m

ater

ials

, S

OP

s an

d fo

rms

dev

elo

ped

Sig

ned

MO

U

Nu

mb

er

of t

rain

ing

m

ater

ials

, S

OP

s an

d

form

s d

evel

op

ed

and

pri

nte

d

Mo

U

imp

lem

ente

d

Lab

Fo

cal

Per

son

s

PM

NA

CP

, AP

HL

, C

DC

NA

CP

, CD

C,

Mo

H, L

oca

l Tr

ansp

ort

U

nio

ns,

EM

S

GIS

map

pin

g

team

trai

ned

an

d w

ork

shee

ts/

trav

el p

lan

s d

evel

op

ed

Co

mp

lete

d

wo

rksh

eets

Dat

abas

e an

d

map

s co

mp

lete

d

Fin

al re

po

rt

com

ple

ted

F

un

din

g id

en-

tified

Nu

mb

er

mee

ting

s co

mp

lete

d;

wo

rksh

eets

co

mp

lete

d

% c

om

ple

ted

w

ork

shee

ts

% o

f site

s w

ith

coo

rdin

ates

an

d m

app

ed

Fin

al re

po

rt

revi

ewed

an

d

fun

din

g fo

r p

ilot s

ecu

red

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

NA

CP

, CD

C,

CH

IM, D

ata

Offi

cers

NA

CP

, CD

C,

CH

IM, D

ata

Offi

cers

NA

CP

, CD

C,

CH

IM

NA

CP

, CD

C,

CH

IM, G

F,

UN

AID

S

xx

x

x x x

x20

17

20

18

20

19

20

20

5.2

.2

5.2

.3

5.3

.4

5.3

.5

5.3

5.3

.1

5.3

.2

20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Pro

cure

men

t of

com

mo

diti

es fo

r sa

mp

le tr

ansp

ort

sy

stem

. 49

0 c

old

b

oxe

s, 2

,45

0,0

00

zip

lo

ck b

ags,

50

low

sp

eed

cen

trifu

ges

, 2

0 fr

eeze

rs, 1

00

S

MS

pri

nte

rs

Sen

sitiz

atio

n

mee

ting

for a

ll st

akeh

old

ers

at E

R

and

WR

Trai

n 2

0 tr

ansp

ort

u

nio

n a

nd

co

uri

er

staf

f on

sam

ple

tr

ansp

ort

atio

n,

safe

ty,

do

cum

enta

tion

an

d

sto

rin

g o

f tra

ckin

g

form

s (1

0 s

taff

per

re

gio

n)

Trai

n 1

92

AR

T

site

sta

ff o

n

sam

ple

co

llect

ion

, p

roce

ssin

g,

sto

rag

e an

d

pac

kag

ing

, sam

ple

re

ceip

t, sa

fety

, d

ocu

men

tatio

n a

nd

p

roce

ssin

g (6

4 A

RT

si

tes

in E

R a

nd

WR

x

3 s

taff

)

Lo

gis

tics

pro

cure

d a

nd

d

istr

ibu

ted

Sen

sitiz

atio

n

mee

ting

co

n-

du

cted

1 w

eek

trai

nin

g

com

ple

ted

for

dri

vers

an

d

cou

rier

sta

ff

1 w

eeks

(2

trai

nin

gs

x 1

w

eek)

trai

nin

g

com

ple

ted

for

staf

f of A

RT

site

s at

ER

an

d W

R

Nu

mb

er

pro

cure

d a

nd

d

istr

ibu

ted

: co

ld b

oxe

s,

zip

lock

bag

s,

cen

trifu

ges

, F

reez

ers

pro

cure

d a

nd

d

istr

ibu

ted

Sen

sitiz

atio

n

mee

ting

co

mp

lete

d a

nd

re

po

rt a

vaila

ble

Nu

mb

er s

taff

tr

ain

ed; n

um

ber

o

f tra

nsp

ort

u

nio

ns

with

tr

ain

ed s

taff

Nu

mb

er

staf

f tra

ined

;

Nu

mb

er o

f site

s w

ith tr

ain

ed

staf

f

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

CD

C, A

PH

L,

NA

CP

GH

S, N

AC

P,

CD

C

NA

CP

, GP

R-

TU

, PR

OT

IA,

CD

C, A

PH

L

NA

CP

, CD

C,

AP

HL

x xx x

5.3

.3

5.3

.4

5.3

.5

5.3

.6


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Str

ate

gy

5.4

: Co

mm

en

ce

the

pil

ot p

ha

se o

f th

e s

am

ple

re

ferr

al s

yst

em

for

6 m

on

ths

Use

co

uri

er (E

MS

) an

d lo

cal t

ran

spo

rt

un

ion

s fo

r sam

ple

tr

ansp

ort

atio

n a

nd

re

sult

s d

eliv

ery

at th

e W

R (3

1 s

ites)

. EM

S

is w

ell e

stab

lish

ed

cou

rier

sys

tem

in

Gh

ana.

Th

ey h

ave

thei

r ow

n fl

eet o

f ca

rs a

nd

mo

tor b

ikes

th

at tr

ansp

ort

lett

ers,

et

c. fr

om

all

ove

r th

e co

un

try.

Ele

ctro

nic

tr

ansm

issi

on

of

resu

lts:

Em

ail r

esu

lts

del

iver

y fo

r 20

site

s (1

0 s

ites

in e

ach

re

gio

n) a

nd

SM

S

resu

lts

del

iver

y u

sin

g

SM

S p

rin

ters

for 2

0

site

s (1

0 s

ites

per

re

gio

n).

Har

d c

op

y re

po

rts

del

iver

ed

Pilo

t ph

ase

com

ple

ted

aft

er

6 m

on

ths

Ele

ctro

nic

co

nfig

ura

tion

s co

mp

lete

d; S

MS

p

rin

ters

inst

alle

d

Nu

mb

er o

f sa

mp

les

tran

spo

rted

fr

om

AR

T s

ites

to te

stin

g

cen

tres

; AR

T

site

s se

nd

ing

sa

mp

les;

re

po

rts

retu

rned

to

AR

T s

ites;

sa

mp

le T

AT

; m

issi

ng

sa

mp

les;

m

issi

ng

resu

lts

Nu

mb

er o

f re

sult

s se

nt

via

emai

ls;

re

sult

s se

nt

via

SM

S;

har

d c

op

ies

of r

esu

lts

rece

ived

;

re

sult

s m

issi

ng

/no

t re

ceiv

ed

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s, L

IS

Team

NA

CP

, CD

C

NA

CP

, CD

C,

CH

IM

xx

5.4

5.4

.1

5.4

.2


Str

ate

gy

5.5

: Na

tio

na

l Sc

ale

up

of s

am

ple

re

ferr

al s

yst

em

to 4

ad

dit

ion

al r

eg

ion

s (A

R, G

AR

, BA

, NR

)

Mo

nito

r th

e sa

mp

le re

ferr

al

syst

em p

ilot (

2

offi

cers

)

Dat

a en

try,

an

alys

is a

nd

wri

te

final

pilo

t rep

ort

Fin

al re

po

rt

dis

sem

inat

ion

(50

p

artic

ipan

ts)

Dis

trib

ute

su

pp

lies

to A

RT

site

s in

AR

, G

AR

, BA

, an

d N

R.

A to

tal o

f 15

0 s

ites.

D

istr

ibu

tion

will

be

do

ne

bas

ed o

n th

e n

um

ber

of s

ites

per

eac

h re

gio

n

and

co

mm

od

ities

n

eed

1 d

ay s

ensi

tizat

ion

m

eetin

g fo

r all

stak

eho

lder

s in

4

reg

ion

s

3 m

on

itori

ng

vi

sits

co

mp

lete

d

for e

ach

reg

ion

Fin

al re

po

rt

dra

fted

Dis

sem

inat

ion

m

eetin

g o

rga-

niz

ed

Su

pp

lies

dis

trib

-u

ted

Sen

sitiz

atio

n

mee

ting

org

a-n

ized

Nu

mb

er o

f ev

alu

atio

n

visi

ts,

eval

uat

ion

vi

sit r

epo

rts

Co

mp

lete

d

final

rep

ort

Fin

al re

po

rt

dis

sem

inat

ed

Dec

isio

n

take

n o

n

wh

ich

m

eth

od

(s) t

o

scal

e u

p

Nu

mb

er o

f co

ld b

oxe

s,

zip

lock

bag

s,

cen

trifu

ges

, F

reez

ers

pro

cure

d a

nd

d

istr

ibu

ted

p

er s

ite

Sen

sitiz

atio

n

mee

ting

co

mp

lete

d

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

NA

CP

, CD

C

CD

C, N

AC

P

CD

C, N

AC

P,

GF

, UN

AID

S,

WH

O

CD

C, A

PH

L,

NA

CP

GH

S, N

AC

P,

CD

C

xx

x

x x x

20

17

20

18

20

19

20

20

5.4

.3

5.4

.4

5.4

.5

5.5

5.5

.1

5.5

.2

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Trai

n (r

etra

in) 4

0

tran

spo

rt u

nio

n

and

co

uri

er

staf

f on

sam

ple

tr

ansp

ort

atio

n,

safe

ty,

do

cum

enta

tion

an

d

sto

rin

g o

f tra

ckin

g

form

s (1

0 s

taff

per

re

gio

n)

Trai

n (r

etra

inin

g)

45

0 A

RT

site

sta

ff o

n

sam

ple

co

llect

ion

, p

roce

ssin

g, s

tora

ge

and

pac

kag

ing

(3

staf

f x 1

50

site

s)

Trai

n (r

etra

in) 1

6 V

L

test

ing

site

sta

ff o

n

sam

ple

rece

ptio

n,

un

pac

kin

g, s

afet

y,

do

cum

enta

tion

an

d

sam

ple

pro

cess

ing

(4

sta

ff x

4 s

ites)

Co

mm

ence

sam

ple

re

ferr

al s

cale

up

in

the

4 re

gio

ns

usi

ng

se

lect

ed m

eth

od

(s)

4 x

1 w

eek

trai

n-

ing

co

mp

lete

d

for d

rive

rs a

nd

co

uri

er s

taff

4 x

1 w

eek

trai

n-

ing

co

mp

lete

d

for s

taff

of A

RT

si

tes

at E

R a

nd

W

R

4 x

1 w

eek

trai

n-

ing

for s

taff

at

VL

test

ing

site

s co

mp

lete

d

Sca

le u

p c

om

-m

ence

Nu

mb

er o

f sta

ff

trai

ned

Nu

mb

er o

f sta

ff

trai

ned

Nu

mb

er o

f sta

ff

trai

ned

Nu

mb

er o

f sa

mp

les

tran

spo

rted

fr

om

AR

T s

ites

to te

stin

g

cen

tres

; AR

T

site

s se

nd

ing

sa

mp

les;

rep

ort

s re

turn

ed to

AR

T

site

s; S

amp

le

TAT

; mis

sin

g

sam

ple

s;

mis

sin

g re

sult

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

NA

CP

, GP

R-

TU

, PR

OT

IA,

CD

C, A

PH

L

NA

CP

, CD

C,

AP

HL

NA

CP

, A

PH

L, C

DC

NA

CP

, CD

C

x

xx

x

xx x

5.5

.3

5.5

.4

5.5

.5

5.5

.6


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Ele

ctro

nic

resu

lts

del

iver

y. E

mai

l re

sult

s d

eliv

ery

for

40

site

s (1

0 s

ites

in

each

reg

ion

) an

d

SM

S re

sult

s d

eliv

ery

usi

ng

SM

S p

rin

ters

fo

r 40

site

s (1

0 s

ites

per

reg

ion

). H

ard

co

pie

s o

f res

ult

s

Mo

nito

r th

e sa

mp

le

refe

rral

for t

he

4

reg

ion

s

Dat

a en

try,

an

alys

is

and

dev

elo

p o

f q

uar

terl

y re

po

rts

(per

M&

E p

lan

)

Rev

iew

of r

epo

rts

Dis

trib

ute

sam

ple

re

ferr

al s

up

plie

s to

AR

T s

ites

in C

R,

UE

R, U

WR

, VR

Ele

ctro

nic

co

nfig

ura

tion

s co

mp

lete

d S

MS

p

rin

ters

inst

alle

d

Th

ree

mo

n-

itori

ng

vis

its

com

ple

ted

for

each

reg

ion

Fin

al re

po

rt

wri

tten

Rev

iew

s co

m-

ple

ted

Ad

equ

ate

sup

-p

lies

dis

trib

ute

d

Nu

mb

er o

f re

sult

s se

nt v

ia

emai

ls. N

um

ber

o

f res

ult

s se

nt v

ia S

MS

. N

um

ber

of h

ard

co

py

rep

ort

s

Nu

mb

er o

f ev

alu

atio

n v

isits

, ev

alu

atio

n v

isit

rep

ort

s

Fin

al re

po

rt

avai

lab

le

Nu

mb

er o

f re

view

mee

ting

s

Nu

mb

er o

f co

ld b

oxe

s,

zip

lock

bag

s,

cen

trifu

ges

, F

reez

ers

pro

cure

d a

nd

d

istr

ibu

ted

Lab

Fo

cal

Per

son

s, L

IS

Team

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

NA

CP

, CD

C,

CH

IM

NA

CP

, CD

C

CD

C, N

AC

P

CD

C, N

AC

P,

TW

G, T

ask

Team

CD

C, A

PH

L,

NA

CP

xx x x x

x x x x xS

tra

teg

y 5

.5: N

ati

on

al S

ca

le u

p o

f sa

mp

le r

efe

rra

l sy

ste

m to

4 a

dd

itio

na

l re

gio

ns

(AR

, GA

R, B

A, N

R)

20

17

20

18

20

19

20

20

5.5

.7

5.5

.8

5.5

.9

5.5

.10

5.6

5.6

.1


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

1 d

ay s

ensi

tizat

ion

m

eetin

g fo

r all

stak

eho

lder

s in

4

reg

ion

s

Trai

n (r

etra

in)

40

tr

ansp

ort

un

ion

an

d c

ou

rier

st

aff o

n s

amp

le

tran

spo

rtat

ion

, sa

fety

, d

ocu

men

tatio

n a

nd

st

ori

ng

of t

rack

ing

fo

rms

(10

sta

ff/

reg

ion

)

Trai

n (r

etra

in) 3

60

A

RT

site

sta

ff o

n

sam

ple

co

llect

ion

, p

roce

ssin

g, s

tora

ge

and

pac

kag

ing

. (3

st

aff x

12

0 s

ites)

Trai

nin

g (r

etra

inin

g)

of 1

6 V

L te

stin

g

site

sta

ff o

n

sam

ple

rece

ptio

n,

un

pac

kin

g, s

afet

y,

do

cum

enta

tion

an

d

sam

ple

pro

cess

ing

(4

sta

ff x

4 s

ites)

Co

mm

ence

sam

ple

re

ferr

al s

cale

up

in

the

4 re

gio

ns

usi

ng

se

lect

ed m

eth

od

(s)

Sen

sitiz

atio

n

mee

ting

org

a-n

ized

4 x

1 w

eek

trai

n-

ing

co

mp

lete

d

for d

rive

rs a

nd

co

uri

er s

taff

4 x

1 w

eek

trai

n-

ing

co

mp

lete

d

for s

taff

of A

RT

si

tes

at E

R a

nd

W

R

4 x

1 w

eek

trai

n-

ing

for s

taff

at

VL

test

ing

site

s co

mp

lete

d

Sca

le u

p c

om

-m

ence

Sen

sitiz

atio

n m

eetin

g

com

ple

ted

Nu

mb

er o

f sta

ff tr

ain

ed

Nu

mb

er o

f sta

ff tr

ain

ed

Nu

mb

er o

f sta

ff tr

ain

ed

Nu

mb

er o

f sam

ple

s tr

ansp

ort

ed fr

om

AR

T s

ites

to te

stin

g c

entr

es; A

RT

si

tes

sen

din

g s

amp

les;

re

po

rts

retu

rned

to A

RT

si

tes;

sam

ple

TA

T; m

issi

ng

sa

mp

les;

mis

sin

g re

sult

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

GH

S,

NA

CP

, C

DC

NA

CP

, G

PR

TU

, P

RO

TIA

, C

DC

, A

PH

L

NA

CP

, C

DC

, A

PH

L

NA

CP

, A

PH

L,

CD

C

NA

CP

, C

DC

x x xx x x

5.6

.2

5.6

.3

5.6

.4

5.6

.5

5.6

.6


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Ele

ctro

nic

resu

lts

del

iver

y. E

mai

l re

sult

s d

eliv

ery

for

40

site

s (1

0 s

ites

in

each

reg

ion

) an

d

SM

S re

sult

s d

eliv

ery

usi

ng

SM

S p

rin

ters

fo

r 40

site

s (1

0 s

ites

per

reg

ion

). N

um

ber

o

f har

d c

op

y re

po

rts?

Mo

nito

r th

e sa

mp

le

refe

rral

for t

he

4

reg

ion

s

Dat

a en

try,

an

alys

is

and

dev

elo

p o

f q

uar

terl

y re

po

rts

(per

M&

E p

lan

)

Rev

iew

of r

epo

rts

Ele

ctro

nic

co

nfig

ura

tion

s co

mp

lete

d.

SM

S p

rin

ters

in

stal

led

Th

ree

mo

n-

itori

ng

vis

its

com

ple

ted

for

each

reg

ion

Fin

al re

po

rt

dra

fted

Rev

iew

s co

m-

ple

ted

Nu

mb

er o

f res

ult

s se

nt v

ia e

mai

ls

N

um

ber

of r

esu

lts

sen

t via

SM

S.N

um

ber

o

f har

d c

op

ies

of

resu

lts

Nu

mb

er o

f eva

luat

ion

vi

sits

, eva

luat

ion

vis

it re

po

rts

Co

mp

lete

d fi

nal

re

po

rt

Nu

mb

er o

f rev

iew

m

eetin

gs

Lab

Fo

cal

Per

son

s, L

IS

Team

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

Lab

Fo

cal

Per

son

s

NA

CP

, CD

C,

CH

IM

NA

CP

, CD

C

CD

C, N

AC

P

CD

C, N

AC

P,

TW

G, T

ask

Team

5.6

.7

5.6

.8

5.6

.9

5.6

.10

xx

x x x

x x

x


OB

JE

CT

IVE

6: Q

UA

LIT

Y A

SS

UR

AN

CE

: To

Est

ab

lish

an

eff

ec

tiv

e q

ua

lity

ass

ura

nc

e

pro

gra

m a

cro

ss a

ll V

L te

stin

g la

bo

rato

rie

s to

ass

ure

the

qu

ali

ty o

f pa

tie

nt t

est

re

sult

s

Str

ate

gy

6.1

: Pe

rfo

rm b

ase

lin

e q

ua

lity

ass

ess

me

nt i

n a

ll th

e

test

ing

lab

s2

01

72

01

82

01

92

02

0

AC

TIV

ITY

OU

TP

UT

/P

RO

DU

CT

IND

ICA

TO

R/

VE

RIF

ICA

TIO

NR

ES

PO

N-

SIB

LE

PA

RT

NE

RS

COST

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Ass

ign

ass

esso

rs

and

ass

ess

all

lab

s (2

team

s o

f 3

asse

sso

rs)

Dev

elo

p a

nd

d

isse

min

ate

QI S

OP

Co

mp

lete

d

asse

ssm

ent

for

each

site

SO

Ps

on

ag

reed

Qu

ality

In

dic

ato

rs d

e-ve

lop

ed

Nu

mb

er o

f SO

Ps

on

ag

reed

Qis

p

rin

ted

an

d d

is-

sem

inat

ed

Lab

F

oca

l p

erso

ns

NA

CP

, C

DC

Lab

foca

l p

erso

ns

Lab

foca

l p

erso

ns

Lab

foca

l p

erso

ns

Lab

ora

to-

ry S

up

er-

viso

rs

NA

CP

, C

DC

NA

CP

, C

DC

NA

CP

, C

DC

MO

H/

GH

S

Nu

mb

er o

f as

sess

men

t re

po

rts

Lab

foca

l p

erso

ns

NA

CP

, C

DC

x

x

xx xx

xx

xx

xx

x

Str

ate

gy

6.2

: Im

ple

me

nt a

nd

mo

nit

or

IQC

an

d E

QA

Str

ate

gy

6.3

: All

lab

ora

tori

es

to m

on

ito

r Q

ua

lity

Ind

ica

tors

6.1

6.1

.1

6.2

6.2

.1

6.2

.2

6.2

.3

6.2

.4

6.3

6.3

.1

20

17

20

18

20

19

20

20

20

17

20

18

20

19

20

20

Dev

elo

p S

OP

S o

n

IQC

an

d P

rofic

ien

cy

Test

ing

an

d

dis

sem

inat

e

En

rol a

ll la

bs

in P

T

and

follo

w u

p o

n

po

or p

erfo

rman

ce

Co

nd

uct

site

vis

its

twic

e p

er a

nn

um

. P

rovi

de

sup

po

rtiv

e si

te s

up

ervi

sio

n a

nd

w

rite

rep

ort

s

All

lab

ora

tori

es to

co

nd

uct

dai

ly IQ

C a

s p

er S

OP

Nu

mb

er o

f SO

Ps

dev

el-

op

ed a

nd

pri

nte

d

Nu

mb

er o

f lab

s w

ith

satis

fact

ory

sco

res

Nu

mb

er o

f lab

s vi

site

d in

a

year

with

rep

ort

s

Evi

den

ce o

f dai

ly re

view

o

f IQ

C c

har

ts a

nd

do

cu-

men

tatio

n o

f co

rrec

tive

actio

ns

per

form

ed if

re

qu

ired

SO

Ps

dev

elo

ped

All

lab

s en

rolle

d

with

an

d a

n

accr

edite

d P

T

pro

vid

er

Tw

o s

ites

visi

ts

con

du

cted

in

a ye

ar to

all

the

test

ing

lab

s

IQC

sch

eme

imp

lem

ente

d in

all

vira

l lo

ad te

stin

g

lab

ora

tori

es


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

OB

JE

CT

IVE

7: T

o e

sta

bli

sh a

ro

bu

st, s

tan

da

rdiz

ed

an

d fu

lly

op

era

tio

na

l la

bo

rato

ry

info

rma

tio

n s

yst

em

for

vir

al l

oa

d te

stin

g s

erv

ice

s in

12

lab

ora

tori

es

to fe

ed

in

form

ati

on

into

DH

IMS

an

d e

tra

ck

er

syst

em

s b

y D

ec

em

be

r, 2

02

0.

Str

ate

gy

7.1

: To

inte

rfa

ce

all

PC

R M

ac

hin

es

wit

h B

LIS

so

ftw

are

an

d D

HIM

S-2

20

17

20

18

20

19

20

20

AC

TIV

ITY

OU

TP

UT

/P

RO

DU

CT

IND

ICA

TO

R/

VE

RIF

ICA

TIO

NR

ES

PO

NS

IBL

EP

AR

TN

ER

S

COST

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Dev

elo

p a

nd

p

rovi

de

mo

nth

ly

rep

ort

form

s to

la

bo

rato

ries

All

lab

ora

tori

es to

co

mp

lete

mo

nth

ly

QI r

epo

rts

and

take

co

rrec

tive

actio

n

wh

ere

nec

essa

ry

Co

nd

uct

a tw

o

5-d

ay Q

MS

trai

nin

g

to a

cco

mm

od

ate

all

VL

test

ing

lab

sta

ff

Per

form

site

as

sess

men

t an

d s

up

po

rt fo

r re

adin

ess

Pro

cure

an

d in

stal

l 1

2 lo

ts o

f har

dw

are/

equ

ipm

ent a

nd

so

ftw

are

for B

LIS

im

ple

men

tatio

n

at e

ach

of t

he

12

te

stin

g s

ites

Mo

nth

ly re

po

rt

form

s d

evel

op

ed

Mo

nth

ly re

po

rt

form

s co

mp

lete

d

with

do

cum

enta

-tio

n o

f co

rrec

tive

actio

ns

take

n

Tw

o s

essi

on

s o

f Q

MS

trai

nin

g c

on

-d

uct

ed fo

r lab

ora

-to

ry s

cien

tists

in a

ll th

e te

stin

g la

bs,

12

Site

ass

esse

d

and

su

pp

ort

ed

for r

ead

ines

s

BL

IS h

ard

war

e an

d s

oft

war

e in

stal

led

in 1

2

site

s

Nu

mb

er o

f m

on

thly

rep

ort

fo

rms

dev

elo

ped

, p

rin

ted

an

d

dis

sem

inat

ed

Nu

mb

er o

f co

mp

lete

d

and

revi

ewed

m

on

thly

QI r

epo

rt

form

s in

eac

h s

ite

Trai

nin

g

rep

ort

su

bm

itted

12

Site

as

sess

ed

and

read

y fo

r BL

IS

dep

loym

ent

Nu

mb

er o

f si

tes

with

B

LIS

inst

alle

d

Lab

foca

l p

erso

ns

Lab

ora

tory

S

up

ervi

sors

Lab

foca

l p

erso

ns

BL

IS

tech

nic

al

team

Ber

nar

d/

Ro

wla

nd

/ P

hili

p

NA

CP

, CD

C

MO

H/G

HS

NA

CP

, CD

C

CD

C

x x

x

x

x

x

xS

tra

teg

y 6

.4: T

rain

all

sta

ff a

t all

lab

ora

tori

es

in Q

ua

lity

Ma

na

ge

me

nt S

yst

em

6.3

.2

6.3

.3

6.4

6.4

.1

7.1

7.1

.1

7.1

.2

20

17

20

18

20

19

20

20


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Un

der

take

a tw

o-

day

on

site

trai

nin

g

for 3

6 s

ite s

taff

of

the

12

(3 p

er s

ite)

VL

test

ing

site

s o

n

the

BL

IS/D

HIM

S

Inte

rfac

e

Co

nve

ne

a th

ree-

day

VL

-TW

G

mee

ting

to d

esig

n

and

dev

elo

p fo

rms,

re

gis

ters

an

d S

OP

s

Ori

enta

te a

nd

fin

aliz

e fo

rms/

reg

iste

rs b

y V

L-T

WG

fo

r 50

0 la

bo

rato

ry

and

AR

T s

ite s

taff

Fin

al e

diti

ng

, cl

ean

ing

, fo

rmat

ting

b

y T

WG

-VL

Pri

ntin

g o

f Fo

rms,

R

egis

ters

an

d

asso

ciat

ed J

ob

-Aid

s

Trai

nin

g c

on

-d

uct

ed fo

r36

st

aff o

f 12

VL

te

stin

g S

ite

3 F

orm

s, 4

reg

-is

ters

an

d th

eir

resp

ectiv

e jo

b-

aid

s d

esig

ned

an

d d

evel

op

ed

Ori

enta

tion

of

staf

f an

d in

pu

ts

for fi

nal

izat

ion

o

f do

cum

ents

d

on

e

Fo

rms,

R

egis

ters

an

d

asso

ciat

ed J

ob

-A

ids

read

y fo

r p

rin

ting

3 F

orm

s, 4

reg

-is

ters

an

d th

eir

resp

ectiv

e jo

b-

aid

s p

rin

ted

Nu

mb

er o

f site

s re

po

rtin

g in

BL

IS

afte

r th

e tr

ain

ing

Nu

mb

er o

f fo

rms

and

reg

iste

rs

dev

elo

ped

Nu

mb

er o

f sta

ff

giv

e o

rien

tatio

n

on

form

s/re

gis

ters

Nu

mb

er o

f fo

rms

and

reg

iste

rs a

nd

Jo

b-A

ids

read

y fo

r p

rin

ting

Nu

mb

ers

of e

ach

ca

teg

ory

of F

orm

s,

Reg

iste

rs a

nd

Jo

b-A

ids

pri

nte

d

Lab

Fo

cal

Po

int N

AC

P

Lab

Fo

cal

Po

int N

AC

P

Lab

Fo

cal

Po

int N

AC

P/

TW

G-V

L

GH

S/N

AC

P

Ph

ilip

/ P

PM

E

(CH

IM) S

taff

PP

ME

-CH

IM

CD

C (F

un

d-

ing

)

CD

C (F

un

d-

ing

)

CD

C/G

lob

al

Fu

nd

(Fu

nd

-in

g)

CD

C/G

lob

al

Fu

nd

(Fu

nd

-in

g)

xx

xx

xx

xx

xx

xx

xx

x

x xx

xx

xx

xx

xx

xx

xx

Str

ate

gy

7.2

: De

ve

lop

sta

nd

ard

ize

d p

ap

er

ba

sed

VL

form

s a

nd

re

gis

ters

(L

ab

re

qu

est

form

s, v

ira

l lo

ad

sa

mp

le r

efe

rra

l re

gis

ter,

La

b r

eg

iste

r, te

st r

ep

ort

form

)2

01

72

01

82

01

92

02

0

7.1

.3

7.2

7.2

.1

7.2

.2

7.2

.3

7.2

.4


OB

JE

CT

IVE

8: T

o p

rov

ide

an

eff

ec

tiv

e M

&E

fra

me

wo

rk a

nd

mo

nit

ori

ng

too

ls to

e

va

lua

te th

e s

uc

ce

ss o

f im

ple

me

nta

tio

n o

f th

is v

ira

l lo

ad

sc

ale

-up

pla

n a

nd

pro

vid

e

qu

art

erl

y r

ev

iew

re

po

rts

Str

ate

gy

8.1

: To

de

ve

lop

pro

gra

m in

dic

ato

rs to

mo

nit

or

sca

le u

p p

rog

ram

im

ple

me

nta

tio

n2

01

72

01

82

01

92

02

0

AC

TIV

ITY

OU

TP

UT

/P

RO

DU

CT

IND

ICA

TO

RR

ES

PO

NS

IBL

EP

AR

TN

ER

S

COST

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Co

nd

uct

a

mee

ting

with

se

rvic

e p

rovi

der

s an

d s

take

ho

lder

s/p

artn

ers

to fi

nal

ize

the

pro

gra

m

ind

icat

ors

(50

)

Inco

rpo

rate

p

rog

ram

an

d la

b

vira

l lo

ad s

cale

u

p in

dic

ato

rs in

to

DH

IMS

2

Up

dat

e th

e ex

istin

g n

atio

nal

H

IV M

&E

Pla

n to

in

clu

de

agre

ed

pro

gra

m a

nd

vir

al

load

ind

icat

ors

an

d ta

rget

s.

Co

nd

uct

qu

arte

rly

mee

ting

s to

revi

ew

pro

gre

ss o

f pla

n

imp

lem

enta

tion

an

d re

view

in

dic

ato

rs

Mee

ting

co

nd

uct

ed

and

vir

al lo

ad

pro

gra

m

ind

icat

or/

targ

et

do

cum

ents

fin

aliz

ed

DH

IMS

2 u

pd

at-

ed to

incl

ud

e p

rog

ram

an

d

vira

l lo

ad s

cale

u

p in

dic

ato

rs

Nat

ion

al H

IV

M&

E P

lan

u

pd

ated

to

incl

ud

e ag

reed

p

rog

ram

vir

al

load

ind

icat

ors

an

d ta

rget

s

Qu

arte

rly

rep

ort

s w

ritt

en

and

dis

cuss

ed

at q

uar

terl

y m

eetin

gs

nu

mb

er o

f p

rog

ram

an

d

vira

l lo

ad s

cale

u

p in

dic

ato

rs

iden

tified

to

mea

sure

set

ta

rget

s

nu

mb

er o

f p

rog

ram

an

d n

um

ber

in

dic

ato

rs in

D

HIM

S2

Up

dat

ed

nat

ion

al M

&E

p

lan

Nu

mb

er

rep

ort

s an

d

mee

ting

s h

eld

p

er y

ear

Lab

ora

tory

fo

cal

per

son

s

Lab

ora

tory

fo

cal

per

son

s

Lab

ora

tory

an

d M

&E

fo

cal

per

son

s

Lab

ora

tory

an

d M

&E

fo

cal

per

son

s

GH

S/N

AC

P,

CD

C, G

F, W

HO

, U

NA

IDS

- F

un

din

g

and

Tec

hn

ical

A

ssis

tan

ce

GH

S/N

AC

P,

CD

C, G

F, W

HO

, U

NA

IDS

- F

un

din

g

and

Tec

hn

ical

A

ssis

tan

ce

GH

S/N

AC

P,

CD

C, G

F, W

HO

, U

NA

IDS

- F

un

din

g

and

Tec

hn

ical

A

ssis

tan

ce

GH

S/N

AC

P,

CD

C, G

F, W

HO

, U

NA

IDS

- F

un

din

g

and

Tec

hn

ical

A

ssis

tan

ce

x

x

x

8.1

8.1

.1

8.1

.2

8.1

.3

8.1

.4

$6,000


20

17

COST

20

18

20

19

20

20

Q2

Q1

Q3

Q4

Q1

Q2

Q3

Q4

Q1

Q1

Q2

Q2

Q3

Q3

Q4

Q4

Test

ing

site

s to

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8.2

.3


1. National HIV Prevalence and AIDS Estimates & Projections Report. 2016.

2. 2016 Annual Report. NACP, GHS

3. Guideline for Antiretroviral Therapy in Ghana. 2016. NACP, GHS

4. WHO 2015. Consolidated Guideline for treatment of Persons Living with HIV

5. Ghana AIDS Commission, 2016. National HIV and AIDS Estimates and Projections Report

References


Viral Load (VL) to be taken:

• At month 6 after initiation on ART or after switch to 2nd Line• Then at month 12 on ART• Then yearly (i.e. Month 24, 36, 48 etc., on ART)

Any patient presenting with clinical or immunological failure should have a triggered viral load performed

VL< 1000 Copies/mlContinue current regimenRepeat VL at 12 months after initiation

VL≥ 1000 Copies/mlEvaluation for adherence concerns

1ST EAC session on day of results

2nd EAC session after 4 weeks(Continue, if more EAC sessions are needed)

Repeat VL 12 week after 1ST EAC (8 week after 2nd EAC) if EAC has been successful and adherence has improved

VL<1000 Copies/mlContinue currentregimen and yearly routine VL monitoring

Follow this algorithm from the top at each subsequent yearly viral load

VL≥1000 Copies/mlRefer to clinician experienced in swithing to 2nd line ART:Gather information on patient from both clinician and counselorsIf > 1000 but is a ≥0.5 log drop: repeat VL after 3 monthsIf > 1000 but drop is < 0.5 log and if no outstanding adherence challenges:consider switch to 2nd line ART, if more than 6 months on treatment.


Appendix II

Distribution of Gene Xpert Platforms


1 Kassena Nankana

2 Builsa North

3 Bawku Municipal

4 Garu-Tempani

1 Abura/Asebu/Kwamankese

2 Mfantsiman Municipal

3 Gomoa West

4 Efutu Municipal

5 Awutu Senya East

6 Agona West Municipal

7 Asikuma/Odoben/Brakwa

8 Assin North Municipal

9 Twifo-Ati Mokwa

10 Upper Denkyira East Municipal

1 Bibiani-Anhweaso-Bekwai

2 Aowin

3 Wassa-Amenfi West

4 Wassa-Amenfi East

5 Prestea Huni-Valley

6 Tarkwa Nsuaem Municipal

7 Axim Municipal

8 Ellembelle

9 Jomorro

10 Wiawso

11 Juabeso

1 Osu Klottey

2 La Nkwantanan

3 Accra Metro

4 Ga West Municipal

5 Tema Metro

6 Ga South Municipal

7 Dangbe East l

8 Dangbe West

9 Ashaiman Municipal

10 Ledzokoku –krowor

UPPER EAST

War Memorial Hospital

Sandema Hospital

Bawku Presby Hospital

Garu Health Center

CENTRAL REGION

Abura Dunkwa Dist Hospital

Saltpond Municipal Hospital

St. Luke Catholic Hospital

Winneba Municipal Hospital

Kasoa Polyclinic

Agona Swedru Municipal Hospital

Our Lady of Grace Hospital

St Francis Xavier Hospital Assin Foso

Twifo Praso Municipal Hospital

Dunkwa on Offin Municipal Hospital

WESTERN REGION

Bibiani Hospital

Enchi Hospital

Asankragua Hospital

Wassa Akropong Hospital

Prestea Hospital

Tarkwa Hospital

Axim Hospital

St Martins de Pores Hospital Eikwe

Half Assini Hospital

Sefwi Wiawso Hospital

Juabeso Hospital

GREATER ACCRA

Trust Hospital

La General Hospital

Achimota Hospital

Ga West Municipal Hospital

Tema General Hospital

Ga South Municipal Hospital

Dangbe East District Hospital

Dangbe West District Hospital

Ashaiman Polyclinic

Lekman Hospital

Navrongo

Sandema

Bawku

Garu

Abura Dunkwa

Saltpond

Apam

Winneba

Kasoa

Swedru

Breman-Asikuma

Assin Fosu

Twifo Praso

Dunkwa On Offin

Bibiani

Enchi

Asankragua

Wassa Akropong

Prestea

Tarkwa

Axim

Eikwe

Half Assini

Sefwi Wiawso

Juabeso

Osu

La

Achimota

Amasaman

Tema

Weija

Ada

Dodowa

Ashaiman

Lekman

DISTRICT GENE XPERT SITES TOWNSHIP


1 West Akim

2 Upper Manya Krobo

3 Birim Central

4 Kwahu Afram Plains North

5 Denkyembour

6 Atiwa

7 Kwahu West

8 East Akim

9 Birim North

10 Nsawam Adoagyiri

11 Akwapi Nort

12 Asuagyaman

13 Fanteakwa

1 Ketu

2 Keta Muncipal

3 South Tongu

4 Hohoe Municipal

5 Ketu

6 Kpando Municipal

7 Nkwanta South

8 Jasikan

9 Kadjebi

10 Nkwanta North

1 Nadowli

2 Lawra

3 Sissala East

1 Adansi South

2 Sekyere South

3 Bekwai Municipal

4 Asante Akim North

5 Atwima Nwabiagya

6 Ejisu-Juaben

7 Kumasi Metro

8 Obuasi

9 Offinso Municipal

10 Mampong Municipal

11 Afigya Kwabre

EASTERN REGION

Asamankese Govt Hospital

Asesewa Government Hospital

Oda Government Hospital

Presby Hospital, Donkokrom

St Dominic’s Hospital

Enyiresi Government Hospital

Holy Family Hospital

Kibi Government Hospital

New Abirim Hospital

Nsawam Government Hospital

Tetteh Quarshie Hospital

VRA Hospital

Begoro

VOLTA REGION

Ketu District Hospital, Aflao

keta Government Hospital

Sogakope Government Hosp

Hohoe Government Hospital

St. Anthony Catholic Hospital

Margaret Macqart Hospital

Nkwanta South District Hospital

Worawora Hospital

Mary Theresa Catholic Hospital

Kpassa Health Centre

UPPER WEST REGIION

Nadowli Hospital

Lawra district Hospital

Tumu district hospital

ASHANTI REGION

New Edubiase Hospital

Asamang SDA

Bekwai Hospital

Agogo Presby. Hospital

Nkawie-Toase

Juaben Hospital

Kumasi South Hospital

Obuasi Hospital

Offinso St. Patrick’s Hospital

Mampong Hospital

Ankaase Meth. Hospital

Asamankese

Asesewa

Akim Oda

Donkokrom

Akwatia

Enyiresi

Nkawkaw

Kibi

New Abirim

Nsawam

Mampong

Akosombo

Begoro

Aflao

Keta

Sogakope

Hohoe

Dzodze

Kpando

Nkwanta

Worawora

Dodi Papase

Kpassa

Nadowli

Lawra

Tumu

N. Edubiase

Asamang

Bekwai

Agogo

Nkawie

Juaben

Kumasi

Obuasi

Offinso

Mampong

Ankaase


1 Yendi Municipal

2 East Mamprusi

3 East Gonja

4 Bole-Bamboi

5 Saboba

6 Tamale Metropolis

1 Asunafo North

2 Kintampo North

3 Atebubu-Amantin

4 Jaman North

5 Tano South

6 Wenchi Municipal

7 Nkoranza South

8 Pru

9 Berekum Municipal

10 Techiman Municipal

11 Dormaa Municipal

12 Asutifi South

NORTHERN REGION

Yendi Hospital

Baptis Med. Centre

Salaga Hospital

Bole Hospital

Saboba Hospital

Tamale Central Hospital

BRONG AHAFO REGION

Goaso Municipal Hospital

Kintampo Municipal Hospital

Atebubu Hospital

Sampa Government Hospital

Bechem Hospital

Methodist Hospital -Wenchi

St Theresa’s Hospital -Nkoranza

Mathias Catholic Hospital

Holy Family Hospital-Berekum

Holy Family Hospital, Techiman

Presbyterian Hospital

St Elizabeth Hospital

Yendi

Naleirugu

Salaga

Bole

Saboba

Tamale

Goaso

Kintampo

Atebubu

Sampa

Bechem

Wenchi

Nkoranza

Yeji

Berekum

Techiman

Dormaa Ahenkro

Hwidiem


Notes

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