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
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September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 3
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
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September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 20204
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.
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 5
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 20206
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 7
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 20208
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 9
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202010
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.
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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
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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.
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 13
• 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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202014
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 15
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.
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202016
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)
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 17
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202018
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.
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 19
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)
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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.
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 21
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.
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202022
• 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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 23
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).
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202024
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.
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 25
b. ACTIVITIES OF VL SCALE UP PLANG
HA
NA
OP
ER
AT
ION
AL
PL
AN
MA
TR
IX F
OR
LA
BO
RA
TO
TY
VIR
AL
LO
AD
SC
AL
E
UP
TE
ST
ING
(2
01
7 -
20
20
)
Ph
ase
1: 2
01
7; P
ha
se 2
: 20
18
; Ph
ase
3: 2
01
9; P
ha
se 4
: 20
20
OB
JE
CT
IVE
1: T
o e
sta
bli
sh a
n e
ffe
cti
ve
pro
gra
m m
an
ag
em
en
t sy
ste
m
Str
ate
gy
1.1
: Est
ablis
h V
L ta
sk te
ams
in th
e r
eg
ion
s an
d te
ach
ing
ho
spit
als
ToR
for t
ask
team
s to
be
dev
elo
ped
d
uri
ng
a o
ne
day
m
eetin
g b
y a
team
o
f 4
Est
ablis
h 1
2
VL
task
team
s co
mp
risi
ng
fou
r (4
) m
emb
ers
each
Co
nd
uct
mo
nth
ly
task
team
mee
ting
an
d re
po
rt to
the
TW
G
ToR
for T
WG
to b
e d
evel
op
ed d
uri
ng
a
on
e d
ay m
eetin
g
by
team
of 4
p
erso
ns
Iden
tify
11
per
son
s to
co
nst
itute
TW
G
and
no
tify
them
Est
ablis
h a
nd
In
aug
ura
te V
L
TW
G
TO
R d
evel
op
ed
12
Tas
k te
ams
esta
blis
hed
Mo
nth
ly ta
sk
team
mee
ting
s h
eld
TO
R d
evel
op
ed
11
Per
son
s id
entifi
ed a
nd
n
otifi
ed
VL
TW
G
esta
blis
hed
an
d
inau
gu
rate
d
Co
py
of T
OR
Nu
mb
er o
f tas
k te
am fo
rmed
d
ocu
men
ted
Nu
mb
er o
f T
ask
team
m
eetin
gs
hel
d
and
rep
ort
s re
ceiv
ed
Co
py
of T
OR
d
evel
op
ed
Let
ter o
f n
otifi
catio
n
Rep
ort
of
inau
gu
ral V
L
TW
G m
eetin
g
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
DG
-GH
S,
PM
-NA
CP
, R
DH
S
PM
-NA
CP
, C
EO
s Te
ach
ing
H
osp
., D
G-
GH
S, R
DH
S
x x
xx
xx
xx
xx
xx
xx
x
x x x
AC
TIV
ITY
OU
TP
UT
/P
RO
DU
CT
IND
ICA
TO
R/
VE
RIF
ICA
TIO
N
Str
ate
gy
1.2
: Est
ab
lish
a N
ati
on
al V
L S
ca
le-U
p T
WG
1.1
1.1
.1
1.1
.2
1.1
.3
1.2
1.2
.1
1.2
.2
1.2
.3
RE
SP
ON
SIB
LE
PA
RT
NE
RS
COST
20
17
20
17
20
18
20
18
20
19
20
19
20
20
20
20
Q2
Q1
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q1
Q2
Q2
Q3
Q3
Q4
Q4
xx
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202026
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
2: T
o h
av
e 1
2 fu
nc
tio
na
l Ro
ch
e T
aq
ma
n a
nd
13
0 G
en
eX
pe
rt m
ac
hin
es
op
era
tin
g o
pti
ma
lly
an
d
we
ll m
ain
tain
ed
by
20
20
Str
ate
gy
2.1
: Est
ablis
h le
ase
ag
ree
me
nts
to r
ep
lace
exi
stin
g p
latf
orm
s in
a
ph
ase
d m
ann
er
Co
nd
uct
qu
arte
rly
TW
G m
eetin
gs
NA
CP
L
abo
rato
ry
foca
l p
erso
n
Qu
arte
rly
TW
G
mee
ting
s h
eld
Nu
mb
er o
f m
eetin
gs
hel
d a
nd
re
po
rts
rece
ived
by
task
team
s
Dire
cto
r C
EU
Pro
cure
-m
ent
offi
cer,
P&
S
Pro
cure
-m
ent
agen
t
Pro
cure
-m
ent
agen
t
NA
CP
, P&
S-
MO
H- c
o-o
rdin
a-tio
n, T
he
Glo
bal
F
un
d- t
ech
nic
al
sup
po
rt,
NA
CP
- co
-ord
ina-
tion
, Th
e G
lob
al
Fu
nd
- tec
hn
ical
su
pp
ort
NA
CP
, P&
S-
MO
H- c
o-o
rdin
a-tio
n, T
he
Glo
bal
F
un
d- t
ech
nic
al
sup
po
rt,
CE
U (G
HS
), N
AC
P, P
& S
- M
OH
- co
-ord
ina-
tion
, Th
e G
lob
al
Fu
nd
- tec
hn
ical
su
pp
ort
,
PM
-NA
CP
, C
EO
s Te
ach
ing
H
osp
., D
G-
GH
S, R
DH
S
x x x x x
x x x
1.2
.4
2.1
2.1
.1
2.1
.2
2.1
.3
2.1
.4
20
17
20
18
20
19
20
20
Pre
par
e an
d
ob
tain
ap
pro
val
for t
ech
nic
al a
nd
p
erfo
rman
ce
spec
ifica
tion
d
ocu
men
ts fo
r th
e eq
uip
men
t
Pre
par
e o
rder
fo
rm b
ased
o
n a
pp
rove
d
tech
nic
al
do
cum
ents
Pro
cure
men
t ag
ent s
ou
rces
for
sup
plie
rs
Pre
par
e th
e le
ase
agre
emen
t
Tech
nic
al a
nd
p
erfo
rman
ce
spec
ifica
tion
d
ocu
men
ts
avai
lab
le
Ord
er fo
rm
com
ple
ted
Su
pp
liers
id
entifi
ed
Lea
se a
gre
emen
t si
gn
ed a
nd
co
ntr
act
esta
blis
hed
Sp
ecifi
catio
n
do
cum
ents
p
rep
ared
an
d
app
rove
d
Ord
er fo
rm
sub
mitt
ed to
p
rocu
rem
ent
agen
t
Pri
ce
qu
ota
tion
fro
m
pro
cure
men
t ag
ent
sub
mitt
ed fo
r re
view
an
d
app
rova
l
Lea
se
agre
emen
t av
aila
ble
x
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 27
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
2.2
: T
o e
nsu
re th
at c
urr
en
t ma
ch
ine
s a
re w
ell
ma
inta
ine
d a
nd
fun
cti
on
ing
o
pti
ma
lly
Inst
all 4
mac
hin
es
in K
orl
e-b
u, G
AR
&
KA
TH
, AR
Inst
all 4
mac
hin
es
in K
orl
e-b
u, G
AR
&
KA
TH
, AR
Dev
elo
p a
nd
d
isse
min
ate
too
l to
mo
nito
r p
reve
nta
tive
mai
nte
nan
ce
per
form
ance
of
equ
ipm
ent
4 M
ach
ines
su
pp
lied
, in
stal
led
an
d
fun
ctio
nal
4 M
ach
ines
su
pp
lied
, in
stal
led
an
d
fun
ctio
nal
Too
l ava
ilab
le
in 1
2 te
stin
g
site
s
4 fu
nct
ion
al a
t G
AR
, AR
, K-b
u,
KA
TH
4 fu
nct
ion
al a
t C
R, B
AR
, VR
, E
R Nu
mb
er o
f si
tes
with
m
on
itori
ng
to
ol i
n u
se
Dire
cto
r CE
U
Dire
cto
r CE
U
NA
CP
L
abo
rato
ry
foca
l per
son
; la
bo
rato
ry
man
ager
s
NA
CP
, P&
S
- MO
H- c
o-
ord
inat
ion
, T
he
Glo
bal
F
un
d-
tech
nic
al
sup
po
rt,
NA
CP
, P&
S
- MO
H- c
o-
ord
inat
ion
, T
he
Glo
bal
F
un
d-
tech
nic
al
sup
po
rt,
MO
H, G
F
x
xx
2.1
.5
2.1
.6
2.2
2.2
.1
20
17
20
18
20
19
20
20
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202028
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
2.3
: To
tra
in la
bo
rato
ry s
taff
, ass
ess
an
d m
ain
tain
co
mp
ete
nc
e
Mo
nito
r an
d e
nsu
re
com
plia
nce
with
le
ase
agre
emen
t w
ith R
och
e o
n th
e m
ain
ten
ance
of
the
new
pla
tfo
rms
Trai
n 3
lab
sta
ff
fro
m e
ach
of t
he
12
site
s o
n V
L
test
ing
, eq
uip
men
t m
ain
ten
ance
, lo
gis
tics
man
agem
ent
Est
ablis
h a
task
te
am to
ass
ess
adeq
uac
y o
f T
aqm
an V
L te
stin
g
cap
acity
an
d
rep
ort
on
fin
din
gs
Dev
elo
pm
ent
of S
OP
S fo
r V
L te
stin
g o
n
Gen
eXp
ert,
if re
po
rt d
eem
s ad
diti
on
al te
stin
g
cap
acity
is n
eed
ed
Ser
vice
m
ain
ten
ance
ca
rrie
d o
ut
Trai
ned
lab
st
aff i
n 1
2 s
ites
Team
rep
ort
on
st
atu
s o
f tes
ting
ca
pac
ity
Req
uire
d S
OP
s re
view
ed a
nd
ap
pro
ved
Nu
mb
er o
f eq
uip
men
t se
rvic
ed b
y
Ro
che
Nu
mb
er o
f st
aff t
rain
ed,
nu
mb
er o
f si
tes
with
tr
ain
ed s
taff
Rep
ort
co
mp
lete
d
and
su
bm
itted
to
NA
CP
Nu
mb
er o
f re
qu
ired
S
OP
s re
vise
d
and
ap
pro
ved
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
NA
CP
L
abo
rato
ry
foca
l per
son
Lab
foca
l p
erso
n
CD
C, N
AC
P
GF
CD
C, N
AC
P
GF
MO
H, G
F
CD
C, N
AC
P
GF
, Ro
che
x
x
x
xx
xx
xx
xx
xx
x
20
17
20
18
20
19
20
20
Str
ate
gy
2.4
: De
ve
lop
SO
Ps
for
Ge
ne
Xp
ert
pla
tfo
rms
to p
rov
ide
vir
al l
oa
d te
stin
g, a
s n
ee
de
d
2.2
.2
2.3
2.3
.1
2.4
2.4
.1
2.3
.2
20
17
20
18
20
19
20
20
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 29
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
2.5
: Est
ab
lish
de
co
mm
issi
on
pro
ce
du
re f
or
old
an
d u
sab
le p
latf
orm
s
OB
JE
CT
IVE
3: T
o e
nsu
re th
at r
ea
ge
nts
an
d c
on
sum
ab
les
for
24
2,8
01
vir
al l
oa
d
test
are
av
ail
ab
le b
y 2
02
0
Str
ate
gy
3.1
: T
o p
rov
ide
ad
eq
ua
te a
nd
co
nti
nu
ou
s su
pp
ly o
f re
ag
en
ts to
me
et
VL
test
ing
targ
ets
Dev
elo
p
dec
om
mis
sio
n
pla
n a
nd
SO
P
Iden
tify
4
pla
tfo
rms
to b
e d
eco
mm
issi
on
ed
Dec
om
mis
sio
n 4
p
latf
orm
s
Co
nd
uct
Nat
ion
al
qu
antifi
catio
n
and
dev
elo
p
sup
ply
pla
n fo
r co
mm
od
ities
Ord
er fo
rm
com
ple
ted
an
d
sub
mitt
ed to
the
pro
cure
men
t ag
ent
Iden
tify
sup
plie
r an
d s
ign
co
ntr
act
Qu
antifi
catio
n
det
erm
ined
an
d
sup
ply
pla
n
rep
ort
ava
ilab
le
Ord
er fo
rm
pre
par
ed a
nd
su
bm
itted
Su
pp
lier
iden
tified
an
d
con
trac
t sig
ned
Qu
antifi
catio
n
and
su
pp
ly
pla
n re
po
rt
avai
lab
le
Ord
er fo
rm
sub
mitt
ed o
n
time
Su
pp
lier
del
iver
s su
pp
lies
as p
er
con
trac
t
PS
M fo
cal
per
son
, NA
CP
P&
S
pro
cure
men
t o
ffice
r
Pro
cure
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202030
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 31
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202032
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 33
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202034
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 35
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202036
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 37
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202038
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 39
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202040
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 41
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202042
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 43
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202044
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 45
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202046
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
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September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 47
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September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202048
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 49
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.
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202050
Appendix II
Distribution of Gene Xpert Platforms
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 51
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202052
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
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 53
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
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202054
Notes
September 2017 Ghana Viral Load Scale Up and Operational Plan 2017 – 2020 55
Notes
September 2017Ghana Viral Load Scale Up and Operational Plan 2017 – 202056
Notes