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INSTITUTO NACIONAL DE SAÚDE

INSTITUTO NACIONAL DE SAÚDE. UEM/UCSD MEPI External Advisory Board Meeting National Institute Laboratory of Molecular Biology and the Biomedical Research Training in Mozambique: domestic and international Nilesh Bhatt MD MMED Researcher. Brief introduction of INS.

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INSTITUTO NACIONAL DE SAÚDE

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  1. INSTITUTO NACIONAL DE SAÚDE UEM/UCSD MEPI External Advisory Board Meeting National Institute Laboratory of Molecular Biology and the Biomedical Research Training in Mozambique: domestic and international Nilesh Bhatt MD MMED Researcher

  2. Brief introduction of INS National Institute of Health is a research and technical-scientific institution subordinated to the Ministry Of Health. The MOH approved in 2009, the Stretegic Plan of INS for period 2010-2014. - Eight strategic axis. - Each axis have one or more strategics objectives. - Each axis is targeted through one or more macro-project.

  3. Mision and vision of INS Mission: Participate in improvement of well being of Mozambican population, by generating and promoting the incorporation of scientific and technology solutions for the principal conditions and health problems in Mozambique. Vision: To be national reference in generating and proposing technical and scientifically based solutions for promotion, prevention and attention to health in Mozambique.

  4. Organizational Structure of INS (1) To implement mission/vision of INS and to implement efficiently the Strategic Plan of INS, a new organic structure was adopted in March 2010. The new organic structure is matrix type, where implementing units are Technology Platforms (Laboratory) and the Macro-Projects. The INS is organised in 5 central Department.

  5. Organizational Structure of INS (2) INS Technology Plataform Research Communication, information and Health surveillance Laboratory network and referral services Molecular Biology Virology Celular immunology Serology BSL-3 MACRO-PROJECTS Others

  6. - HIV-1 DNA PCR (available for all country) - HIV-2 PCR (available for all country) - HIV indeterminate cases (available for all country) - HTLV-1 PCR (available for all country) - Influenza PCR (available for all country) - HIV-1 resistance testing - HIV-1/HBV/ HCV viral load Molecular Biology Unit – referral unit for the National Health System INS INS

  7. Mozambique EID Context early 2009 INS • 2 Labs • >3000 samples per month nationally • Result turnaround times minimum of 3-4 months Nampula Lab INS Maputo 7

  8. Laboratory capacity – Early Infant Diagnosis (HIV 1) INS 2008 (HCN) 2010 (Quelimane) 2010 (Beira) 2006 (INS) 16,000 tests/lab/year

  9. HIV diagnosis in children – expansion of services (2007 – 2010) INS Sample tested 2010: Health units = 350 Samples tested = 42.000

  10. INS PMTCT Provincial Hospital PMTCT Provincial Hospital Mozambique Early Infant Diagnosis Logistics Expedited Results System (ERS) PCR Lab Results to Site Samples to lab ART

  11. Expedited Results System (ERS) INS Server saves data and sends to printers, results only deleted once confirmed receipt from the printer Data codified when sent via GPRS with no possibility of erroneous transmission Admin sends results using automated software, saving precious tech time Server GPRS Wireless Network Internet Printer simple “black box” so HCWs only need to plug in and await their results Real-time stats Printer in Health Center Lab Database (LIS) Lab manager can monitor results transmission and know if printers are functioning or not 11

  12. ERS Impact - Results in Maputo City INS Result Ready Result to Patient Sample Collection Result to Site Sample at Lab Patient Enrolled C&T

  13. “Real-time” Statistics for Program Monitoring INS

  14. Sample Message INS Date: 14-05-2010 Time: 10:05:00 Laboratory: INS Maputo Health Center: CS - 1 de Junho Analysis: DNA PCR _________________________ Laboratory Code: 1468/10 Date of Processing: 13-05-2010 Date of Collection: 01-05-2010 Result: Positive Name: Nilesh Bhatt NID: 078/10 Date of Birth: 01/04/2010 Patient Contact: 823861130 _________________________ Patient should be urgently referred for care and treatment!

  15. Partner, Private Sector, and Government Partnership INS Ministry of Health/ National Institutes of Health • National Institutes of Health anchors the program, provides MoH leadership • Provincial health directorates plan rollout and provide 1st line of supervision/support Private Sector Partners • CHAI provides technical support and coordination • PEPFAR/MSF procure printers and support rollout • CDC/APHL support future applications (CD4, TB, etc.) and LIS Database management • MCEL agrees to cover ongoing network usage fees • Sequoia Technologies maintains server and provides ongoing TA and support

  16. Further Application of the Expedited Results Systems INS • Strengths: • 100% confidentiality of results • 100% guarantee of transmission • Low cost of GPRS network usage (~1% of SMS cost) • Easy, rapid scale-up • Automated, reduces workload of HCWs • Challenges: • Use of a single network, APN required • Upfront programming at labs • Requirements: • At labs: electricity, internet • At health centers: electricity, network coverage • Printers: ~$295*/unit with 2-year warranty • Thermal paper rolls: <$1 each, prints 2-300 results Aim is to include TB Culture, CD4, and Viral Load Results in the ERS in near future *Price varies with volume

  17. Biomedical Research Training in Mozambique: domestic and international INS • Currently, INS employs 128 workers: • 3 with PhD level and 7 with MSc/MMED level. • 73 are graduated. • 45 with elementary, basic and medium level. • 30 staff of INS are involved in MSc and PhD programs. • Master of Science • Field Epidemiology and Laboratory Training Program (FELTP) • Infectious Diseases • Basic science • Others

  18. Pos-Graduation Courses - INS (1) Master in Health Science Collaboration between INS and FIOCRUZ (Brasil). 10-15 students every 2 years. Started in 2008. The first 6 students graduated in Novembro 2010 in Maputo. Master in Field Epidemiology and Laboratory Collaboration between INS, UEM and CDC (USA). 10-12 students every 2 years. Started in August 2010 with 11 students (10 are MOH staff).

  19. Pos-Graduation Courses - INS (2) PhD in Public Health and Bio-Medicine Collaboration between INS, UEM, FIOCRUZ (Brasil) aand IHMT (Portugal). To be started in 2012.

  20. Future INS Building - Marracuene INS

  21. New INS Building - Marracuene

  22. Director’s Suite • Human Resources / Finance / Data Processing • Epidemiology Staff • Reference Libray • Multipurpose Room • Accessioning Lab • Shipping / Receiving • Insectary • Animal Care ~2,360 m2 / ~25,400 SF + ~180 m2 / ~1,960 SF covered outdoor space Mechanical / Core 176 m2 Vivarium 583 m2 Insectary 128 m2 BSL2 Lab 193 m2 Lab Support 73 m2 Circulation 87 m2 Building Support 427 m2 Open Office 287 m2 Amenity 291 m2 Vertical Circulation 115 m2 Covered Outdoor 180 m2 Space

  23. Training

  24. Bacteriology & Parasitology Department: • - Fungal & Mycobacterial Isolation • - Bacteriology & Serology • - Parasite & Host Biology • - Intestinal & Urinary • - Teaching Laboratory • Glass Wash • Media Prep ~2,570 m2 / ~27,700 SF Circulation 48 m2 Building Support 108 m2 Open Office 864 m2 Conference 70.5 m2 Vertical Circulation 115 m2 Mechanical / Core 155.2 m2 BSL 3 Lab 35.2 m2 BSL2 Lab 498 m2 Lab Support 683.4 m2

  25. Teching Lab

  26. Microbiology

  27. Virology & Cell Biology Department: • - BSL-3 Lab • - Virus Isolation • - Molecular Biology & Genomics/Proteomics • - Cellular Immunology • Morphology & Immunoassay ~2,570 m2 / ~27,700 SF Circulation 48 m2 Building Support 108 m2 Open Office 864 m2 Conference 70.5 m2 Vertical Circulation 115 m2 Mechanical / Core 155.2 m2 BSL 3 Lab 118 m2 BSL2 Lab 476 m2 Lab Support 617.3 m2

  28. BSL-3

  29. Instituto Nacional de Saúde de Moçambique

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