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

INS

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.

INS

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.

INS

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.

INS

Organizational Structure of INS (2)

INS

Technology Plataform

Research Communication, information and

Health surveillance

Laboratory network and

referral services

MACRO-PROJECTS

Molecular Biology

Virology

Celular immunology

Serology

Others

BSL-3

- 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

INS

Molecular Biology Unit – referral unit for the National Health SystemINS

7

Mozambique EID Context early 2009

Nampula Lab

INS Maputo

• 2 Labs• >3000 samples per

month nationally• Result turnaround

times minimum of 3-4 months

INS

2008 (HCN)

2010 (Quelimane)

2010 (Beira)

2006 (INS)

16,000 tests/lab/year

Laboratory capacity – Early Infant Diagnosis (HIV 1)

INS

0

5000

10000

15000

20000

25000

30000

35000

2007 2008 2009

Am

ostr

as T

esta

das

0

50

100

150

200

250

300

US

qu

e c

olh

em

DB

S

Negativos USSample tested

2010: Health units = 350 Samples tested = 42.000

HIV diagnosis in children – expansion of services (2007 – 2010)

INS

Mozambique Early Infant Diagnosis Logistics

PMTCT

Provincial Hospital

PCR Lab

ARTPMTCT

Sam

ples

to la

b Results to S

ite

Expedited Results System (ERS)

Provincial Hospital

INS

11

Expedited Results System (ERS)

Admin sends results using automated software, saving precious tech time

Printer simple “black box” so HCWs only need to plug in and await their results

Data codified when sent via GPRS with no possibility of erroneous transmission

Server

Lab Database (LIS)

Internet

Printer in Health Center

GPRS Wireless Network

Real-time stats

Lab manager can monitor results transmission and know if printers are functioning or not

Server saves data and sends to printers, results only deleted once confirmed receipt from the printer

INS

ERS Impact - Results in Maputo City

Sample Collection

Sample at Lab

Result Ready

Result to Site

Result to Patient

Patient Enrolled C&T

0 30 60 90 120 150 180 210

Ap

r 2

00

9O

ct 2

00

9M

ar

20

10

Days

Transport

Processing

Result Transmission

Results to Patient

Patient to C&T

INS

“Real-time” Statistics for Program Monitoring

INS

Sample Message

INS

Date: 14-05-2010Time: 10:05:00Laboratory: INS MaputoHealth Center: CS - 1 de JunhoAnalysis: DNA PCR_________________________Laboratory Code: 1468/10Date of Processing: 13-05-2010Date of Collection: 01-05-2010

Result: Positive

Name: Nilesh BhattNID: 078/10Date of Birth: 01/04/2010

Patient Contact: 823861130_________________________Patient should be urgently referred for care and treatment!

• MCEL agrees to cover ongoing network usage fees

• Sequoia Technologies maintains server and provides ongoing TA and support

Partner, Private Sector, and Government Partnership

Ministry of Health/National Institutes of Health

• 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

Private Sector Partners

• National Institutes of Health anchors the program, provides MoH leadership

• Provincial health directorates plan rollout and provide 1st line of supervision/support

INS

Further Application of the Expedited Results Systems

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

*Price varies with volume

INS

Aim is to include TB Culture, CD4,

and Viral Load Results in the ERS in near future

• 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

Biomedical Research Training in Mozambique: domestic and international

INS

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).

INS

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.

INS

Future INS Building - Marracuene

INS

New INS Building - Marracuene

1st Floor 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

Circulation 87 m2

Building Support 427 m2

Open Office 287 m2

Amenity 291 m2

Vertical Circulation 115 m2

Covered Outdoor 180 m2

Space

Mechanical / Core 176 m2

Vivarium 583 m2

Insectary 128 m2

BSL2 Lab 193 m2

Lab Support 73 m2

1st Floor

Training

2nd Floor 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

2nd Floor

Teching Lab

2nd Floor

Microbiology

3rd Floor Virology & Cell Biology Department:- BSL-3 Lab- Virus Isolation- Molecular Biology & Genomics/Proteomics- Cellular Immunology

Morphology & Immunoassay

Mechanical / Core 155.2 m2

BSL 3 Lab 118 m2

BSL2 Lab 476 m2

Lab Support 617.3 m2

Circulation 48 m2

Building Support 108 m2

Open Office 864 m2

Conference 70.5 m2

Vertical Circulation 115 m2

~2,570 m2 / ~27,700 SF

3rd Floor

BSL-3

Instituto Nacional de Saúde de Moçambique