Masanza et al. BMC Public Health 2010, 10(Suppl 1):S8 http://www.biomedcentral.com/1471-2458/10/S1/S8 Table 1. Residents and graduates of Laboratory Track programs in AFENET member FELTPs Graduates Current Trainees Total Enrollment Program Kenya South Africa Nigeria Tanzania Rwanda WAFELTP* Totals Year Started 2004 2007 2008 2008 2010 2010 20 0 0 0 0 0 20 12 15 13 8 4 3 55 32 15 8 13 4 3 75 *West Africa Field Epidemiology Program, based in Ouagadougou, but serves four French speaking countries – Burkina Faso, Togo, Mali and Niger. So far, 75 trainees have been enrolled and 20 have graduated from the Laboratory Track in the six FELTPs. To our knowledge, these are the ﬁrst advanced-level training programs focusing on public health laboratories, combining technical, managerial and leadership skills in this region. Even FETPs without a designated Laboratory Track are contributing by enrolling laboratory personnel for training in Field epidemiology. For example, the Zimbabwe and Uganda FETPs have so far trained six and two laboratory personnel, respectively. The training is designed to impart a ripple eﬀect throughout the region. This is achieved through three approaches: 1) by utilizing the existing programs to train “seed” personnel from other countries in the region, who will then play a central role in the development of national programs; 2) by encouraging graduates to participate in mentoring programs in other countries; and 3) by having residents and graduates conduct short courses. For example, the Kenya program has trained residents from Ghana, Southern Sudan, Tanzania, and Uganda. The Nigeria, South Africa, and Tanzania programs were mentored by graduates of the Kenya program. Ideally, as more countries gain the capacity to run their own FELTPs, there will be an algorithmic growth of trained professionals in the region. The graduate-level training is complemented by short in-service training courses for mid-level managers and other peripheral laboratory staﬀ to enhance systems for routine laboratory operations in district/provincial levels. The short courses employ two innovative approaches: 1) jointly training medical and laboratory personnel primarily on laboratory matters; and 2) incorporating a 3-month ﬁeld mini-project with presentations of ﬁndings before a panel. Over 500 ﬁeld staﬀ have been trained in these short courses. The short course curricula are available as open resources, and AFENET provides tech- nical support to any country desiring to conduct these courses at any time [12]. Through the graduate and short Page 3 of 7 course trainings, AFENET is playing a critical role in fast- tracking the building of a sustainable senior-level cadre of laboratory personnel that will champion the attainment and maintenance of IHR core capacities in the region. Moreover, there is evidence that if appropriate steps are taken, the retention rate of these graduates in their countries of origin is quite high [11]. Laboratory outbreak investigation kit To enhance timely laboratory support during outbreak investigations, as well as to facilitate the learning of the FELTP trainees, AFENET packages and distributes a comprehensive outbreak response kit to countries where disease outbreaks occur regularly. The contents are adapted according to the speciﬁc country’s needs and most frequent diseases. This kit has been provided to Ministries of Health in Uganda, Kenya, Zimbabwe, Ethiopia and Ghana. The generic kit content and guide- lines are available at the AFENET website. Laboratory quality assurance: The HIV external quality assurance (EQA) project The unreliability of laboratory results is cited as one of the major limitations to laboratory support for health care in Africa [2]. The utility of laboratory systems in the implementation of the IHR is also greatly dependent on the reliability and quality of laboratory results. However, applicable and cost-eﬀective models for achieving accurate and reliable laboratory results in the low-income African countries have yet to be optimized. One of the areas where external quality assurance (EQA) is critical is in the monitoring of the routine HIV rapid testing. Most countries in the region depend on re- testing as the primary means of monitoring the quality of HIV serologic testing. This approach is expensive, time- consuming and logistically challenging in decentralized settings [13]. Traditionally, HIV external quality assur- ance programs use liquid serum or plasma specimens that require special cold storage and transportation conditions. The biohazard risks and costs of this approach have resulted in national quality assurance programs being weak, and consistent quality assurance is generally lacking in lower-tier laboratories [13]. In 2009, AFENET, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC) and the mandated national institutes in Uganda and Tanzania, began a pilot HIV EQA project using the recently developed dried tube specimen (DTS) Proﬁciency Testing (PT) panels. This approach addressed a number of the technical and logistical challenges of re-testing as reported in the Atlanta and Kenya studies [13]. The DTS is a cost-eﬀective approach and is easy to prepare, stable at high temperatures and can be transported by mail to any part of the country.