Lab Matters Spring 2018 | Page 22

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