INSTITUTO NACIONAL DE SAÚDE UEM/UCSD MEPI External Advisory Board Meeting National Institute...
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Transcript of INSTITUTO NACIONAL DE SAÚDE UEM/UCSD MEPI External Advisory Board Meeting National Institute...
INSTITUTO NACIONAL DE SAÚDE
UEM/UCSD MEPI External Advisory Board Meeting
National Institute Laboratory of Molecular Biology and the Biomedical Research Training in Mozambique:
domestic and international Nilesh Bhatt MD MMED
Researcher
INS
Brief introduction of INS
National Institute of Health is a research and technical-scientific institution subordinated to the Ministry Of Health.
The MOH approved in 2009, the Stretegic Plan of INS for period 2010-2014.
- Eight strategic axis.
- Each axis have one or more strategics objectives.
- Each axis is targeted through one or more macro-project.
INS
Mision and vision of INS
• Mission: Participate in improvement of well being of Mozambican
population, by generating and promoting the incorporation of scientific and technology solutions for the principal conditions and health problems in Mozambique.
• Vision:
To be national reference in generating and proposing technical and scientifically based solutions for promotion, prevention and attention to health in Mozambique.
INS
Organizational Structure of INS (1)
• To implement mission/vision of INS and to implement efficiently the Strategic Plan of INS, a new organic structure was adopted in March 2010.
• The new organic structure is matrix type, where implementing units are Technology Platforms (Laboratory) and the Macro-Projects.
• The INS is organised in 5 central Department.
INS
Organizational Structure of INS (2)
INS
Technology Plataform
Research Communication, information and
Health surveillance
Laboratory network and
referral services
MACRO-PROJECTS
Molecular Biology
Virology
Celular immunology
Serology
Others
BSL-3
- HIV-1 DNA PCR (available for all country)
- HIV-2 PCR (available for all country)
- HIV indeterminate cases (available for all country)
- HTLV-1 PCR (available for all country)
- Influenza PCR (available for all country)
- HIV-1 resistance testing
- HIV-1/HBV/ HCV viral load
INS
Molecular Biology Unit – referral unit for the National Health SystemINS
7
Mozambique EID Context early 2009
Nampula Lab
INS Maputo
• 2 Labs• >3000 samples per
month nationally• Result turnaround
times minimum of 3-4 months
INS
2008 (HCN)
2010 (Quelimane)
2010 (Beira)
2006 (INS)
16,000 tests/lab/year
Laboratory capacity – Early Infant Diagnosis (HIV 1)
INS
0
5000
10000
15000
20000
25000
30000
35000
2007 2008 2009
Am
ostr
as T
esta
das
0
50
100
150
200
250
300
US
qu
e c
olh
em
DB
S
Negativos USSample tested
2010: Health units = 350 Samples tested = 42.000
HIV diagnosis in children – expansion of services (2007 – 2010)
INS
Mozambique Early Infant Diagnosis Logistics
PMTCT
Provincial Hospital
PCR Lab
ARTPMTCT
Sam
ples
to la
b Results to S
ite
Expedited Results System (ERS)
Provincial Hospital
INS
11
Expedited Results System (ERS)
Admin sends results using automated software, saving precious tech time
Printer simple “black box” so HCWs only need to plug in and await their results
Data codified when sent via GPRS with no possibility of erroneous transmission
Server
Lab Database (LIS)
Internet
Printer in Health Center
GPRS Wireless Network
Real-time stats
Lab manager can monitor results transmission and know if printers are functioning or not
Server saves data and sends to printers, results only deleted once confirmed receipt from the printer
INS
ERS Impact - Results in Maputo City
Sample Collection
Sample at Lab
Result Ready
Result to Site
Result to Patient
Patient Enrolled C&T
0 30 60 90 120 150 180 210
Ap
r 2
00
9O
ct 2
00
9M
ar
20
10
Days
Transport
Processing
Result Transmission
Results to Patient
Patient to C&T
INS
“Real-time” Statistics for Program Monitoring
INS
Sample Message
INS
Date: 14-05-2010Time: 10:05:00Laboratory: INS MaputoHealth Center: CS - 1 de JunhoAnalysis: DNA PCR_________________________Laboratory Code: 1468/10Date of Processing: 13-05-2010Date of Collection: 01-05-2010
Result: Positive
Name: Nilesh BhattNID: 078/10Date of Birth: 01/04/2010
Patient Contact: 823861130_________________________Patient should be urgently referred for care and treatment!
• MCEL agrees to cover ongoing network usage fees
• Sequoia Technologies maintains server and provides ongoing TA and support
Partner, Private Sector, and Government Partnership
Ministry of Health/National Institutes of Health
• CHAI provides technical support and coordination
• PEPFAR/MSF procure printers and support rollout
• CDC/APHL support future applications (CD4, TB, etc.) and LIS Database management
Private Sector Partners
• National Institutes of Health anchors the program, provides MoH leadership
• Provincial health directorates plan rollout and provide 1st line of supervision/support
INS
Further Application of the Expedited Results Systems
Strengths:• 100% confidentiality of results• 100% guarantee of transmission• Low cost of GPRS network usage (~1% of
SMS cost)• Easy, rapid scale-up• Automated, reduces workload of HCWs
Challenges:• Use of a single network, APN required• Upfront programming at labs
Requirements:• At labs: electricity, internet• At health centers: electricity, network
coverage• Printers: ~$295*/unit with 2-year warranty• Thermal paper rolls: <$1 each, prints 2-300
results
*Price varies with volume
INS
Aim is to include TB Culture, CD4,
and Viral Load Results in the ERS in near future
• Currently, INS employs 128 workers:– 3 with PhD level and 7 with MSc/MMED level.– 73 are graduated.– 45 with elementary, basic and medium level.– 30 staff of INS are involved in MSc and PhD programs.
• Master of Science• Field Epidemiology and Laboratory Training Program
(FELTP)• Infectious Diseases• Basic science• Others
Biomedical Research Training in Mozambique: domestic and international
INS
Pos-Graduation Courses - INS (1)
• Master in Health Science– Collaboration between INS and FIOCRUZ (Brasil).– 10-15 students every 2 years.– Started in 2008.– The first 6 students graduated in Novembro 2010 in Maputo.
• Master in Field Epidemiology and Laboratory– Collaboration between INS, UEM and CDC (USA).– 10-12 students every 2 years.– Started in August 2010 with 11 students (10 are MOH staff).
INS
Pos-Graduation Courses - INS (2)
• PhD in Public Health and Bio-Medicine– Collaboration between INS, UEM, FIOCRUZ (Brasil) aand
IHMT (Portugal).– To be started in 2012.
INS
Future INS Building - Marracuene
INS
New INS Building - Marracuene
1st Floor Director’s Suite Human Resources / Finance / Data Processing Epidemiology Staff Reference Libray Multipurpose Room Accessioning Lab Shipping / Receiving Insectary Animal Care
~2,360 m2 / ~25,400 SF +~180 m2 / ~1,960 SF covered outdoor space
Circulation 87 m2
Building Support 427 m2
Open Office 287 m2
Amenity 291 m2
Vertical Circulation 115 m2
Covered Outdoor 180 m2
Space
Mechanical / Core 176 m2
Vivarium 583 m2
Insectary 128 m2
BSL2 Lab 193 m2
Lab Support 73 m2
1st Floor
Training
2nd Floor Bacteriology & Parasitology Department:- Fungal & Mycobacterial Isolation- Bacteriology & Serology- Parasite & Host Biology- Intestinal & Urinary- Teaching Laboratory
Glass Wash Media Prep
~2,570 m2 / ~27,700 SF
Circulation 48 m2
Building Support 108 m2
Open Office 864 m2
Conference 70.5 m2
Vertical Circulation 115 m2
Mechanical / Core 155.2 m2
BSL 3 Lab 35.2 m2
BSL2 Lab 498 m2
Lab Support 683.4 m2
2nd Floor
Teching Lab
2nd Floor
Microbiology
3rd Floor Virology & Cell Biology Department:- BSL-3 Lab- Virus Isolation- Molecular Biology & Genomics/Proteomics- Cellular Immunology
Morphology & Immunoassay
Mechanical / Core 155.2 m2
BSL 3 Lab 118 m2
BSL2 Lab 476 m2
Lab Support 617.3 m2
Circulation 48 m2
Building Support 108 m2
Open Office 864 m2
Conference 70.5 m2
Vertical Circulation 115 m2
~2,570 m2 / ~27,700 SF
3rd Floor
BSL-3
Instituto Nacional de Saúde de Moçambique