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Jeff N. Borchert Health Scientist, Division of Vector-Borne Diseases Global Health Security Demonstration Project Centers for Disease Control and Prevention.

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Presentation on theme: "Jeff N. Borchert Health Scientist, Division of Vector-Borne Diseases Global Health Security Demonstration Project Centers for Disease Control and Prevention."— Presentation transcript:

1 Jeff N. Borchert Health Scientist, Division of Vector-Borne Diseases Global Health Security Demonstration Project Centers for Disease Control and Prevention - Uganda Global Health Security US efforts towards more rapid and effective response 5 th Annual AFENET Conference, Addis Ababa, November 2013

2 Biological threats, whether naturally occurring, intentionally produced or the result of laboratory accident, constitute a growing international threat to humans and the global economy






8 Global Health Risks are Increasing Emergence and Spread of New Pathogens Globalization of Travel, Food and Medicines Rise of Drug Resistance Intentional Engineering of Microbes XDR TB MRSA Anthrax Recombinant Technologies HIV Avian Flu Food Supply


10 Global Health Security – A world safe and secure from global health threats posed from infectious diseases by: Preventing or mitigating naturally occurring outbreaks and intentional or accidental releases of dangerous pathogens, Rapidly detecting and reporting outbreaks Employing an interconnected global network that can respond effectively to limit spread of infectious disease Mitigating human suffering, loss of life and economic impact

11 Detect Respond Prevent …threats early …rapidly and effectively …avoidable catastrophes and epidemics …avoidable catastrophes and epidemics 3 Pillars of CDC’s Approach to Global Health Security

12 CDC sought to develop a model approach of rapid GHS capacity upgrades that could be implemented, improved and duplicated Uganda and Vietnam March – September 2013 Engagement with MoH and Stakeholders (AFENET) Mechanism to accelerate country progress toward IHR goals CDC Global Health Security Demonstration Projects

13 Strengthen the disease surveillance system’s capacity for detection, specimen referral and laboratory confirmation of: MDR-TB and XDR-TB Cholera VHF- Ebola Establish a functional public health Emergency Operations Center Enhance information systems to enable real-time monitoring of epidemics and response by integrating data sources from the disease surveillance and EOC GHS Objectives in Uganda (April-Sept 2013)

14 Demo - Build Upon Existing Efforts Ministry of Health (MOH), Uganda Central Public Health Laboratory (CPHL) Uganda Virus Research Institute (UVRI) National TB Reference Laboratory (NTRL) PEPFAR Investments Enhance District Health Information System-2 (DHIS-2); a web- supported, password protected data base Support MOH district surveillance officers to investigate and report credible events via short message service (SMS) alerts through DHIS- 2 Utilize Early Infant ‘HIV’ Diagnosis (EID) specimen referral hub system to transport, using motorcycles and postal service, biologic specimens for laboratory testing Augment NTRL’s TB GeneXpert roll-out and testing scheme WHO AFRO and AFRICHOL Support culture-based confirmation of Vibrio cholerae at regional hospitals and AFENET Uganda

15 Districts and Hubs

16 Uganda - Laboratory Systems GHS Uganda pathogens of interest Ebola: Suspect cases isolated, specimens collected and transported to UVRI via hub network and Posta Uganda Cholera: Rapid diagnostic tests pre-positioned at 17 district health facilities with specimen referral to regional referral hospital or CPHL via Posta Uganda for culture MDR TB: Sputum transported to a GeneXpert site via EID transportation hubs; rifampin-resistant TB specimens sent to NTRL via Posta Uganda for culture and drug resistance testing Notification Laboratory results interlinked via EOC through SMS; online reporting and tracking via DHIS-2

17 Uganda - Emergency Operations Center Obtained physical space for interim EOC Link with Ministry of Health (MoH) Resource Center (PEPFAR) Permanent facility with National Health Laboratory and Resource Center compound in Port Bell (vision for a NPHI) Organized a visit for senior MoH leaders to CDC Provided emergency management training for operations Supported the EOC manager position

18 Uganda - Information Systems Improve real-time detection, monitoring and confirmation through improved connectivity, timely data collection and access within the District Health Information System (DHIS2) Develop disease-specific mobile tools for data capture and use during outbreaks (Epi-Info based) Improve lab data quality, timeliness and use through a centralized specimen tracking system and expand availability of results Build an integrated data system using the EOC as the hub Develop dashboards and reports for access by health system stakeholders at all levels on a “need to know” basis

19 Accomplishments SOPs and protocols established Exercise drill completed Sept 2013 Evaluated specimen transport, SMS communication, DHIS-2 tracking, and EOC management of mock response Used GHS Uganda system components: Crimean-Congo hemorrhagic fever outbreak in Agago District: Referral hub transported suspect VHF specimens within 24 hrs Suspect case of XDR-TB at Mulago Hospital’s isolation ward had sputum collected, tracked and transported to NTRL (extracted M. tuberculosis DNA for sequencing in Atlanta)

20 EOC Activations Pilgrims returning from Hajj Solar Eclipse in Pakwatch, NW Uganda eMTCT HIV

21 Next Steps - Response Conduct Incident Command Structure training for key staff Train rapid response teams and develop disease-specific district SOPs for outbreak response Train village health teams in disease containment and reporting Re-administer lab assessment tool to identify GHS improvements and maintain continuous quality improvement Expand GHS model beyond 17 pilot districts; add 23 districts/year Perform 2014 exercise drill focused on response capabilities

22 Most effective roll out of GHS Replicable model of GHS capacity upgrades Multi partner engagement International partnerships Different in every country “…we must come together to prevent, and detect and fight every kind of biological danger - whether it’s a pandemic like H1N1, or a terrorist threat or a treatable disease.” President Barack Obama, 2011

23 Thank you US DoD Defense Threat Reduction Agency AFENET Uganda Uganda Ministry of Health Uganda Virus Research Institute CDC Atlanta CDC Fort Collins

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