distribute, and track commodities, but challenges to assuring consistent and reliable supply chain functioning remain in many countries. These challenges are a common issue across countries and are not PEPFAR-specific. Reliable supply chains will be critical for sustainable and cost-efficient HIV/AIDS responses and for avoiding disruptions to the clinical care and treatment of people living with HIV/AIDS.

Laboratory Infrastructure

Functioning laboratories, with the capacity to run screening, diagnostic, and clinical laboratory tests, are fundamental to the monitoring and management of patients with HIV/AIDS and other diseases (Gershy-Damet et al., 2010). In PEPFAR’s early years, access to and the quality of laboratory services was a major challenge in partner countries (Cohen, 2007; Sturchio and Cohen, 2012). A lack of prioritization and leadership (e.g., no national policies or strategic plans), inadequate workforce capacities, and dilapidated infrastructures affected laboratory systems, which tended to have limited available resources. In many countries, limited laboratory capacity was “a major barrier” or “rate-limiting step” for the scale-up of HIV/AIDS and other health services that was necessary to meet the Millennium Development Goals (Birx et al., 2009, p. 849; WHO, 2008, p. 1).

Within the past 5 years, global stakeholders have declared their commitment to strengthening laboratory systems, particularly in Africa. In January 2008, 33 countries and 3 multilateral organizations signed the Maputo Declaration on Strengthening of Laboratory Systems (WHO, 2008). The Maputo Declaration called on national governments to prioritize support to laboratory systems through the development of national laboratory policies, national laboratory strategic plans, and departments of laboratory systems within the various countries’ ministries of health in order to address the challenges that limit the scale-up of services for tuberculosis, malaria, and HIV diagnosis and care. The Maputo Declaration also called on donors and partners to support these national efforts and to coordinate and collaborate with each other to support the strengthening of laboratory systems, including efforts to build public–private partnerships (WHO, 2008).

PEPFAR Inputs

Guidance During PEPFAR I, support for laboratory services focused on the provision of those basic services that were needed for HIV diagnosis and care (Justman et al., 2009). PEPFAR’s first Five-Year Strategy committed to improving laboratory capacity for HIV testing and treatment monitoring as well as to training laboratory technicians in order to quickly



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