global health
Public Health System Reform in Ukraine:
Making Impactful Changes in the Public
Health Laboratory
By Marie-Claire Rowlinson, PhD, assistant laboratory director, Florida Bureau of Public Health Laboratories-Jacksonville, Florida Department of Health;
Olga Ponomareva, MD, laboratory services program director, Miami-Dade County Health Department, Florida Department of Health; Marianna
Azarskova, MD, PhD, MBA, CDC Ukraine; and Sherrie Staley, MPH, manager, Global Health
Much has happened in Ukraine since
2010 when APHL began working in the
country under the President’s Emergency
Plan for AIDS Relief (PEPFAR) funding.
Now Ukraine is taking the first steps
to completely reform its public health
system. This creates an opportunity for
public health and its laboratory partners
to make some important changes in a
system that has been rigid for many years.
In close collaboration with the US Centers
for Disease Control and Prevention
(CDC) and Ministry of Health partners
in Ukraine, APHL staff and consultants
have worked on various projects to
support HIV laboratories—starting with
a laboratory assessment in 2010 and
going on to more targeted activities such
as developing a new algorithm for HIV
testing, strengthening the public health
laboratory network, building management
and leadership skills among laboratory
professionals, and assisting with strategic
and operational planning. During this
time, a twinning relationship between
the Ukraine Ministry of Health and
the Florida Department of Health has
blossomed. Three public health laboratory
consultants from APHL work with the
Florida Department of Health, leading the
partnership from strength to strength.
In November 2017, four colleagues from
Ukraine swapped the snow for sunshine
and visited Florida. The week-long visit
was a whirlwind around the state. The
first day was spent at Florida Department
of Health headquarters in Tallahassee,
meeting with senior staff in the Division
of Disease Control and Health Protection,
and the Bureau of Epidemiology,
who provided a general overview of
epidemiology and surveillance in the state
as well as an in-depth review from the
HIV and STD Programs. The following two
days were spent at the state public health
laboratory in Jacksonville learning about
the HIV laboratory, testing algorithm and
new molecular methods on the horizon,
such as whole genome sequencing.
The final two days were spent at the
Miami-Dade County Health Department,
and the local and state public health
laboratories in Miami. The Florida
Department of Health shared best
practices and activities related to their
goal of eliminating HIV transmission.
These included:
• The “Test and Treat” program
• Use of post- and pre-exposure
prophylaxis (nPEP and PrEP
respectively)
(from l to r) Dr. Marianna Azarskova (CDC Ukraine), Sherrie Staley, Dr. Volodymyr Kurpita (UCPH), Dr. Marie-Claire Rowlinson, Dr.
Ulana Suprun (Ukraine MOH) Scott Becker, Dr. David Mills, Robyn Sagal
20
LAB MATTERS Spring 2018
• Routine and targeted HIV screening
and testing at the community level
• HIV surveillance, database verification
and management.
Our colleagues from Ukraine also visited a
needle exchange site and a care resource
center to see how Miami is battling the
epidemic. Their last day in Miami aptly
coincided with World AIDS Day.
“In the Florida warmth we had an
opportunity to discuss many positive
considerations related to laboratory
improvement,” said Dr. Marianna
Azarskova, CDC Ukraine laboratory lead.
“Now we are back to our winter weather,
but the enthusiasm to instantly embody
new ideas is not frozen in us.” This is true
from both sides of the Atlantic Ocean!
In February 2018, APHL consultants
traded their sun for snow and headed
to Ukraine to facilitate a works