FIGURE 9-6 Select indicators related to PEPFAR’s laboratory activities.
NOTES: For FY 2004 and FY 2005, data were reported by the 15 focus countries. For FY 2006–FY 2010, the number of countries that reported data varied by year from 26 to all 31 of the countries that are the focus of this evaluation (see Chapter 2). For “Number of testing facilities [. . .],” FY 2004 to FY 2009 numbers correspond to PEPFAR I indicator 12.1, which has a slightly different definition: Number of laboratories with capacity to perform (1) HIV tests and (2) CD4 tests and/or lymphocyte tests (OGAC, 2007b). This indicator only captures USG-supported testing facilities and does not represent national capacity.
SOURCE: Program monitoring indicators provided by OGAC.
Despite PEPFAR’s achievements with laboratory strengthening in partner countries, challenges remain. In many countries capacity is still limited to large labs or urban areas, and the process of transporting samples or specimens to labs creates delays between testing and getting results (636-17-PCGOV; 240-24-USG; 272-13-USG; 461-10-PCNGO). Some interviewees described challenges in monitoring patient CD4 counts or identifying ARV resistance caused by limited capacity (166-11-USG; 166-15-USACA; 461-10-PCNGO; 934-15-PCGOV; 636-17-PCGOV). Across countries, stakeholders expressed the need for more (and newer) laboratory equipment (461-10-PCNGO; 116-12-PCNGO; 116-19-PCACA; 166-15-USACA; 934-34-USNGO) yet also cited equipment maintenance as a challenge (240-8-USG; 240-21-PCGOV; 331-17-USG; 934-17-PCGOV; 934-28-PCNGO; 396-22-USG). Laboratory networks are also affected by procurement and supply chain challenges (described in the previous section), which can result in stock-outs of reagents, test kits, and other laboratory commodities (587-18-PCGOV; 196-10-PCGOV; 116-12-PCNGO; 116-19-PCACA; 166-15-USACA; 934-28-PCNGO). In many countries, shortages of appropriately trained laboratory personnel (e.g., lab technicians) are the greatest barriers to expanding access to laboratory services (272-13-USG; 461-13-USACA; 461-18-USG; 934-2-USG; 166-11-USG). Ongoing challenges include adequate pre-service training, lack of management capacity, and site supervision, which are critical for quality services (396-22-USG; 166-12-USG) (Justman et al., 2009).