Pathology Enhancing Services in Lower and Middle Income Countries (LMIC) Milton Datta, on behalf of Dan Milner (ASCP) Hospital Pathology Associates University of Minnesota Medical School

Models of Pathology Care Laboratory Clinical Pathology – Laboratory testing Anatomic Pathology Surgical pathology Autopsy Pathology Community Hospital Model Administration by a single or small number of pathologists Reference Lab Model Separate Divisions with specialist pathologists Administrators Clinical pathologists Microbiology, Chemistry, Blood Bank, Hematology, Coagulation, Toxicology Anatomic Pathologists Gynecologic Pathology, Hematopathology, Dermatopathology, Head and Neck, Breast, Gastrointestinal, Genitourinary, etc

Reference Lab Model Provides focused care with specialized expertise Advanced training (fellowship) Difficult to staff Need many pathologists with advanced training Most effective with large volume laboratories Large hospital Laboratory serves multiple hospitals

Reference Lab Example 4 Metro Hospitals 13 Regional Community Hospitals *** clinics 7,600,000 lab tests 80,000 surgical specimens 3,700 bone marrow biopsies 4,200 Fine needle aspirations 5,600 cytology specimens 71,400 PAP smears 75,000 square feet space 700 laboratory professionals 37 pathologists

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American Society for Clinical Pathology Since 1922, world’s largest organization of pathologists and laboratory professionals Education, certification, quality standards International certification 80 countries 2005; President’s Emergency Plan For AIDS Relief (PEPFAR) ASCP developed testing capacity in countries affected by the AIDS epidemic. ASCP volunteers and staff traveled to selected countries, assessed the needs of each environment, and created training programs for local technologists Labs testing for human immunodeficiency virus (HIV), associated with treatment.

Key Components Leverage PEPFAR laboratories Currently support diagnostics for HIV, Malaria, TB Have infrastructure in place Collaboration capabilities and management assistance Specialty specific workflow Utilize existing technology Secure private medical records Whole slide imaging technology High speed Internet connections Cloud storage

Supporters and Partners Partners in Health American Cancer Society Institute for Health Metrics and Evaluation American Society for Microbiology Association of Public Health Laboratories The African Strategies for Advancing Pathology Africa Society for Laboratory Medicine Sakura Finetek Roche Diagnostics Pfizer Omnyx, LLC/GE Healthcare IBM Watson The following government organizations support this effort: The White House Office of Science and Technology Policy The National Security Council The National Institutes of Health The National Cancer Institute The Centers for Disease Control and Prevention

Rwanda December 2016 A memorandum of understanding with the Minister of Health of Rwanda Working with the Rwandan Minister of Health First site in Butaro Rwanda Goal: cancer diagnosis and treatment to clinicians in 47 different hospitals

Butaro, Rwanda One Primary Pathologist 2,500 cases 75% covered by primary pathologist Remaining can benefit from telepathology consultation Expand to 25,000 cases as regional reference lab Dr. Deo Ruhangaza serves as the pathologist for the newly opened pathology laboratory in Butaro, Rwanda. The laboratory opened in October 2016 as part of the Partners Initiative, led by ASCP.

Program Expansion Democratic Republic of Congo Biamba Marie Mutombo Hospital, Kinshasa ASCP Country Assessments Kenya Uganda Tanzania Malawi Ethiopia In March 2017, ASCP Dr. Milner and several Partners Steering Committee members visited hospitals, met with the Ministers of Health, and conducted country assessments.

Tanzania and KCMC Opportunities for ASCP Dan Milner, M.D. KCMC Gilleard Masenga, M.D Sarah Urasa, M.D. Furaha Serventi, M.D. Chief of Oncology Balthazar Nyombi, M.D. Laboratory Director Alex Mremi, M.D. Pathologist Patrick Amsi, M.D. Pathologist Pietor Slotwieg, M.D. Pathologist Duke-KCMC PEPFAR SITE John Bartlett, M.D. Duke - Pathology Jiaoti Huang, M.D. HPA – Minnesota Milt Datta, M.D.

Key Additional Needs High throughput tissue processor and slide stainer Laboratory technicians trained in histology Immunohistology autostainer Refrigeration Electrical backup Reagents Antibodies Staining supplies

Preliminary Pathologist Participation List Specialties Number of Pathologists Fellowship trained Faculty Experience Breast 4 Yes Gastrointestinal 3 Gynecologic Genitourinary Hemepathology 2 No Head and Neck Dermatopathology Soft Tissue 1 Lung North Carolina Duke University Minnesota Hospital Pathology Associates HealthPartners