Lab Matters Summer 2020 | Page 22

GLOBAL HEALTH A Global Response to COVID-19: Mozambique, Zambia and Zimbabwe By Sarah Snyder, specialist, Global Health and Lucy Maryogo-Robinson, director, Global Health APHL was the first US laboratory partner that the US Centers for Disease Control and Prevention (CDC) turned to for technical assistance support at the launch of the President’s Emergency Plan for AIDS Relief (PEPFAR). APHL began implementation of PEPFAR activities in 2004 working to strengthen laboratories across Africa, the Caribbean, Europe and Asia. While activities under PEPFAR focused on HIV/TB epidemic response, APHL has been unwavering in its commitment to building laboratory systems globally. This emphasis on laboratory system strengthening has proven invaluable to COVID-19 response efforts. Zimbabwe In 2013 APHL began a partnership with the Ministry of Health of Zimbabwe to improve the quality of laboratory testing within the country. Over the next six years, APHL worked with local stakeholders to identify six major laboratories across the nation to support their journey towards international accreditation. Thanks to APHL mentorship, procurement, training, internal assessments and continuous quality improvement projects all six laboratories received ISO accreditation in January 2020. This major achievement could not have happened without the dedicated APHL staff in Zimbabwe who, despite economic turmoil and political unrest, continued to ensure APHL success on the ground. Today all six accredited laboratories are testing for COVID-19 as the current pandemic rages on. Mozambique Mozambique was a pioneer in standardizing laboratory data management. Even though they began in 2006 with an initial focus on paper-based A technician inputs test results into a reporting program systems, strengthening their paper-based tools and logbooks laid a foundation for deploying electronic laboratory information systems at central and provincial laboratories throughout the country. To reduce turnaround time, APHL also supported implementation of an electronic sample referral system for remote test order and results receiving at over 150 locations. All these data are pushed to a laboratory data repository hosted at the Ministry of Health that can be used to provide key performance indicator data for one or multiple laboratories. This robust structure has been essential in enabling the Ministry of Health to be prepared for a public health emergency. These networks and systems have been successfully repurposed for the COVID-19 response, empowering health facilities to submit test requests electronically for COVID-19 testing, utilizing previously implemented automation in testing laboratories and rapidly developing data visualization options utilizing the laboratory data repository. APHL has been recognized as a trusted laboratory partner for the Mozambique Ministry of Health. Zambia APHL has supported Zambia’s Ministry of Health laboratory services unit through the implementation of efficient, cost effective and high-quality clinical and public health laboratory services: • Implementation of power backup systems in the wake of increasingly inconsistent grid power supply • Capacity building in testing at hub laboratories • Strengthening courier systems for specimen transportation • Electronic laboratory information management systems implementation/ support • Remote electronic specimen registration/results receipt • Overall laboratory data management. Key COVID-19 testing laboratories— including the main COVID-19 testing laboratory, University Teaching Hospital— have benefited from this support while scaling up pandemic response. APHL’s work continues as efforts expand to ensure the safe disposal of laboratory waste through waste management training and the installation of modern incineration systems in laboratories across the country. The COVID-19 pandemic has illuminated the significance of global health to domestic health security and underscored the need to implement a “One Health” approach. APHL’s consistent focus on strengthening laboratory systems globally has helped countries better prepare for outbreaks. This work must continue to be a priority–the future of US public health and US health security are inextricably tied to global health.• 20 LAB MATTERS Summer 2020 PublicHealthLabs @APHL