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The Laboratory’s Key Role in Scale-Up and Sustainability Seema Meloni, Ph.D., M.P.H.

The Laboratory’s Key Role in Scale-Up and Sustainability Seema Meloni, Ph.D., M.P.H. Harvard School of Public Health. AIDS Prevention Initiative Nigeria.

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The Laboratory’s Key Role in Scale-Up and Sustainability Seema Meloni, Ph.D., M.P.H.

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  1. The Laboratory’s Key Role in Scale-Up and Sustainability Seema Meloni, Ph.D., M.P.H. Harvard School of Public Health AIDS Prevention Initiative Nigeria

  2. BirxD, de Souza M, Nkengasong JN. The interaction of health and laboratory systems, clinical research, and service delivery. Am J ClinPathol. 2009; 131:849-51. “Strengthening national health laboratory systems in resource-poor countries is critical to meeting the United Nations Millennium Development Goals.”

  3. Notes from the Field The Harvard PEPFAR Track 1.0 Program Experience in Nigeria

  4. Overview: Harvard PEPFAR Nigeria • 2000: Through Bill & Melinda Gates Funding, Harvard has been working with multiple hospitals and prevention programs in Nigeria • 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

  5. Objectives of the Harvard PEPFAR Nigeria Lab Program • Integrate within the Federal Government of Nigeria health system plan • Develop state-of-the-art laboratory services for multiple service tiers • Provide cost-effective, accurate, and high-quality laboratory service • Develop sustainable continuous training program to support partner sites • Build program-wide quality system for lab diagnosis and/or monitoring • Support electronic data capture of all laboratory records

  6. Jos University Teaching Hospital

  7. Laboratory Network & Infrastructure • Tertiary Laboratories: 11 labs in 6 states • Secondary Laboratories: 15 labs in 7 states • Primary Laboratories: 45 (in progress)

  8. 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

  9. Jenvak Hospital Tundun Wada Solat Women’s Hospital Nassarawa Medical Center Abnira Medical Center PHC Amo Katako Seventh Day Adventist PHC Jengre PHC Zabolo PHC Dorowa Babuje BarakinLadi General Hospital PHC Maikatako Jos University Teaching Hospital PHC Sho PHC Kerang Panyam Cottage Hospital PHC Mangu PHC Gindiri PHC Amper Pankshin General Hospital PHC Kabwir FCE Clinic PHC Ganawuri Vom Christian Hospital PHC Chugwi PHC Riyom Plateau State, Nigeria:Model for Satellite Development

  10. Volume of Laboratory Tests Performed in 2011

  11. Notes from the Field The Harvard PEPFAR Laboratory Master Trainer and Site Support Program in Botswana

  12. Train site-level lab personnel as site Master Trainers Laboratory Master Trainer & Site Support Program Team Laboratory Master Trainer Corps Coordinator (Director of the National HIV Reference Laboratory) 1 Lab Master Trainers (assigned by Government) 6 BHP-PEPFAR Lab Master Trainers

  13. 2002-2004: 2 Labs with CD4 and Viral Load Capabilities BHHRL NHHRL BHHRL – Botswana Harvard HIV Reference Laboratory NHHRL – Nyangagbwe Hospital HIV Reference Laboratory

  14. 2005-2008: 21 Laboratories with CD4 Capabilities CD4 Equipment FacsCalibur FacsCount Coulter Partec CyFlow FacsCount at a Clinic

  15. 2005-2008:8 Laboratories with Viral Load Capabilities Viral Load equipment Roche Taqman48 CavidiExaVir Load Equipment available – no space

  16. Effect of Decentralization of Labs Number of Tests

  17. 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)

  18. Acknowledgements P. Okonkwo T. Jolayemi J. Samuels E. Ofuche B. Banigbe S. Ochigbo R. Olaitan P. Akande T. Oyebode B. Akinyemi O. Eberendu C. O’Martins J. Adeola I. Abbas A. Obakeye I. Adewole D. Olaleye J. Idoko S. Sagay O. Agbaji O. Idigbe D. Onwujekwe C. Okany R. Nkado W. Gashau H. Muktar J. Abah C. Chukwuka S. Akanmu F. Ogunsola P. Kanki (PI) R. Marlink J-L. Sankalé D. Hamel B. Chaplin H. Rawizza A. Dieng-Sarr G. Eisen C. Smith M. O’Malley C. Chang H. Reyes N. Ulenga L. Dinic J. Hosseini U. Ijeoma E. Koch C. Wen A. Weiss P. Burns M. Farhani All our colleagues at the PEPFAR sites in Nigeria and Botswana. And, most importantly, the patients R. Murphy K. Scarsi K. Hurt B. Taiwo C.Achenbach J. Makhema T. Gaolathe M. Mine This work was funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration.

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