GHS Capacity Statement

October 1, 2022

Laboratory Systems Strengthening

Since 2007, Baylor-Uganda, with funding from CDC and USAID, has been supporting the Ministry of Health to build a laboratory network with the capacity to provide diagnostic and surveillance services. Baylor Uganda uses the Strengthening Laboratory Management Towards Accreditation (SLMTA) approach to train labs to implement the Laboratory Quality Management System (LQMS) and attain international accreditation status. Baylor-Uganda also supports Laboratory infrastructure and equipment procurement, Laboratory equipment management through subgrants to two regional laboratory equipment workshops, supply chain management, Biosafety and Biosecurity and a robust specimen referral and transportation system. The Laboratory capacity-building program is done through training, mentorships and quality assurance in collaboration with Uganda MOH’s National Health Laboratory System (UNHLS). Through this capacity, the laboratory network is able to deliver quality results to inform clinical decisions, early detection and response to disease outbreaks.

Public health laboratory leadership, coordination and communication:

32 districts in Rwenzori, Bunyoro and Mbale region implementing district-specific laboratory network plans and district-led diagnostic network improvements.
LQMS:

1394 Laboratory staff trained in LQMS; 15/21 lab hubs attained and sustained international/ISO 15189 accreditation by the South African National Accreditation System, one regional laboratory additionally accredited for microbiology diagnostics, and the Center of Excellence Laboratory (Kampala) attained and sustained the College of American Pathologists accreditation.
Laboratory infrastructure improvements:

Upgraded/refurbished 25 laboratories in 21 districts to optimize testing workflow and enhance biosafety and biosecurity
Capacity for the detection of priority diseases:

Trained and mentored 2,231 Health care workers from 55 health facilities in 17 districts and 3 cities on COVID-19 RDT use, reporting using electronic laboratory investigation forms and supply chain management, and quality assurance; Rolled out point of care EID/Viral load and Xpert/MTB Rif testing in 32 health facilities in 21 districts.
Biosafety and Biosecurity:

Trained and mentored 394 laboratory personnel in biosafety and biosecurity, creating a pool of personnel to support the implementation of comprehensive and sustainable biosafety and biosecurity procedures and practices at the health facility level
Laboratory Supply Chain Management:

Trained and mentored 428 laboratory personnel in logistics management to support the purchasing and management of diagnostic commodities; Provided buffer microbiology laboratory reagents for two regional laboratories as a stop-gap measure
Specimen referral and transport system:

Established mechanisms to ensure transportation of specimens from over 300 health facilities (i.e. >90% of health facilities) are transported to 20 hub laboratories and two national reference laboratories.

ANTIMICROBIAL RESISTANCE (AMR) PREVENTION AND CONTROL

The emergence and spread of drug-resistant pathogens that have acquired resistance to existing antimicrobial agents is a threat to human health and modern medicine and is a risk to animal health and food production. Baylor-Uganda supports the Ministry of health to prevent and control the spread of AMR through strengthening AMR surveillance and ensuring the appropriate use of antimicrobials. This support is delivered through technical assistance provided to MOH in the AMR technical working groups, building the capacity of hospitals to conduct AMR surveillance and implement antibiotic stewardship activities.

AMR surveillance:

• Conducted AMR diagnostic network capacity assessments at 12 hospitals and developed and implementation of site-specific QI plans.
• Two regional labs conducting bacterial culture and susceptibility testing.
• Provided buffer Microbiology/AMR reagents to avert stockout and critical equipment (incubators).
• Standardized AMR detection and reporting procedures and practices by adapting and disseminating technical AMR laboratory SOPs and tools at two regional referral hospitals labs (Hub) and 10 general hospitals (spokes)
Promoting optimal use of antibiotics:

Established Medicines and Therapeutics Committees (MTCs) and developed site-specific QCI plans at 10 hospitals. Operationalized QCI learning collaborative between the 10 hospitals to promote sharing of Knowledge and best practice sharing.

FIELD EPIDEMIOLOGY TRAINING PROGRAM (FETP)

Since 2020, Baylor-Uganda has served as an attachment site and provides mentors for the National FETP fellows. The national FETP was formed in 2015 as a partnership between the Ministry of Health, CDC and Makerere University School of Public Health. The FETP trains fellows to identify and contain outbreaks before they become epidemics and strengthen their skills in data collection and translation of data into evidence-based action. Baylor-Uganda programs including the HIV/AIDS, RMCAH and GHS programs together with the experienced mentors provide excellent attachment experience for fellowships. Since 2020, we have hosted and mentored 8 fellows and done 8 projects.

Investigation of possible preventable causes of COVID-19 deaths in the Kampala Metropolitan Area, Uganda, 2020–2021.

https://www.sciencedirect.com/science/article/pii/S120197122200296X

Community Dialogue Meetings among District Leaders Improved Their Willingness to Receive COVID-19 Vaccines in Western Uganda, May 2021. https://uniph.go.ug/district-leader-community-dialogue-meetings-improved-willingness-to-receive-covid-19-vaccines-in-western-uganda-may-2021-a-pre-post-study/

High blood pressure and associated factors among HIV-infected persons aged 13 to 25 years selected health facilities in Rwenzori region, western Uganda, September–October 2021.
Birth outcomes among HIV-positive women in Rwenzori region, Western Uganda, 2021.

Individual and household risk factors for COVID-19 infection among household members of COVID-19 patients in Home based care in Western Uganda, 2020.

Factors associated with retention in care among HIV-exposed infants in Rwenzori region, Western Uganda.
Cascade of NCD care in HIV clinics in Western-Uganda
Effects of COVID-19 on ART services utilisation among people living with HIV and AIDS in the Rwenzori Region, Mid-Western Uganda, 2020-2021

COVID-19 VACCINE TRIALS

Baylor-Uganda is implementing two clinical trials to test the efficacy of COVID-19 vaccines:

CoVPN 3008 (Ubuntu): Multi-Center, Randomized, Efficacy Study of COVID-19 mRNA Vaccine in Regions with SARS-CoV-2 Variants of Concern:

The study is designed to help inform which vaccine regimen, likely in combination with enhanced HIV care, could serve as a public health model for an effective and cost-efficient approach to preventing SARS-CoV-2 disease, prolonged viral shedding, and the emergence of VOCs within this population. The study will also evaluate whether immune responses postvaccination can be correlated to these clinically important outcomes. The study will enroll 15,600 adults from many clinics in Eastern and Southern Africa. All participants in the study will get the study vaccine.

VAT 00008(COVPN 3005): A parallel-group, Phase III, multi-stage, modified double-blind, multi-armed study to assess the efficacy, safety, and immunogenicity of two SARS-CoV-2 Adjuvanted Recombinant Protein Vaccines (monovalent and bivalent) for prevention against COVID-19 in adults 18 years of age and older