EID, CPHL, MoH, DBS, PITC

And I thought consultants use a lot of acronyms...

Today I got to attend a meeting at CPHL which is Uganda's Central Public Health Laboratories. Many of our teams work closely with folks at CPHL so I'll be spending time here probably every week. ​

Most of the work I'll be supporting over the next few weeks relates directly to EID (Early Infant Diagnosos). In order to get all HIV+ children on ART (antiretroviral therapy), we need to make sure that we increase rates of testing. 

I'm learning more about the testing algorithms, but generally, it's important to test infants until they are no longer breastfeeding (false positives result due to antibodies from the mother). 

The health facilities use DBS (dry blood spot) tests for EID. It basically looks like a little index card with 5 perforated circles where you prick the infant and drop a little bit of blood into each of the circles. The index card also includes all the patient and health facility information for tracking. What's great about these DBS tests is that they don't need to be refrigerated and are easily transported (the index card gets put into a sandwich-sized zip lock bag).

These get consolidated and delivered or shipped (not sure about the logistics) to CPHL where there's a room of folks opening, consolidating, and running quality checks on the tests and associated information. Data then gets entered into some sort of computer system, which the lab also has access to.

The lab computer allows the lab technicians (is that their title?) to create "worksheets" of samples with bar codes. They look for the correct DBS tests, and start setting up their trays. 

​No idea how the science works behind all this...but the lab tech puts all the samples in order, then puts one of the little blood samples (still on the paper) into a little test tube with a reagent. That reagent pulls the blood off the paper and into the fluid, so that it can be tested for the antibodies. I think they sit for awhile on that machine (where they're in the square configuration) before they are ready to get put into the large machine scanners. ​The bar codes allow the machines to assign results from the trays (based on location in the tray) directly to the profile in the computer system. 

From what I've been hearing, consolidating all the testing in this central lab (they also run sickle cell tests, TB, malaria, and probably others) was a big success. I think there was a CHAI team working on that (maybe why our logo is on the plaque) to increase quality control, data collection and reporting, and process standardization. The CPHL website says that funding comes from the Government of Uganda and PEPFAR (United States President's Emergency Plan for AIDS Relief) through the MoH (MInistry of Health)-CDC Cooperative Agreement. PEPFAR is a huge source of funding and I believe one of the few that will support the purchase of commodities (e.g. test kits) which is important because there's a predicted stock shortage coming soon. I don't know much about the MoH-CDC relationship, maybe some of my Deloitte federal friends know a thing or two about this :)

I'm excited to continue geeking out over all this over the next few months. It was really cool to see things in action today and next week I'll be "in the field" helping with a lot of data collection at health facilities. We're gathering a lot of data that create a baseline for many different indicators (# of HIV+ children started on ART, % of tests given to children in the TB ward, etc.) that we'll measure against over time. 
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Also, last night I had amazing bibimbap that, I have to say, was better than Del Seoul. I had leftovers but the power was out all day today which means no refrigeration...think it's still good?

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