1. 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

2. 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

3. 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

4. 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

5. Organizational Structure of INS (2) INS Technology Plataform ResearchCommunication, information and Health surveillance Laboratory network and referral services MACRO-PROJECTS Molecular Biology Virology Celular immunology Serology Others BSL-3

6. - 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 System INS

7. 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

8. 2008 (HCN) 2010 (Quelimane) 2010 (Beira) 2006 (INS) 16,000 tests/lab/year Laboratory capacity – Early Infant Diagnosis (HIV 1) INS

9. Sample tested 2010: Health units = 350 Samples tested = 42.000 HIV diagnosis in children – expansion of services (2007 – 2010) INS

10. Mozambique Early Infant Diagnosis Logistics PMTCTProvincial Hospital PCR Lab ART PMTCT Samples to lab Results to Site Expedited Results System (ERS) Provincial Hospital INS

11. 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

12. ERS Impact - Results in Maputo City Sample Collection Sample at Lab Result Ready Result to Site Result to Patient Patient Enrolled C&T INS

13. “Real-time” Statistics for Program Monitoring INS

14. Sample Message INS Date: 14-05-2010 Time: 10:05:00 Laboratory: INS Maputo Health Center: CS - 1 de Junho Analysis: DNA PCR _________________________ Laboratory Code: 1468/10 Date of Processing: 13-05-2010 Date of Collection: 01-05-2010 Result: Positive Name: Nilesh Bhatt NID: 078/10 Date of Birth: 01/04/2010 Patient Contact: 823861130 _________________________ Patient should be urgently referred for care and treatment!

15. 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 SectorPartners National Institutes of Health anchors the program, provides MoH leadership Provincial health directorates plan rollout and provide 1st line of supervision/support INS

16. 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

17. 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

18. 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

19. 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

20. Future INS Building - Marracuene INS

21. New INS Building - Marracuene

22. 1 st Floor  Director’s Suite  Human Resources / Finance / Data Processing  Epidemiology Staff  Reference Libray  Multipurpose Room  Accessioning Lab  Shipping / Receiving  Insectary  Animal Care ~2,360 m 2 / ~25,400 SF + ~180 m2 / ~1,960 SF covered outdoor space Circulation 87 m 2 Building Support 427 m 2 Open Office 287 m 2 Amenity 291 m 2 Vertical Circulation 115 m 2 Covered Outdoor 180 m 2 Space Mechanical / Core 176 m 2 Vivarium 583 m 2 Insectary 128 m 2 BSL2 Lab 193 m 2 Lab Support 73 m 2

23. 1 st Floor Training

24. 2 nd Floor  Bacteriology & Parasitology Department: - Fungal & Mycobacterial Isolation - Bacteriology & Serology - Parasite & Host Biology - Intestinal & Urinary - Teaching Laboratory  Glass Wash  Media Prep ~2,570 m 2 / ~27,700 SF Circulation 48 m 2 Building Support 108 m 2 Open Office 864 m 2 Conference 70.5 m 2 Vertical Circulation 115 m 2 Mechanical / Core 155.2 m 2 BSL 3 Lab 35.2 m 2 BSL2 Lab 498 m 2 Lab Support 683.4 m 2

25. 2 nd Floor Teching Lab

26. 2 nd Floor Microbiology

27. 3 rd Floor  Virology & Cell Biology Department: - BSL-3 Lab - Virus Isolation - Molecular Biology & Genomics/Proteomics - Cellular Immunology  Morphology & Immunoassay Mechanical / Core 155.2 m 2 BSL 3 Lab 118 m 2 BSL2 Lab 476 m 2 Lab Support 617.3 m 2 Circulation 48 m 2 Building Support 108 m 2 Open Office 864 m 2 Conference 70.5 m 2 Vertical Circulation 115 m 2 ~2,570 m 2 / ~27,700 SF

28. 3 rd Floor BSL-3

29. Instituto Nacional de Saúde de Moçambique