Highlights of the PIHOA Regional Lab Initiative in the US-affiliated Pacific Islands Vasiti Uluiviti Regional Lab Coordinator PIHOA 58 th Meeting – Honolulu, HI Aug 5 th – 7 th 2015

Overview  Background of the USAPI Laboratories  Lab Capacity Building in the USAPI  Laboratory Preparedness and Infectious Disease Surveillance in the USAPI  Communication, networking and collaborations with partner agencies/institutions  Challenges  Conclusion

ASA LBJTMC CNMI GPHL (L2) YAP KOS CHK EBE MAJ PNI ASA THC PIHOA Regional Lab Initiative Association of USAPI Labs (AUL)  All (except GPHL) provide both public health & clinical lab services CLIA- waived CLIA- regulated Non- regulated PAL I. Background of the USAPI Laboratories

II. Lab Capacity Building in the USAPI  Improving Lab Quality Management Systems in the USAPI GOAL By 2018 – 2019, one to two labs in the freely-associated states of FedSM, Palau and RMI seek lab accreditation to an accrediting institution of their choice. a. Lab Quality Management System (LQMS) Training Involves training of all lab staff in the USAPI 2014 – completed for Yap, Palau & A/Samoa 2015 – completed for CNMI, Kosrae & Ebeye Note: Kosrae LQMS training delivered by Maria Marfel (Yap Lab supervisor); Ebeye LQMS training delivered by Tebuka Toatu (SPC Lab Specialist, Pohnpei, FSM) 2015 – upcoming for Pohnpei (Aug), Guam (Nov) 2016 – upcoming for Majuro (Jan)

 Improving Lab Quality Management Systems in the USAPI b. Development of Quality Lab Manuals Manuals compiled are tailored to meet the needs and requirements of the local lab (takes into account the local government systems in place) 2014 – completed for Yap, Palau, A/Samoa (THC & LBJTMC Labs) 2015 – completed for CNMI 2015 – to be completed for Kosrae & Ebeye (Sept) and Guam (Nov) Pohnpei Lab – utilizes the FedSM National Quality Manual 2016 – upcoming for Majuro (Jan)

 Improving Lab Quality Management Systems in the USAPI c. Strengthening Lab Management Towards Accreditation (SLMTA) 2016 – upcoming SMLTA initiative Objective:  Build the potential and capabilities of lab managers/supervisors to confidently improve their labs’ quality management systems in the USAPI and focus on becoming accredited to a lab accrediting institution of their choice.  closely work with lab managers/supervisors to implement LQMS improvements in a step-by-step manner SLMTA training workshops will be conducted at 3 sub-regional sites in the USAPI

 Microbiology Enhancement & Skill-up Training at Guam Public Health Lab (GPHL) GOAL By June 2016, GPHL to provide confirmatory testing for Typhoid, Cholera and food and water-borne infections. A SPC – PIHOA collaboration Initiative to: o Provide training to skill-up microbiology lab diagnostic capacity o Provide preparatory training for the enhancement of public health food and water microbiology lab capacity o Provide technical assistance to strengthen lab-based surveillance of PPHSN outbreak-prone diseases Phases 1 and 2 completed as of May 17 th Upcoming Phase 3 in August 2015.

 Microbiology & Hematology Enhancement & Skill- up Training at the Yap State Hospital Lab, FedSM 3 weeks onsite training in Yap, FedSM Fiji MOH Trainers Completed in May – June 2015

III. Laboratory Preparedness and Infectious Disease Surveillance in the USAPI GOAL Support lab surveillance through effective facilitation of testing and specimen transport to reference and confirmatory lab testing during outbreak situations. Advisory for referral of specimens to reference labs in Hawaii & US mainland Ebola MERS-CoV Specimen transport in the USAPI On-going IATA shipping training As of May 31 st 2015 – 94 currently certified shippers in the USAPI (67% are lab shippers) Effective use of the PIHOA shipping mechanism

Endorsement of the PIHOA Meeting resolution # “Concerning Lab Preparedness among PIHOA member States to support shipping Ebola and/or highly infectious disease specimens for reference public health laboratory testing; and/or other emergent outbreak/situations” $2,000 - $3,000 contribution to the PIHOA Reimbursable Fund for specimen transport and other urgent lab needs.

Overview of reference labs used by the USAPI labs PIHOA shipping mechanism Dengue/ Lepto/Chikun /Flu Measles/Rubella /Mumps HIV GC/ Chlamydia Hawaii State Lab CDC Labs (Atlanta/Puerto Rico/Fort Collins) NRL, Melbourne, Aust Institut Pasteur, Noumea, NC

12 CDC Labs (Atlanta/Fort Collins, CO CDC Labs (Puerto Rico) Cairns GUAM HONOLULU NOUMEA

Specimen transport mechanism in the USAPI The PIHOA Shipping Mechanism 13 Airline Cargo charges PIHOA account Hawaii State Lab or Diagnostic Lab Services (DLS) Freight Forwarder (Courier Corporation of Hawaii/TNT-Guam) Airline Cargo Station (United Airlines/Hawaiian Airlines) USAPI Lab Shippers PIHOA pays shipping invoices PIHOA (PIHOA Revolving Fund) CCH/TNT charges PIHOA account PIHOA seeks reimbursement of shipping costs from institution concerned CDC Labs, Atlanta Replenishment of PIHOA Revolving Fund Communicate s

IV. Communications, networking and collaborations with partner agencies/institutions Association of the USAPI Laboratories (AUL) On-going interactive collaboration between AUL and PIHOA which helps provide support with the implementation of lab improvement activities in the USAPI. PIHOA – APHL collaboration PIHOA continues to collaborate closely with the Association of Public Health Labs (APHL) in the development of work plans and activities for the new Guam Biosafety Level 3 Public Health Lab facility (DoD funded) to be built by the next 3 years.

PIHOA – HHS collaboration Currently revising USAPI shipping poster and job aids for USAPI shippers. Currently collaborating with HHS on using webinars for the next AUL conference calls. PIHOA – SPC collaboration PIHOA continues to be part of the SPC PPHSN Coordinating Body (CoB). SPC continues to financially support the flu shipment costs through the use of the PIHOA shipping mechanism. SPC - PIHOA co-facilitation of the microbiology enhancement training at GPHL.

PIHOA – FNU Seeking academic credits for the PIHOA-SPC facilitated microbiology enhancement training course at GPHL.

V. Challenges  Slow receipt or in-coming of the $2,000 - $3,000 contribution by each USAPI for the PIHOA Reimbursable Fund (as per the PIHOA meeting resolution # 57-01)  Slow progress in LQMS improvement activities Lack of quality culture Lack of priority or urgency for laboratory issues Inadequate resources and infrastructure Lack of quality champions Poor lab management Lack of support by Ministries of Health Weak area of human resources and capacity No urgency in LQMS implementation Little incentive for staff/small salaries (2 nd jobs, etc. )

V. Conclusion Acknowledgements: CDC/APHL for continual support of the PIHOA Regional Lab Initiative ASTHO – support of the LQMS training in the USAPI PIHOA BoD

Thank you!!! (w) (cell)