feature
APHL staff and members with Vietnam team
APHL is now transitioning the LIMS support to Kenya’s MOH. The next step is
to create one seamless uber-system for data exchange among laboratories,
hospitals and national health officials, and a technical working group is
already meeting to figure out the details.
A second APHL initiative is laboratory mapping—documenting the capabilities
and testing capacities of all laboratories in Kenya, so, said Ochieng, “if there is
an outbreak in any part of the country, the MOH will know the nearest facility
that has the capability to test that specimen [for the outbreak pathogen].”
A questionnaire focusing on priority diseases—cholera, measles, anthrax,
brucellosis and others—has been developed and an electronic survey system
selected. Data collection will begin late 2016.
A third critical activity centers on data quality—instituting a system for
external proficiency testing to gauge the accuracy of test results and identify
training needs. APHL has been managing the effort for the past two years and
has achieved a laboratory participation rate of 95%. Ochieng and Nyaga are
now in discussion with the MOH regarding the creation of a national repository
for all external quality assurance data.
We want to provide a good solution for all these [provincial]
laboratories to refer these samples up even before the
physical specimen arrives [at the Institut Pasteur] and to
be able to securely get results back.
Vietnam—“All they need is a computer and an internet
connection.”
Vietnam was one of the first countries APHL worked with under PEPFAR
and one of the first to begin work under the GHSA. This populous nation of
93 million has long borders and a busy commercial life, with $159 billion in
exports in 2015, including textiles, seafood, rice and electronics.
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LAB MATTERS Fall 2016
Ken Landgraf, MS, a CDC advisor from the QED Group consulting firm, has
been working in-country here for the past 2.5 years. He said, “One of Vietnam’s
biggest trading partners is the United States, but there’s also lots of trade with
China, a lot of poultry crossing borders and lots of opportunities for new flu
strains to arise in the region. Antibiotic stewardship is very limited.”
Strengthening the country’s disease surveillance, said Landgraf, is a “win
for everyone.”
As in Kenya, a hallmark APHL activity has been LIMS implementation.
Reshma Kakkar, MA, APHL’s global health LIMS manager, said when she
arrived here in 2005, “all of the laboratories we saw used paper-based systems,”
including the national public health laboratory. “Nobody knew what a
LIMS was.”
She said, “[T]hey were already fairly organized and somewhat standardized.
. . . What we sensed was they didn’t necessarily want a proprietary LIMS they
would have to keep paying for in the long run. We had to figure out an optimal
solution that was sophisticated enough to support a variety of tests, but that
also could be in a sense owned by them, so they would have control over it.”
The answer was OpenELIS, an open source LIMS designed by three US public
health laboratories. Fast forward to 2016, and that system is now in 39
Vietnamese laboratories.
During a March 2016 visit, Kakkar met with the laboratory director in a large,
pediatric hospital in Ho Chi Minh City. The hospital’s 400 doctors and 800
nurses see between 5,000 and 8,000 patients each day. The laboratory—now
accredited under ISO 15189—performs seven million hematology tests per
year. When samples arrive at the laboratory, they are tagged with the same
barcode appearing on the accompanying paperwork with patient information.
Doctors no long write test requests out longhand. Transcription errors are way
down, and test data is searchable: “You don’t have to flip through books. Now
they can actually do some analysis of the data.”
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