Lab Matters Summer 2019 - Page 22

GLOBAL HEALTH APHL Mozambique Responds to Cyclone Idai By Elizabeth Toure, MPH, senior specialist Global Health; Palmira Mangae, specialist Global Health and Solon Kidane, senior technical advisor, APHL Mozambique On the night of March 14, 2019, Cyclone Idai made landfall near Beira, one of Mozambique’s largest cities. The damage caused by one of the Southern Hemisphere’s most powerful cyclones was catastrophic, with thousands of lives lost and millions affected by the flooding. Much of the infrastructure in and around Beira was severely damaged, including the central hospital, many health facilities and laboratories. The Ponta Gea Health Facility in Beira is the main reference laboratory for HIV viral load (VL) testing for two entire provinces. VL testing is critical for monitoring the treatment regimen of people living with HIV and is a major focus of the President’s Emergency Plan for AIDS Relief (PEPFAR) and the UNAIDS 90-90-90 initiative. Dozens of health centers across two provinces refer VL samples to Ponta Gea and receive electronic results using an electronic test order and result return system maintained by APHL. When Cyclone Idai made landfall, the Ponta Gea Health Facility was severely damaged. The roof on parts of the building—including part of the laboratory—was blown off, resulting in heavy rains pouring directly into the building. In the main laboratory, the server and many other electronics were damaged. Patient results that had not yet been sent back to the referring sites were seemingly lost, and the two provinces had nowhere to refer VL samples for testing. As a result of APHL Mozambique’s back up and data recovery system, staff were able to immediately take action to ensure that no data was lost and that HIV VL testing could continue uninterrupted. The Ponta Gea server went down at 7:45 pm on March 14 and APHL was able to recover all patient data up to the last registered sample minutes before the server went offline. Results that had not been electronically sent back to referring sites were printed at the APHL office in Maputo and securely distributed back to the sites by road. Additionally, in coordination with the Mozambican Ministry of Health (MoH) and CDC-Mozambique, APHL modified the electronic referral system to refer Cyclone Idai’s path across Africa. Photo: UN Office for Coordination of Humanitarian Affairs electronic sample data to VL testing labs in two unaffected provinces, Nampula and Quelimane, while the Ponta Gea lab is being repaired. PEPFAR clinical partners are assisting with the physical transport of the specimens between health facilities and reference labs. APHL is monitoring data from the two referral labs closely to identify any testing backlogs that could result from the sudden influx of additional specimens. As a result, APHL has already mitigated a backlog at one lab by re-routing samples to a third VL lab in Maputo. The unprecedented damage caused by Cyclone Idai tested the laboratory backup systems that the MoH and APHL had built. The fact that no patient information was lost from the damaged server at the Ponta Gea laboratory and that patients can continue to receive results from critical VL tests demonstrates the resilience of the nation’s laboratory systems and the importance of a fully functioning electronic laboratory information system. n The Ponta Gea Health Facility in Beira, Mozambique was badly damaged by Cyclone Idai in March 2019. 20 LAB MATTERS Summer 2019 PublicHealthLabs @APHL