Category Archives: Global Health
The Association of Public Health Laboratories (APHL) is very concerned about the decline in federal funding for public health functions such as detection, surveillance and response in the administration’s budget for fiscal year 2019. “It is extremely disheartening and disappointing to see such severe cuts to public health programs at CDC, HRSA, USAID and the Department of State at a time when the services they support are most in need,” said Scott Becker, executive director of APHL. “What is more, these cuts to public health funding come after a historic bipartisan agreement between Congress and the White House to increase federal spending overall for the next two years.”
CDC cuts include:
- $60 million from National Center for Emerging and Zoonotic Infectious Diseases, which focuses on preventing and responding to outbreaks such as Zika, Ebola and antibiotic resistant infections ($25 million cut from antibiotic resistance specifically);
- $44 million from the National Center for Immunization and Respiratory Diseases, which protects the public from vaccine preventable diseases;
- $27 million from the National Center of Birth Defects and Developmental Disabilities;
- $26 million from the Office of Public Health Scientific Services, which supports science standards and policies to reduce the burden of diseases domestically and globally; and
- $21 million from the National Center for Environmental Health.
HRSA cuts include:
- $0 – Elimination of the Maternal & Child Health Heritable Disorders program, which works to reduce illness and death in newborns and children who have or are at risk for heritable disorders, such as sickle cell anemia, cystic fibrosis and hearing impairment.
- $0 – Elimination of the Universal Newborn Hearing Screening and Intervention Program, which allows for early hearing detection and intervention systems in all babies born in the US.
Global Health Programs:
- $1.26 billion cut to Department of State Global Health Programs which includes funding provided to CDC for PEPFAR; and
- $1.11 billion cut to USAID Global Health Programs.
While the majority of the president’s budget proposal is grim for public health, there were a few areas that are not as dark. APHL was pleased to see that the budget request designates $175 million to CDC to address the growing opioid crisis. Additionally, funding for the Global Disease Detection Program would increase by $51 million and funding for the Public Health Emergency Preparedness program would increase by $4.5 million.
As Scott Becker explained, “The director of the president’s Office of Management and Budget said, ‘the budget is a messaging document.’ In that case, the message to the American people seems to be, ‘Good luck if there is an outbreak or other public health emergency because federal early warning and response programs won’t be there to help you through.’”
APHL will continue work with Congress to assure that funding levels continue at the much-higher amounts provided in previous years. Adequate levels of federal support for state and local laboratory contributions are critical to the nation’s public health security.
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The APHL International Team Meeting allows for US-based APHL leadership and global health program staff and consultants working in-country to discuss organizational operations and key programmatic successes and challenges. In most cases, this is the only time during the year that these individuals have an opportunity to meet face-to-face. Participants from Zambia, Zimbabwe, Kenya, Tanzania, Mozambique, Guinea, Sierra Leone and APHL’s US headquarters were all in attendance.
In November, Scott Becker, APHL’s executive director, traveled to Johannesburg, South Africa for the second APHL International Team Meeting. While he was there, he sat down with five members of the APHL international team to discuss their work and what led them to pursue a career in laboratory science.
- Levi Vere, Laboratory Quality Monitoring Manager, APHL Zimbabwe
- Shanette Nixon, Global Health Consultant, APHL
- Esther Vitto, Laboratory Program Support, APHL Sierra Leone
- Mohamed Fofanah, Associate Specialist, Administration and Finance, APHL Sierra Leone
- Rufus Nyaga, LIS Technical Consultant and Project Manager, APHL Kenya
The post Lab Culture Ep. 7: APHL’s International Team Meeting appeared first on APHL Lab Blog.
By Robyn Sagal, specialist, Global Health, APHL; Samantha Dittrich, manager, Global Health Security, APHL
When HIV first struck Ghana in 1986, it didn’t adhere to global trends. There was a high prevalence of HIV in females, not males. The spread began in rural areas, not urban centers. Regions with more polygamy had lower rates of HIV, not higher. Over 30 years later, Ghana has made significant headway in slowing new infections, but there continues to be an upward trend that’s deeply concerning.
The top HIV/AIDS experts around the world see substantial evidence that antiretroviral therapy (ART) can be highly successful in suppressing the virus in infected people and decreasing the likelihood of transmission. In fact, evidence shows that when the virus is suppressed to the point of being undetectable, the infected individual has low or no risk of transmitting the virus to others. Given these facts, one key to slowing and eventually halting the transmission of HIV is close monitoring of every infected person’s viral load (testing for the amount of HIV in the blood). Regular and consistent viral load testing can determine whether ART is a success or failure. If ART is successful, viral load testing will indicate viral suppression; if not, as when treatment is inconsistent or the virus has become drug resistant, it will show either no change or an increase in viral load. Viral load testing is critical to determining next steps for individual treatment as well as determining whether the epidemic is progressing or regressing.
In keeping with global HIV response efforts, Ghana is shifting their attention to scaling-up viral load testing per the World Health Organization’s (WHO) “treat all” recommendation. That is, not only should infected and high-risk individuals receive ART, they should also have access to regular viral load testing. Additionally, the country has adopted the UNAIDS 90/90/90 global targets aimed at ensuring that 90% of the people receiving treatment are virally suppressed, with the goal of ending HIV/AIDS by 2030. Scaling-up viral load testing requires increasing laboratory capacity, an undertaking to which Ghana and APHL are committed.
In order to develop the Ghana Laboratory Viral Load Testing Extension plan, APHL has worked closely with CDC-Ghana, the Ghanaian Ministry of Health (MOH), Ghana Health Service (GHS), the National AIDS Control Programme (NACP) and many other partners and stakeholders. This plan outlines a strategy to increase and monitor laboratory capacity for viral load testing. It includes an ambitious, targeted approach that balances achieving global goals of ART treatment monitoring with the limited resources available in the country. The plan accelerates the scale-up of viral load testing by defining national testing targets and a timeframe for achieving them, improving stakeholder collaboration and pooling available resources for better distribution.
In addition, APHL has collaborated with the Centre for Remote Sensing and Geographic Information Services (CERSGIS) to map all 245 ART centers in Ghana. This huge undertaking generated geo-referenced maps for each site, including the latitude and longitude of the ART centers along with other related attributes such as differentiated models of care sites, regional viral load centers, sector viral load centers, functional viral load centers, testing staff capacity, ART equipment at the centers and much more. Visualizing these data at various administrative levels provides national decision makers with a more nuanced understanding of program coverage and priorities for scale-up. By mapping rather than graphing or charting the data, users are better able to recognize important patterns.
As the global health community works to end AIDS by 2030, laboratory testing will continue to be essential for diagnosis, treatment and prevention. APHL’s viral load scale-up activities in Ghana will help those already afflicted by HIV/AIDS to receive effective treatment and will ultimately decrease the number of new infections in the country.
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By Samantha Dittrich, manager, Global Health Security Agenda, APHL
Over the past 60 years, the number of new diseases per decade has increased nearly fourfold. Since 1980, the number of outbreaks per year has more than tripled. These alarming trends have serious implications for human and animal health as well as severe and lasting economic consequences in affected areas.
In order to address these human health threats, a One Health approach is needed. One Health recognizes that the health of people is connected to the health of animals and the environment, and calls for interdisciplinary collaboration and communication in healthcare and public health practice. With the Global Health Security Agenda (GHSA) in progress, the One Health approach is more important than ever before, and partners must come together to accelerate progress towards a world safe and secure from infectious disease threats.
Inside public health laboratories around the world, scientists handle dangerous pathogens while testing human, animal and environmental specimens for disease. But these pathogens aren’t just confined to laboratory vials and storage tubes: they travel. Often diseases originate in local communities where samples are collected at healthcare facilities that are not equipped to safely and securely handle them. Blood, stool and even animal carcasses may be stored at clinics or emergency operations centers for hours or even days before the samples are transported to laboratories, often on via methods that lack the security requirements for safe sample handling, storage and disposal.
- Safe handling of pathogens in a laboratory or public health setting by scientists or clinicians is biosafety. Simply put, biosafety is keeping yourself (the public health laboratory professional) safe from laboratory mishaps.
- Keeping dangerous pathogens secure and out of the hands of someone who may want to use them intentionally to harm others is biosecurity.
Biosafety and biosecurity are fundamental parts of the GHSA. Laboratory biorisk management means instituting a culture of rigorous assessment of the risks posed by infectious agents and toxins and deciding how to mitigate those risks. It involves a range of practices and procedures to ensure the biosecurity, biosafety and biocontainment of those infectious agents and toxins. Threats posed by deliberate release (aka, bioterrorism) and accidental release of infectious agents from a laboratory can happen anytime and anywhere. To mitigate the risks, it is critical that we are prepared to prevent, detect and respond to these threats.
As a partner in the GHSA, APHL collaborates with ministries of health worldwide to develop effective national laboratory systems. One of the ways we do that is by providing guidance to our global partners to reduce laboratory biosafety and biosecurity risk. All laboratories – whether they test human, animal or environmental specimens – should develop and maintain biorisk management systems tailored to their unique operations and risks. There is no one-size-fits-all biorisk management system.
Most recently, APHL drafted a Biorisk Management Framework as a tool for partners in Ghana. The Framework offers a comprehensive, systematic approach to laboratory biorisk management. It includes a list of essential elements Ghanaian laboratories can use to assess their operations and better integrate and enhance biosafety and biosecurity programs, whether it is a human, veterinary or environmental laboratory.
In the coming months, APHL will work with partners from public health laboratories, local hospitals, and the veterinary and research communities to discuss a comprehensive, standardized approach to the development of a national Biorisk Management Framework. The goal of this One Health effort is to reduce laboratory biosafety and biosecurity risk.
Preventing the next outbreak will require a One Health approach with close collaboration among the health, animal, agriculture, defense, security, development and other sectors. APHL will be there as a partner, advisor and sounding board for countries working to better manage laboratory biosafety and biosecurity risk.
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Dr. Isabel Pinto, Director of the National Directorate of Medical Assistance (DNAM) at the Mozambique Ministry of Health, has a clear and simple vision for the future of public health in Mozambique: quality information. “Information is key for all decisions,” she says.
Paper-based systems are the norm for tracking health information in most laboratories in Mozambique. There are backlogs of paper forms needing to be recorded into laboratory logbooks; patients waiting weeks or months for routine laboratory test results; and public health officials lacking timely disease surveillance data to inform public health responses. Simply put, paper-based systems are laborious, prone to errors and unmanageable.
Now Dr. Pinto and her team are tackling this challenge with the help of APHL’s Mozambique field team. Their goal is to move all of Mozambique’s major laboratories from paper-based to electronic laboratory information systems (LIS) to better capture and track clinical and public health data. Laboratories around the world use LIS to manage patient and public health data including ordering diagnostic tests, capturing test results, generating reports and tracking samples.
Transitioning laboratories from a paper-based system to an electronic system is no small task. Dr. Pinto and the APHL Mozambique team began this endeavor by implementing an enterprise LIS for the country’s eight main referral hospital laboratories. Each laboratory first needed to be equipped with a network server to store and transmit data, the LIS software and computers to store and retrieve data from the server, diagnostic equipment that electronically transmits patient results to the LIS and well-trained laboratory staff to effectively use the LIS to support their work. In many cases, installing an LIS even requires an overhaul of the laboratory’s workflow because certain processes often prove to be redundant when an electronic system is introduced. After several years of intensive work and funding from the CDC and PEPFAR, all eight hospital laboratories are now equipped with LIS.
Beyond the LIS, a secure central database was also created within the Ministry of Health to capture the participating laboratories’ information. Data from all laboratories using the LIS are sent to this central database on a near real-time basis allowing for rapid analyses and reporting, and the ability for national decision makers, such as Dr. Pinto and her colleagues, to provide feedback to laboratories throughout the country.
With the central database at the Ministry of Health and LIS at major referral hospital laboratories, the APHL Mozambique team, working with the CDC, turned to the country’s health centers as the next phase. For these smaller health centers, installing LIS is not yet feasible due to limited infrastructure and staff capacity, so laboratory scientists still rely on a paper-based system to track their samples and data. The paper-based system becomes especially arduous when health centers need to send samples to a referral hospital for additional testing. To address this problem, APHL, working with the LIS vendor, developed a simple software application that creates a unique barcode for each sample after it is collected and transmits the test order and patient data electronically to the referral laboratory. The health center then ships the sample to the referral laboratory where the barcode is scanned into the LIS, and the previously entered patient and sample data are matched with this barcode. Once testing is completed, the referral laboratory returns the test results to the health center via the same application. While not the ultimate solution, it is a significant step forward. This software application drastically reduces the dependence on paper-based systems, which means faster and more accurate results for patients, higher data quality for public health officials and less overwhelmed laboratory staff. Thanks to funding through PEPFAR, nearly 60 health centers across Mozambique are now using this software application, and the APHL team is working with partners to install it at an additional 100 health centers.
Many challenges still remain. Most significantly, linking rural health centers to the system poses unique logistical and infrastructural challenges given inconsistent electricity and internet connectivity in those areas. The APHL Mozambique field staff continues to work to find creative solutions that will allow even the most remote locations to order tests and track results electronically.
Project by project, Dr. Pinto’s vision for Mozambique’s public health system is taking shape. Millions of laboratory records are flowing into Mozambique’s central database. What’s more, laboratories in Zambia, Tanzania, Kenya, Ethiopia and Vietnam have looked to Mozambique as a model for their own LIS solutions.
Now Dr. Pinto and her team face a new challenge: analyzing all that data.
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By David Mills, PhD, retired director, Scientific Laboratory Division, New Mexico Department of Health
When I first got involved in twinning, I had no idea that Halloween costumes would be part of the process. Let me explain.
During my time as director of the New Mexico public health laboratory, APHL connected my team with an equivalent lab in Paraguay. This entailed sending personnel to train their laboratorians, who later came to Albuquerque to see our work in action. Our “twin” labs developed strong bonds and this “twinning” project left a good taste in everyone’s mouth.
A year later, when APHL asked if we’d help Uganda’s Central Public Health Laboratory evolve into a national reference lab, we jumped at the chance to twin again.
Our first step was to visit Uganda to learn about their priorities and see what was truly achievable. We had an instant rapport with the Ugandan team and their director, Steven Aisu, and our discussion quickly reinforced how well matched our labs were. Our team had just moved from an old, cramped facility to a state of the art facility, just as the Ugandan team needed to do.
Because Aisu’s team was developing a new paradigm without ever seeing the process in action, our task was to help them clearly visualize the goal and then make it a reality through technical assistance, management and leadership training. We were all excited to get started.
The second step was for Sally Liska, retired director of the San Francisco public health lab, and me to hold training sessions in Kampala, the capital of Uganda. I loved doing these interactive courses because, for me, teaching is the best way to learn.
The Ugandan team was eager to know everything about how we ran our biosafety level 3 (BSL-3) lab, so the third step was for the Ugandan team to visit our facility in New Mexico. They met with experts from epidemiology to IT, quality assurance to maintenance, as well as senior officials. They were especially interested in how we worked with agricultural and environmental partners; Aisu described such collaborations as akin to bridging chasms. We shared our hard-won experiences. His team quickly gained proficiency in physical and scientific quality systems.
Just as important, we built strong relationships that will last.
I invited the team to my home for their last night in New Mexico before their return flight to Uganda. It happened to be Halloween, but we had been so busy it hadn’t come up in conversation. When the first trick-or-treaters arrived, I suddenly realized that my friends had never experienced the holiday. They were surprised and enchanted to find witches, ghosts and other costumed children at the door. It’s a good thing they were delighted—150 creatures of the night rang our bell over the next few hours! The following morning, we said farewell, but not goodbye.
I retired in 2015, but my connection to the Uganda team has continued without breaking stride. In June 2016, I went to Kampala for two weeks to help them develop strategic plans for their national health lab system and for oversight and regulation of the country’s entire health system. On my team were APHL consultants Kim Lewis and John Pfister, who has retired from the Wisconsin state lab.
A month later, we three musketeers facilitated a stakeholders’ meeting to review those plans and helped refine the strategic plan for their new facility (built by CDC) as they prepared for the September 2016 grand opening.
The New Mexico team has continued working with the Ugandan team as they transitioned into their new roles, and I have jumped in with both feet as a consultant through APHL. If they can stand my jokes, the least I can do is help them take their next steps. It’s my calling.
A Little Extra Fun…
This story isn’t directly related to my work with the laboratory, but I love telling it! While we were in Uganda, we stayed in a small hotel where the friendly manager would often come and chat. One day, she asked, “Have you ever had an avocado before?” I said, “Yes, I make guacamole with avocados.” She’d never heard of guacamole, so I described it and she grimaced, saying, “That sounds terrible!” I offered to make some anyway.
Two days later, I had a night off from teaching and was sitting in the lobby when the manager came up to me and said, “We’re ready! Let’s make the guacamole. The whole kitchen staff is waiting!” Sure enough, a chef with a tall white hat and his crew were lined up behind the ingredients: avocados, lemon juice, garlic, onions. I was astonished and eager to get cooking!
Together, we made a huge batch for the hotel staff and served it on fried corn tortillas. Everyone was game to try it. Although first their reactions were uniformly polite yet skeptical, they eventually grew enthusiastic.
My conclusion: Guacamole is an acquired taste.
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