Archive for the 'Global Health' category

Using Technology to Combat HIV/AIDS in Swaziland

Apr 25 2012 :: Published in Global Health

This week is National Medical Laboratory Professionals Week and National Environmental Laboratory Professionals Week.  APHL is honoring the many individuals working public health and environmental laboratories around the world.  Stay tuned for blog posts this week featuring the work of many of those unsung heroes working to protect the public’s health.
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Computerized information systems make work easier in many fields, including laboratory practice. But can a laboratory information system (LIS) help make a dent in one of the world’s worst HIV epidemics?

Laboratory and health experts in the Kingdom of Swaziland are betting the answer is yes.

Swaziland, a geographically small, landlocked nation bordering South Africa and Mozambique, has been home to human inhabitants since at least the early Stone Age 200,000 years ago. Today, however, the country’s population of 1.2 million is seriously threatened by the highest HIV prevalence rate on the African continent. An estimated one of every four adults is infected with HIV, and many of those are co-infected with TB or multi-drug resistant TB, both of which are also highly prevalent.

Swaziland

Health experts know that HIV prevention, education, testing, counseling and treatment programs are essential to reverse such a daunting public health crisis. Swaziland has responded with a campaign to reduce HIV transmission by circumcising HIV-negative men aged 15-49, and with greatly increased access to testing at voluntary counseling and testing centers and other Ministry of Health (MOH) laboratories. Yet these efforts have been complicated and slowed by reliance on paper-based systems.

Marie-Claire Rowlinson, PhD, a former senior APHL global health specialist, said an electronic LIS “is important for quality of testing and therefore for the quality of patient services.” She continued, “It enables laboratory technicians to test samples more efficiently and with fewer errors in the testing process. For example, because the LIS is integrated with testing instruments, there are fewer manual transcription errors, and quality control procedures can be monitored more easily.”

All of this has a positive impact on testing quality, speed and volume. Technicians are able to spend more time generating potentially life-saving test results, rather than entering data by hand. And the test data can be retrieved in seconds.

Rowlinson added, “A common issue for the labs in Swaziland is that patients will get the same test two days in a row when they only need one, which wastes much needed resources. With a paper-based system, it is much harder to track what tests a patient is getting, but with an electronic LIS this can be monitored.”

Fortunately, the advantages of electronic information management will be coming to Swaziland Ministry of Health (MOH) laboratories soon. APHL completed a laboratory assessment in Swaziland last year and is assisting the MOH with development of an LIS strategic plan for the country. Previously APHL helped MOH stakeholders in the selection of an LIS software vendor.

In 2012, the new electronic LIS system will be installed in the national reference laboratory, the Mbabane Government Hospital National Reference Laboratory, and five other MOH laboratories. It is hoped that the new LIS system will eventually be installed in all 18 MOH laboratories, and the current stand-alone systems made interoperable to enable real-time data exchange.

“In addition to improving quality and expanding test volume, the LIS can be used to centralize data and support MOH decision making,” said Ralph Timperi, MPH, a senior advisor for laboratory practice and management at APHL. He explained, “You can put personnel data on a central database so you can see where your technicians are, their ages and education. You can determine whether you need to provide training for people in one location or if key people are nearing retirement.” He added, “You can store supply information and equipment information, so you know: Where is the equipment? How old is it? An LIS gives you the ability to accurately keep track of things in real time. That’s a very helpful thing.”

In the end, said Timperi, it all comes down to one critical trade-off that can indeed make a difference in a HIV epidemic:  “Putting out quality test results versus moving paper.”

 

Other Lab Week blog posts: 

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Social Media As a Tool for Real Time Tracking of Diseases?

Oct 13 2011 :: Published in Global Health, Infectious Diseases

By Sikha Singh, MHS, Senior Specialist, Laboratory Response Network

Recently CNN.com featured an article titled Using social media for disease surveillance, providing examples of real life breakouts that demonstrate how the internet has fundamentally changed global health surveillance.  Epidemic intelligence, says the author John Brownstein, flows not only through government hierarchies but also through informal channels, ranging from press reports to blogs to chat rooms to analyses of Web searches.  Social media outlets promote real-time reporting, accessible almost anywhere to users with internet-capable devices.  Twitter users, for example, tweet first hand information that has the potential to provide a wealth of information to groups that monitor trends in social media activity.  The downside of self-reporting, however, is that false information may generate widespread misperceptions.

Researchers at the Johns Hopkins University have adapted a model that can rapidly comb millions of public twitter messages to identify up-to-the-minute trends.  Initial studies have revealed patterns in self-medication for illnesses that don’t typically require a visit to the doctor.  For example, Twitter users reported using Tylenol or Advil for pain relief and Claritin or Zyrtec for allergies.

Google Flu Trends, a website that maps flu activity around the world based on data from Google searches, is another demonstration of how information expressed in web searches enables extraction of social and health trends.  Additionally, the web resource called HealthMap offers real-time, contextualized information on health events both local and distant.

It is undeniable that social media is an emerging tool that plays an increasing role in alerting the public to what is happening in the world.  Consider the vast reach of social media: if Facebook were a country, it would be the world’s fourth largest, behind only China, India and the United States.   What are the public health surveillance and disease tracking implications of self-reporting through social media?  Will health agencies increase their reliance on ubiquitous social media outlets for disseminating vital health information?

I wonder how Facebook feels about the potential for capturing, synthesizing and analyzing the information generated from the chatter of its over 800 million active users.  Can social media services capitalize on their wide reach to promote public health campaigns?  Will self-reporting in the form of tweets and status updates ever truly benefit epidemiological investigations by offering accurate and reliable data?   Maybe the masterminds (ahem, Mr. Zuckerberg) behind some of the most popular social media services will answer these questions.  Calls for comment to Facebook headquarters were not returned. (Or made).

To learn more about APHL and its social media activities please connect with us on our Blog, like us on Facebook, follow us on Twitter, join us on LinkedIn and watch us on YouTube.

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APHL Assists Haiti to Rebuild Devastated Lab System

Jul 22 2010 :: Published in Global Health, Partners

On January 12, 2010 tragedy struck in Haiti. A massive earthquake rocked the tiny national, particularly Port-au-Prince, causing damage and destruction that will take years to repair.

One of the buildings severely damaged in the earthquake was the public health laboratory. Deemed unsafe for use, laboratory operations moved to a tent erected outside of L’Hôpital de l’Université d’État d’Haïti (HUEH). Since the earthquake, the number of patients being treated at HUEH has tripled from 14,000 per month to almost 42,000 thus increasing demands for laboratory testing. Due to extremely high temperatures and no air conditioning in the tent, automated testing requiring cooler temperatures, such as hematology and blood chemistry, are being run manually. The result is that the current testing capacity is only 25% of the daily demand.

Following the earthquake, the Centers for Disease Control and Prevention requested and authorized APHL Senior Technical Consultant and Team Leader for the APHL Haiti Field Laboratory Support Team, Dave Doherty, to assist all of the public health network laboratories in Haiti in getting testing services back up and running to support the enormous demands for medical care and treatment

Upon learning of the dire needs in the tent laboratory, Doherty sought out to find an air conditioner that would help keep the tent at the appropriate temperature. Before he knew it, a casual conversation with a Doctors Without Borders volunteer led him to International Relief Solutions (IRS), a Georgia based company that creates modular buildings in areas of need. The APHL Haiti Field Laboratory Support Team led by Doherty provided technical assistance to IRS in planning and design of a new modular laboratory facility to will replace the temporary tent facility.

The 24’ by 36’ modular laboratory will stand next to HUEH. The facility is designed with infrastructure for work benches, heating, ventilation, plumbing and electrical services. With direct hookup to electrical and water supplies, the laboratory building will have the air conditioning necessary to meet the requirements of the many intricate and delicate tests that the laboratory technicians on scene perform routinely. The lab will arrive with the electrical system and plumbing pre-installed allowing for a quick start-to-finish set up of approximately four days.

Better lab facilities will improve testing services and will enable laboratory technologists to get back to work. According to Doherty, “Many well-trained technologists in Haiti are unable to work and provide testing services because of the loss of laboratory facilities to earthquake damage.”

It could be years before the permanent structures are rebuilt; the new modular lab serves as a long term solution. This initiative was a success due to the collaboration of willing and committed partners, each of whom brought essential resources and expertise to assure an effective solution for meeting a critical need in Haiti. Lives will be saved and illnesses treated effectively because of the efforts of APHL, IRS and CDC. Doherty modestly explains, “We were able to come through. APHL has always come through in Haiti.”

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Rebuilding Haiti’s Labs: Governance, Policies and Systems Before Bricks and Mortar

Apr 20 2010 :: Published in Global Health

At a March 31 United Nations special session on rebuilding Haiti, countries responded with pledges of significant funding for the decimated nation; however, funding alone will not rebuild Haiti, and certainly not its battered laboratories.

First, Haitian leaders must find the courage and commitment to confront corruption and inefficiency within their government. Without a fundamental shift from opportunism to public service, donors will not be willing to sustain the long—and costly—process of recovery.

Photo: A typical lab in Port-au-Prince, Haiti

Second, the international donor community must adopt new operational models that are less dependent on the services of ex-patriots. Good models are available. Paul Farmer at Partners in Health and Jean William Pape at GHESKIO/ Weill Cornell Medical College, for example, have shown that impoverished communities with few resources can combat diseases and improve health care. Their approach—like that of APHL’s project in Haiti—is to build long-term partnerships with local groups and to help train their doctors and healthcare professionals.

Third, Haiti’s laboratories need to be reconceived and rebuilt as part of an integrated national laboratory network operated under a strong quality management system. A precursor to this is development and implementation of a revised national laboratory policy and strategic plan to guide the orchestration of the necessary resources, including a trained and competent workforce.

Yet the reality at the moment is that there isn’t a comprehensive and forceful Haitian laboratory policy, strategic plan or network, only the commitment of the country’s national laboratory to forge a true laboratory system and support from some non-governmental organizations. How can APHL best support development of a nationwide laboratory system that will serve all of Haiti’s people? We look forward to your comments.

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National Public Health Week — APHL Honors Public Health Laboratories

Apr 08 2010 :: Published in Environmental Health, Food Safety, General, Global Health, Infectious Diseases, Newborn Screening and Genetics, Public Health Preparedness & Response

By Mary Shaffran, Senior Director, Public Health Programs, APHL

Along with our partners, the public health laboratories are working to keep communities healthy. Laboratorians work behind the scenes. Public health laboratories serve as the nation’s early warning system for diseases and other health hazards. When health risks emerge or re-emerge, public health laboratories analyze the threat, provide the answers needed to mount an effective response and act to protect the public in collaboration with other decision makers. They protect our health by monitoring continuously for diseases and other health hazards.

Just a few of the things that laboratories are doing every day to make sure that you and your neighbors are healthy:

- Public health laboratories in every state are the backbone of our nation’s infectious disease surveillance networks. They are analyzing infectious diseases such as influenza to determine if they are changing and reporting this information to public health officials so they can determine effective prevention measures. [More on the Infectious Disease Program]

- More than 11,000 babies are screened daily for potentially life-threatening genetic and congenital disorders

  • Matt and Noelle Bamonte discovered that their seemingly healthy baby boy had PKU, a serious disorder that can cause brain damage if not treated from a very early age. Noelle is certain that without laboratory screening, her little boy would have been vastly different. Now, aside from a strict diet, he lives a normal life! [More of their story]

- Public health laboratorians confirm whether people are infected with sexually transmitted diseases, and confidentially report back the results so that people can be treated and others are not exposed. [More on the Sexually Transmitted Disease Program]

- In order to detect foodborne outbreaks and ultimately keep Americans safe from foodborne disease, public health laboratorians test human specimens and food samples for bacteria such as Salmonella and E. Coli.

  • In 2006, the New Mexico public health laboratory pinpointed the exact source of the E. Coli that made its way into spinach and made hundreds of people sick. [More on the E.Coli outbreak]

- Public health laboratorians test environmental, clinical and food samples to determine whether they contain hazardous agents in order to protect Americans from terrorist attacks, and they are able to do this 24/7.

  • California scientists are collecting specimens from 2,000 people to test for the presence toxins used in used in industry, agriculture and the home. They’ll use this information to explore such things as the connection between exposure and diseases, and to examine changes in exposure over time and the connection to changing health policies and industry regulations working to reduce exposure. [More on the work in California]

- Public health laboratorians test water samples in flood-ravaged areas to ensure that the water is safe to drink.

  • In 2008, severe flooding in Mason City, Iowa caused the closure of the water treatment facility. Residents were advised to boil their water until the system was restored and the water was tested to ensure it was safe to drink. The Hygienic Lab rose to the task and tested the water quickly bringing the treatment operation back online. [More on the floods in Iowa]

We would like to thank our unsung heroes in lab coats for protecting the public’s health – every day. Join APHL and our many partners in celebrating National Public Health Week. For more information, visit http://www.nphw.org/.

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APHL Working to Ensure Power for Laboratory Services in Haiti

Feb 16 2010 :: Published in Global Health, Laboratory Systems and Standards, Public Health Preparedness & Response

When the electrical grid comes back on-line in Haiti, the country’s laboratory system will be able to ramp up services quickly thanks to measures put in place before the magnitude 7.0 temblor January 12.

Even before the devastating earthquake, electrical power in Haiti was unreliable, with routine outages and serious voltage and frequency variations that compromised laboratory testing. Outages can lead to the loss of valuable testing reagents that must be stored at controlled temperatures, while “dirty power” is damaging to a wide range of laboratory equipment, including instruments used for diagnostic testing to support antiretroviral treatment for HIV-infected patients.

With funding from CDC’s Global AIDS Program and funding and technical assistance from the US Agency for International Development, APHL invested in site-specific technologies to improve the quality of the power received from the electric grid and provide continuous power during grid power outages. The core technologies include uninterruptible power supplies, generator back-up power with automatic transfer switches and no-contact inverter battery systems.

In addition, APHL has provided on-site maintenance and supervisory support visits with two-person teams comprised of one laboratory technologist and one service technician that travel to 16 supported sites throughout the country. Thankfully, Haiti’s national public health laboratory, the Laboratoire National de Santé Publique in Port-au-Prince, remains standing in the aftermath of the earthquake.

Although the massive relief effort has consumed all the country’s resources—with surviving laboratory staff understandably focusing on their homes and families—APHL is hopeful that conditions will improve enough to enable public health testing to resume in the not too distant future. At that point, the electrical support infrastructure will be a valuable help.

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First Day Back in Haiti: Notes from January 22, 2010

Jan 26 2010 :: Published in Global Health, Public Health Preparedness & Response

By David Doherty, APHL Consultant

Just had an aftershock as I was beginning to type this message. Here is a very brief synopsis of the site visits from today:

1) Bernard Mevs
- no damage to hospital or lab
- no electricity but a 100kW generator is supposed to arrive from Jamaica tomorrow AM
- they have Sysmex but no automated chemistry; Drs. Bitar (Jerry and
Marlon) are desperate to get up and running to do haemograms and blood typing; they are doing as many as 20 surgeries an hour
- all lab techs survived but are homeless; spoke with two of them this afternoon; one is in Miragoane and is willing to return to work on Monday; another is sleeping outside in P-ville and will be returning to Hinche to accompany the older members of her family out of the city

2) HUP
- some damage to lab and hospital; mostly horizontal cracks on non-load bearing walls; all beams seem to be intact
- no electricity in lab
- Sysmex but no automated chemistry
- spoke with lab supervisor and Drs. Fontilus and Sant Fleur; all technicians are ready to report to work once they open the lab; she has requested one of the APHL techs if we get them a Vitros

3) Hopital Carrefour
- no damage to infrastructure; MSF has taken over the hospital temporarily; they will be moving to a new site on Monday and Carrefour will resume independent operation
- inverter and generators are intact; only concern will be availability of fuel
- no automated hematology except Hb and white cells using Point Care instrument; no automated chemistry
- spoke with the medical director, Dr. Dauphin; Ms. Barolette, the lab supervisor, had just left; all his technicians survived and are available as soon as he gives the word

4) Fame Pereo
- major structural damage to second floor; lab is intact but unsafe due to the unstable mass of concrete above
- inverters are damaged but functional Sysmex and Reflotron operational
- all technicians are available for work except one who returned to Gros Morne; spoke with her this evening and she is ready to return once she has a place to work
- spoke with the medical director, Dr. Pean; she is looking for another building to house the clinic temporarily; she will require some funds to get the lab set up if space is located

5) Maternite Isaie Jeanty
- no major structural damage to hospital or lab; hospital opening half days for emergency cases only
- lab was operating with power during the visit
- no automated hematology except Hb and white cells using Point Care instrument; no automated chemistry

Did not attempt to visit HUEH because it has been taken over by the US Military and PIH.

We need to help CMMB unload a plane tomorrow morning. I will visit NPFS if there is time while we are in the neighborhood. Hoping to get to Leogane tomorrow afternoon to see Sanatorium Sigueneau and St. Croix. (Ran into a team of US doctors on the plane to Miami; they were being posted to the latter site.)

Taking a team of orthopedic surgeons and anesthesiologists to Jacmel on Saturday morning. I will check out St. Michel and Marigot. Don’t think I will have time (or a road) to get to Bainet and Lavalee.

We will resume visits to the remaining sites in the West on Monday (Grace, St. Fracis de Sales, IMIS, etc.). We will not schedule a visit to the GHESKIO main campus as they are overwhelmed.
Lastly, went to the Petionville Club to speak with Coty Reinbold. (He is managing the relief camp there, currently 53,000 people.) The situation for Vitros DT60 is as follows:
a) he has two instruments for GHESKIO that have not been installed
b) he has two instruments for PIH that have not been installed
c) AIDS Relief has 5 or 6 instruments at the warehouse in Delmas that have not been installed; I will be meeting with Olivia tomorrow to confirm that those could be made available for the relief effort if needed; their office and storage depot were not damaged.

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APHL Aids Agencies, NGOS to Set Up Critical Lab Testing Services in Haiti

Jan 22 2010 :: Published in Global Health

Dave Doherty, senior technical consultant for APHL in Haiti, manages a four-person field team that is presently assessing the post-earthquake status of public laboratories for Dr. Jacques Boncy, Director of Laboratoire National de Santé Publique (LNSP), and in support of PEPFAR activities under the direction of Dr. Steve Harris, CDC/GAP Haiti Chief of Party.

Although many of the facilities are severely damaged, many laboratory technicians and supervisors are at the hospital sites and doing what they can under these difficult circumstances. The response of the Haitian laboratory staff is commendable and an illustration of the heroic response of the people of Haiti who have lost family and homes.

The AIDS Relief organization in Haiti identified five Vitros chemistry analyzers and the PEPFAR Supply Chain Management System will provide reagents, so these needed instruments can be used at emergency trauma centers. Doherty’s team will transport the equipment and reagents, and coordinate staff needs and training for technicians. Dr. Boncy has directed APHL to put the instruments into operation at the major hospitals in the Southwest and South where most of the trauma patients are received.

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Public/Global/Environmental Health Leaders Among “Best Thinkers”

Dec 08 2009 :: Published in Environmental Health, Global Health

Foreign Policy Journal just published a special issue centered on the idea of the “Top 100 Global Thinkers.”

As I was reading through my copy, I noticed that a significant number were chosen/noteworthy for public health, global health, climate change, or other environmental issues. While there is overlap (and a likelihood of “classification bias” by me) my review finds the following:

1.) 10 persons noteworthy for public health thought and initiatives…
2.) 5 persons for global health…
3.) 6 persons for climate change…
4.) 2 persons for other environmental issues.

Perhaps this might be of use/interest…or at least a diversion from H1N1. Additionally, several persons are further profiled on what they are reading, who they think are the “best thinkers,” what their best/worst ideas were, etc.

Pat Luedtke, MD, MPH
Laboratory Director
Utah Division of Epidemiology and Laboratory Services

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PulseNet International: Detecting Global Foodborne Outbreaks

Nov 23 2009 :: Published in Food Safety, Global Health

by Kristy Kubota, MPH, senior specialist for PulseNet Program, and Kara Watarida, temporary PulseNet program coordinator

Imagine an international outbreak of E. coli O157:H7. With the changes of the nation’s eating habits, the dynamics of the US population, increased international travel and the globalization of the food supply, global foodborne outbreaks do occur and may increase due to these factors. Thanks to PulseNet International there is a way to determine if an outbreak happening in your town is linked to an outbreak in Europe.

On November 12-13, CDC, APHL, WHO and PulseNet regional coordinators from around the world met in Buenos Aires, Argentina, for the 2nd PulseNet international Steering Planning meeting. This meeting brought together PulseNet coordinators from the United States, Europe, Canada, Pacific Asia, Latin America and Middle East to discuss issues related to protocols/next generation subtyping methods, regional updates and development of a strategic plan for the coming year.

One of the more interesting aspects of this meeting was learning about international outbreaks and how molecular subtyping has been applied for foodborne investigations worldwide. With all nations using the same standardized PulseNet protocols, DNA fingerprints are generated and can be “matched” across country borders. For example, in 2009 PulseNet Pacific Asia conducted an E. coli O157:H7 outbreak investigation associated with a steakhouse restaurant with possible links to U.S. imported beef. The link was dismissed upon sharing the subtyping information between the US and Japan.

The PulseNet network has come a long way since its inception in 1996, as a collaborative “project” between CDC, APHL and a few US states. It has now grown to PulseNet International — United States, Europe, Canada, Asia Pacific, Latin America, Middle East and soon Africa. APHL will continue to support these partners in working towards a sustainable international foodborne diseases surveillance network.

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