The Laboratory’s Key Role in Scale-Up and Sustainability Seema Meloni, Ph.D., M.P.H. Harvard...
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Transcript of The Laboratory’s Key Role in Scale-Up and Sustainability Seema Meloni, Ph.D., M.P.H. Harvard...
PEPFAR
The Laboratory’s Key Role in Scale-Up and Sustainability
Seema Meloni, Ph.D., M.P.H.Harvard School of Public Health
AIDS 2012: Turning the Tide Together
25 July 2012 AIDS PreventionInitiative Nigeria
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
“Strengthening national health laboratory systems in
resource-poor countries is critical to meeting the United
Nations Millennium Development Goals.”
Birx D, de Souza M, Nkengasong JN. The interaction of health and laboratory systems, clinical research, and service delivery. Am J Clin Pathol. 2009; 131:849-51.
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Overview: Harvard PEPFAR Nigeria
• 2000: Through Bill & Melinda Gates Funding, Harvard has been working with multiple hospitals and prevention programs in Nigeria
2004 2005 2006 2007 2008 2009 2010 20110
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000 Cumulative in HIV Care
Current in HIV Care
Cumulative on ART
Current on ART
• 2004: In collaboration with AIDS Prevention Initiative in Nigeria (APIN), PEPFAR HIV care and ART activities started at 6 tertiary hospitals
• 2005-2012: Expanded to a total of 32 ART sites and 64 PMTCT sites
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Objectives of the Harvard PEPFAR Nigeria Lab Program
1. Integrate within the Federal Government of Nigeria health system plan
2. Develop state-of-the-art laboratory services for multiple service tiers
3. Provide cost-effective, accurate, and high-quality laboratory service
4. Develop sustainable continuous training program to support partner sites
5. Build program-wide quality system for lab diagnosis and/or monitoring
6. Support electronic data capture of all laboratory records
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Laboratory Network & Infrastructure
• Tertiary Laboratories: 11 labs in 6 states• Secondary Laboratories: 15 labs in 7 states• Primary Laboratories: 45 (in progress)
Lab Equipped
Training complete
Internal QA/QC
EQA program
Serology (HIV, HBV, HCV) X X X CAP 2007
CBC X X X Cross-site
Chemistry X X X CAP 2007
CD4- flow X X X UK-NEQAS (2006)
Viral Load X X X Harvard (2006)
Infant DNA PCR X X X CDC (2007)
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Training
• Three tertiary labs have been designated training centers for hands-on workshops and training sessions
• Training model relies on tiered system– Tertiary institutions responsible for training satellite sites
• Standardized training guidelines across program
Jos University Teaching Hospital
Abnira Medical Center
Solat Women’s Hospital
Jenvak Hospital Tundun Wada
Nassarawa Medical Center
Pankshin General Hospital
PHC Amper
PHC Kabwir
FCE Clinic
Seventh Day Adventist
PHC Amo Katako
PHC Zabolo
PHC Jengre
Barakin Ladi General Hospital PHC Maikatako
PHC Dorowa Babuje
PHC Sho
Panyam Cottage Hospital
PHC Kerang
PHC Mangu
PHC Gindiri
Vom Christian Hospital
PHC Riyom
PHC Ganawuri
PHC Chugwi
Plateau State, Nigeria: Model for Satellite Development
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Lab Hematology ChemistryCD4 or CD4% Viral Load DNA PCR
Drug resistance Genotype
ABUTH 8430 7056 8594 3951 395 JUTH 20833 20902 22622 14185 4801 90LUTH 12312 12348 12966 6692 2445 NIMR 18173 18458 18469 8669 3294 66UCH 8384 12897 15761 8069 2155 20FMCM 15718 16216 17003 3578 964 OLA 4290 4392 4365 2610 204 UMTH 9762 6237 9606 4753 690 UNTH 8863 8825 8870 2996 500 Eleta 812 788 811 Ogbomosho 1173 1011 1014 Ijebu-Ode 2062 1232 2336 Sacred Heart Lantoro 1392 1452 1437 FMC Nguru 250 220 1315 SSH Maiduguri 711 3 780 Shendam 1610 1150 1602 Solat 999 655 1393 Adeoyo 3424 3274 3333 Total 119,198 117,116 132,277 55,503 15,448 176
Volume of Laboratory Tests Performed in 2011
PEPFAR
The Harvard PEPFARLaboratory Master Trainer and
Site Support Programin Botswana
Notes from the Field
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Laboratory Master Trainer & Site Support Program Team
Laboratory Master Trainer Corps
1 Lab Master Trainers (assigned by Government)
6 BHP-PEPFAR LabMaster Trainers
Train site-level lab personnel as site Master Trainers
Coordinator (Director of the National HIV Reference Laboratory)
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
2002-2004: 2 Labs with CD4 and Viral Load Capabilities
NHHRL
BHHRL
BHHRL – BotswanaHarvard HIV Reference Laboratory
NHHRL – NyangagbweHospital HIV Reference Laboratory
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
2005-2008: 21 Laboratories with CD4 Capabilities
FacsCalibur
FacsCount
CD4 Equipment
Partec CyFlow
Coulter
FacsCount at a Clinic
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
2005-2008: 8 Laboratories with Viral Load Capabilities
Roche Taqman 48Cavidi ExaVir Load
Viral Load equipment
Equipment available – no space
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Effect of Decentralization of LabsN
umbe
r of T
ests
GETTING TO 6 MILLION: LESSONS FROM THE TRACK 1.0 PEPFAR PROGRAM
Challenges• Upgrades and updates needed
– Early renovations and equipment need replacement– More trained engineers needed to keep up with numbers – New kits = adapted logistics and trainings
• Big sites cannot continue to support the increasing demand
• Bridging gap between care providers and the laboratories to ensure data are appropriately used in course of care (Birx et al, 2009)
PEPFAR
Acknowledgements
This work was funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration.
P. Kanki (PI) R. MarlinkJ-L. SankaléD. HamelB. ChaplinH. RawizzaA. Dieng-SarrG. EisenC. SmithM. O’MalleyC. ChangH. ReyesN. UlengaL. DinicJ. HosseiniU. IjeomaE. KochC. WenA. WeissP. BurnsM. Farhani
R. MurphyK. ScarsiK. HurtB. TaiwoC.Achenbach
P. OkonkwoT. JolayemiJ. SamuelsE. OfucheB. BanigbeS. OchigboR. OlaitanP. AkandeT. OyebodeB. AkinyemiO. EberenduC. O’MartinsJ. AdeolaI. AbbasA. Obakeye
I. AdewoleD. OlaleyeJ. IdokoS. SagayO. AgbajiO. IdigbeD. OnwujekweC. OkanyR. NkadoW. GashauH. MuktarJ. AbahC. ChukwukaS. AkanmuF. Ogunsola
All our colleagues at the PEPFAR sites in Nigeria and
Botswana.
And, most importantly, the patients
J. MakhemaT. GaolatheM. Mine