This paper examines the concept of a developing nation that has a high HIV prevalence and lacks appropriate laboratory infrastructure necessary to cope with a treatment and care program. Several issues are discussed including personal experience in the context of project management for the creation and coordination of a facility aimed at providing the laboratory support required for the appropriate delivery and monitoring of HAART. Key issues about political will and prioritization are discussed in concert with current international guidelines and mechanisms of technology transfer and human resource development. The paper gives the benefit of the teams experience in coordinating the project, dealing specifically with issues such as the process of equipment procurement, staff recruitment, and capacity building. The need for the highest level of quality control and standard operating practices are discussed in the context of limited regional expertise and manpower support. Emphasis is placed on the long term objectives of operational research focusing on cheaper and simpler algorithms for monitoring and providing support for a comprehensive but affordable and sustainable program.