Category Archives: Global Health Security

01Dec / 2017

Scaling-up viral load testing in Ghana is critical to stopping HIV

Scaling-up viral load testing in Ghana is critical to stopping HIV | www.APHLblog.org

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.

The post Scaling-up viral load testing in Ghana is critical to stopping HIV appeared first on APHL Lab Blog.

Posted by in aids, All Posts, APHL, ghana, Global Health, Global Health Security, HIV, World AIDS Day

Permalink

30Oct / 2017

Partner, Train, Respond: Increasing Global Emergency Management Capacity

People walking a busy street in Zanzibar.

Countries in Africa are no strangers to major disease outbreaks that can result in illness and death of millions of people.  In the past two years alone the continent has experienced infectious disease outbreaks of cholera, meningitis, Ebola Virus Disease, Lassa fever, and Yellow fever, and other public health emergencies such as drought and famine.

Understanding the big picture

Training participants from Zanzibar discuss the development of an emergency management program
Training participants from Zanzibar discuss the development of an emergency management program.

It is vitally important to have a big picture perspective on emergency management and response – if one country is not prepared for a public health emergency, then all the countries in the region are susceptible to public health threats that can easily cross borders and impact surrounding countries. This is where public health emergency management (PHEM) comes in. In-country PHEM capacities and systems can be strengthened to support global health security. When the workforce is trained, emergency management infrastructure is in place, and functional systems exist, a country is better positioned to execute a coordinated response that can mitigate risk and save lives.

CDC and other international partners support ongoing efforts to help countries across Africa build capacity in outbreak detection and response. This includes preventing avoidable epidemics, detecting public health threats early, and responding rapidly and effectively to outbreaks of international concern. CDC provides expertise in PHEM to train emergency management technicians, provide input on emergency management operations, and guide development of functional processes and systems for ministries of health around the globe.

Getting the workforce ready to respond

In August 2017, CDC spearheaded a 5-day PHEM workshop in partnership with the World Health Organization, the United States Defense Threat Reduction Agency, and Public Health England.  The workshop brought together 55 emergency management staff members from across Africa to learn from experts in the field about how to enhance coordination and response capabilities of their country’s PHEM programs.

Participants came from seven countries – Tanzania, Uganda, Kenya, Ethiopia, Liberia, Sierra Leone, and Nigeria – which all share common interests and challenges related to emergency response. The training focused on developing core principles in PHEM, including trained staff, physical infrastructure, and processes to run a fully functional Public Health Emergency Operations Center (PHEOC). The training highlighted best practices, but since many of the participants had first-hand accounts of responding to public health events in their own countries, they were encouraged to share experiences and network with their peers.

Sharing knowledge and expertise

Public health professionals who work in emergency response know that it’s important to build relationships before an incident so that during a response you work effectively and efficiently with partners. One participant noted that the “rich, valuable contributions from other people’s experiences to build upon what I already knew” was one of the most rewarding parts of the workshop.

The tabletop exercises at the end of the workshop emphasized the importance of information and idea sharing. Participants engaged in tabletop exercises that simulated a response to a Yellow Fever outbreak in northern Tanzania. Participants were divided into 7 teams: management, plans, logistics, operations, finance and administration, communication, and partners. Each team had a mix of participants from different countries.  Teams utilized information they had learned throughout the workshop to developed response products, including an organizational structure chart, objectives for the response, and an initial situation report. This exercise led to a robust conversation about different approaches to public health emergency response.

Seeing response in action

Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.
Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.

A highlight of the training was when Dr. Ally Nyanga, the Tanzania Ministry of Health PHEOC Manager and an alumni of the CDC Public Health Emergency Management Fellowship, took workshop participants on a tour of the Tanzania PHEOC, a small room on the third floor of the Ministry of Health building. Previously used as a storage area for the library, the 10 x 20 foot PHEOC is now an efficient space that staff can use when they respond to public health emergencies and outbreaks.  To date, Tanzania’s PHEOC has been activated to respond to widespread cases of Aflotoxicosis, a type of severe food poisoning, and cholera outbreaks in Tanzania.

While the workshop is over and participants have returned home, the work that they do to prepare for the next public health emergency is ongoing. The workshop highlighted some important takeaways – you do not need a big space and high-tech equipment to respond quickly and efficiently to a public health emergency.  Instead, coordination to share information, resources, and ideas is vital to a successful emergency response, both in-country and across an entire region.

Learn more

Posted by in africa, exercise, Global Health Security, Preparedness, public health, public health emergency management, Public Health Emergency Operations Center, Response, sierra leone, tanzania, training, workforce development

Permalink

27Feb / 2017

Stockpile Expert Helps Responders Prepare for Emergencies

Tom Jackson touring proposed medical materiel storage site in Yaounde, Cameroon in March 2015.
Tom Jackson touring proposed medical material storage site in Yaounde, Cameroon in March 2015.

In the United States, most of us take it for granted that if we need medicine – cough syrup, aspirin, or even most antibiotics – we can just run down to the pharmacy and get it. That’s because our medical supply chain – the series of organizations, companies, and systems that make sure those shelves are stocked – works well. In an emergency, we even have a stockpile of medicines on hand and people with the skills and resources to deliver it anywhere in the United States within 12 hours.

In many parts of the world, it can be hard to even get the basics.

One of the essential goals of the Global Health Security Agenda is to create a structure for sending and receiving medicines and materials (medical countermeasures) and staff between international partners during public health emergencies. As a senior training advisor for the Strategic National Stockpile, my job is to help responders in other countries figure out how to make their supply chains work in any type of public health crisis. The stockpile has hosted medical supply chain workshops in developing countries, including Ethiopia, Uganda and Cameroon.

Every link in the chain is critical

From L to R – Tom Jackson, Joe Vital, and Michael Ayres: DSNS facilitators for medical countermeasures workshop at Ethiopia Public Health Institute in Addis Ababa, Ethiopia, February 2016.
From left to right – Tom Jackson, Joe Vitale, and Michael Ayres: DSNS facilitators for medical countermeasures workshop at Ethiopia Public Health Institute in Addis Ababa, Ethiopia, February 2016.

In a crisis, every link in the chain has to be working properly.

For example, if there’s a disease outbreak, what good is it to send a team to take a sample if you can’t ship that sample to a lab?

Or maybe there’s a nearby lab, but the lab workers don’t have the equipment or training to process the sample. How do you figure out what you’re up against and what supplies to order?

And, finally, if the supply chain can’t get the necessary medicines and supplies to the people who need them, all the other response achievements don’t matter. It all has to be in place, and it all has to work together.

Every emergency – and every place – is different

If every emergency were the same and required the same resources, figuring out how to help people would be easy and no one would ever have to suffer due to a lack of medicine or supplies.

But every place in the world is different, both in the risks people face and the resources they have available. I always tell responders to ask the right questions: What emergencies are most likely to happen? And what can we do to make the supply chain work better?

Let’s say there’s a large-scale public health crisis, and a ship full of medical supplies comes into the harbor. But, there’s not a single dock to unload it. What good are those supplies? However, if there’s even one dock – even if it’s not the best dock – people can unload the ship and deliver help. Improving any part of the supply chain helps.

Any plan is better than none

When I travel to other countries, I tell responders that any plan, even an imperfect plan, is better than no plan at all. In a crisis, we don’t want to be starting from scratch.

What will you do when you’re used to receiving and distributing 20 pallets of medicines and materials and all of a sudden you receive 200…or 2,000? These are the kinds of questions countries should be able to answer before disaster strikes.

Also important is to practice and exercise response plans ahead of time so everyone knows what to do. In the United States, the stockpile partners with state, territorial and local public health to conduct large-scale exercises that simulate a real emergency. This kind of practice is critical to identifying gaps in the plan.

So, in a nutshell, what is it I do? I help countries ask the right questions, plan, and find the resources they need to respond quickly and efficiently. And why do I do what I do? Because I believe this is how we stop outbreaks close to the source and keep epidemics from spreading around the world.

This story illustrates our commitment to implementing the Global Health Security Agenda (GHSA), which aims to improve the world’s ability to prevent, detect, and respond to infectious disease threats. CDC is partnering with 31 countries around the world to reach the goals of the GHSA, including having a national framework for transferring (sending and receiving) medical countermeasures and public health and medical personnel among international partners during public health emergencies.

Posted by in General, global, Global Health Security, medical supply chain, PHPR: Health Security in Action, Preparedness, strategic national stockpile

Permalink

28Nov / 2016

New Lab Matters: Strengthening global health security

New Lab Matters: Strengthening global health security | www.APHLblog.org

The Global Health Security Agenda (GHSA) aims to assure all participating countries implement the revised WHO International Health Regulations so they are able to prevent, detect and respond to disease outbreaks in near real-time. APHL is using the lessons learned in-country through PEPFAR programs to strengthen global health security initiatives involving public health laboratories around the world.

In the fall issue of Lab Matters, our feature article takes a look at the progress toward more robust laboratory infrastructures in three countries.

Here are just a few of this issue’s highlights:

Subscribe and get Lab Matters delivered to your inbox, or read Lab Matters on your mobile device.

The post New Lab Matters: Strengthening global health security appeared first on APHL Lab Blog.

Posted by in All Posts, General, GHSA, Global Health, Global Health Security, lab matters

Permalink

05Jul / 2016

Global Health Security: How is the U.S. doing?

Joint External Evaluation team in Washington DC
The Joint External Evaluation Team joins U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA) colleagues in front of the Humphrey Building, Washington DC, May 2016

A team of evaluators takes an independent look at our systems

The Story Behind the Snapshot

At first glance, this photo taken on a set of concrete steps in Washington, D.C., may look like an ordinary group shot—but it took an extraordinary series of events to make it happen.

The photo shows colleagues from U.S. Department of Health and Human Services (HHS) and U.S. Department of Agriculture (USDA) standing alongside a team of 15 international experts from 13 different countries, known as the Joint External Evaluation Team. The team had been invited by the U.S. government to assess how well the country is prepared to prevent, detect, and respond to major public health threats. The goal was to receive an independent and unbiased evaluation of our capabilities.

We would never have arrived at this moment without these things: a wake-up call, a historic agreement, and a renewed commitment to work together to protect the world’s health.

Leading up to now: A brief timelineInternational Health Regulations: Protecting People Everyday

Near the turn of this century, the emergence of diseases like severe acute respiratory syndrome (SARS) and H5N1 influenza was a big wake-up call and showed the world more clearly than ever that a health threat anywhere is a threat everywhere — what affects one country affects us all.

Eleven years ago, countries came together to sign the International Health Regulations (IHR), a historic agreement which gave the world a new framework for stopping the spread of diseases across borders. The IHR obligates every country to prepare for, and report on, public health events that could have an international impact.

However, five years after the IHR went into effect, nearly 2/3 of countries were still unprepared to handle a public health emergency.

Two years ago, the Global Health Security Agenda (GHSA) gave countries common targets they can work toward to stop infectious disease in its tracks. This led to the need for the Joint External Evaluation Team, an independent group that travels to countries to report on how well public health systems are working to meet global health security goals.

Last October, the Centers for Disease Control and Prevention (CDC) and the Office of the Assistant Secretary for Preparedness and Response (ASPR) began working together to arrange for the team to visit the U.S.

In May, the team’s five-day visit took place. Two days were spent in Washington, D.C., assessing federal response capabilities. The remaining three days were spent at CDC, because the agency works in nearly all of the 19 technical areas included in the evaluation.

On the final day of their visit in Atlanta, the evaluation team shared their preliminary results. The final, full report is now available online.

What the team found

In the final report, the assessment team concluded that, “the U.S. has extensive and effective systems to reduce the risks and impacts of major public health emergencies, and actively participates in the global health security system established by the IHR.” They recognized the high level of scientific expertise within CDC and other federal agencies, and the excellent reporting mechanisms managed by the federal government.

They also identified opportunities for improvement in some areas, such as:

  • Combining and utilizing data from multiple surveillance systems, including systems that monitor human, animal, environmental, and plant health
  • Conducting triage and long-term medical follow-up during major radiological disasters
  • Communicating risks quickly and consistently with communities across the country
  • Improving overall One Health surveillance systems for antimicrobial resistance and zoonotic diseases

They specifically recognized the challenges any federal public health system faces, and advised the U.S. to continue improving the understanding of the IHR among different federal and state agencies. Their observations will help drive improvements for programs throughout CDC and the nation.

The U.S. requested this unbiased review of its response capabilities and hopes that the entire world will do the same.

For More Information

Posted by in General, Global Health Security, International Health Regulations, Joint External Evaluation, PHPR: Health Security in Action, Preparedness, public health

Permalink