Highlights - CHART-CCAS-CDC 2nd Joint Meeting
Overview:
The CHART-CCAS-CDC 2nd Joint Meeting and 7th CCAS HIV/AIDS Workshop was held at the Accra Beach Hotel and Spa from 22nd to 27th of
August 2010. 
Based on regional needs, the workshop was themed Cost Effective Management and Q uality Laboratory Monitoring of Individuals with HIV and Co-infection with TB. The meeting aimed to reinforce the fundamentals of immunology and virology related to HIV during the special imm
unology mini-symposium, and great emphasis was laid on laboratory quality management systems and laboratory accreditation. A significant addition to this year’s programme was the introduction of a session on strategic information that highlighted the need for synergism between the laboratory and strategic information teams and adequately capturing and organising data for effective health service utilisation and decision making. The worksho
p comprised of 23 presentations in plenary sessions over the five days and three break-out workshop sessions between Wednesday and Friday covering issues and insights on treatment adherence, stigma and discrimination, laboratory diagnosis, laboratory quality management system and accreditation. A total of 136 persons from Canada, Europ
e, North America, Rwanda, South Africa, South America and the United Kingdom and 16 Caribbean countries participated in the week-long meeting. 16 third-year medical students from the Faculty of Medical Sciences, University of the West Indies-Cave Hill Campus benefited from the mini-symposium in immunology. The main sessions have received 27 hours of CME credits from the Medical Council of Jamaica. CME certificates can be requested from the info [at] caribcas [dot] org (CCAS Secretariat).
Political Will and Buy-in:
The opening ceremony of the 2nd Joint Meeting and 7th CCAS HIV/AIDS Workshop was held under the patronage of the Ministy of Health, Government of Barbados. The Parliamentary Secretary in the Ministry of Health Senator Irene Sandiford Garner welcomed the delegates and gave a brief overview of the Caribbean epidemic and Barbados profiles. The Chief Medical Officer Dr Joy St John delivered the vote of thanks. 
The 5th CCAS Distinguished lecturer was Dr Bharat Parekh, who is the team lead from the HIV Serology / Incidence and Diagnostics Team, International Laboratory Branch, Global AIDS Program, CDC Atlanta USA. Dr Parekh has managed the HIV Serology and Diagnostics Laboratory providing laboratory support to CDC's epidemiologic work in the USA and worldwide and serving as a national and international reference laboratory. His work encompasses but is not limited to early diagnosis in infants, factors affecting perinatal transmission of HIV-1, development of novel assays for detecting recent infections and its applications for HIV-1 incidence estimates. Currently he is providing support and expertise to PEPFAR supported countries to improve the quality of HIV diagnostic testing and detection of recent HIV infection for incidence. In his lecture he highlighted the cross-cutting role of the laboratory in public health and how it directly implies stronger public health systems, specifically as it relates to HIV Diagnosis, care, treatment and prevention and surveillance activities.
Haiti Representative Received Standing Ovation:
Dr Patrice Joseph, featured on the local show Good Morning Barbados on 23rd of August 2010. He pointed out that HIV in Haiti is truly a success story for the country and the people of Haiti with the prevalence of HIV been reduced from 6.3% in 1993 to 2.2% currently. “We need to strengethen our strategies as a region” he said inorder to fight this battle of HIV and Tuberculosis. Dr Joseph also delivered a presentation on the HIV
and TB situation in Haiti post the January 2010 earthquake. A TB field hospital was set-up as part of the 3 major tasks in the contingency plan for provision of continued servies to patients with HIV and TB post the earthquake. All TB laboratory activity was halted temporarily as the facility was destroyed and staff affected. However, the dedication and selflessness of health care professionals was beyond outstanding in the management of patients who survived the disaster, inspite of the vast devastation of the country and even families and homes of the care providers. The Gheskio Centre resumed all activities to pre-earthquake level for HIV and TB care in two weeks, research was continued after four weeks and training resumed within ten weeks of the earthquake.
Barbados' Contribution:
Madge Dalrymple from the Ministry of Tourism and Nicole Gilkes from the Ministry of Health presented preliminary data from a survey done on the behaviours and sexual attitudes of tourists while vacationing in Barbados. Assistant Director of the National HIV/AIDS Commission, Nicole Drakes, discussed the phase 1 results of the ongoing survey on transactional and intergenerational sex conducted amongst Barbadian girls in the 15-19 age group.
Strengthening Laboratory Services and Networking in the Caribbean to Maximise Available Resources:
The recently completed and approved Partnership Framework on HIV/AIDS between the United States, CARICOM and other partners has sought to formalise the plan on strengthening laboratory services in the region. As part of this initiative, the United States Government has pledged to improve the laboratory services in Barbados. This initiative recognises the potential for Barbados to provide further laboratory support to the entire Caribbean region. The Government of Barbados already provides access to laboratory services for the OECS countries and the region.
Kudos to te Ladymeade Reference Unit Laboratory:
The Ladymeade Reference Unit (LRU) Laboratory in Barbados is the first and currently the only public medical laboratory in the Caribbean to be accredited by the College of American Pathologists in October 2009. In the plan to strengthen laboratory services for HIV/AIDS testing in the Caribbean, the LRU Laboratory will play a key role in providing support to the OECS for DNA PCR, viral load, quality assurance programmes and training and in the future for HIV drug resistance and other other emerging complex diseases, e.g H1N1 etc.
Partners in the Process:
The President's Emergency Plan for AIDS Relief (PEPFAR) II is envisioned to provide to the region laboratory strenghtening and overall health systems strenghtening with eventual transfer of ownership to the respective countries. The laboratory emphasis is on capacity building, quality management systems, infrastructure upgrades and long-term
sustainability. PEPFAR II will continue the support of HIV diagnostics tests and drug resistance testing for Barbados and the Eastern Caribbean after cessation of support of the same by the (Clinton Health Access Initiative (CHAI) and the Pan American Health Organisation (PAHO). The PANCAP Global Fund round 9 has also been approved and will support rapid testing and CD4 reagents, but will not support molecular tests such as DNA
PCR, viral load and HIV drug resistance tests. PEPFAR II funds should be received in the region by October 2010 for support of charted out activities. PAHO has channelled its support in the Caribbean in four major areas, health systems strengthening, service delivery, procurement and strategic information. CHAI took a leap forward by presenting an analysis done on instrument down-time for CD4 tests and maintainence contracts as these were the leading impediments in HIV laboratory monitoring identified by delegates at the 2009 CHART-CCAS-CDC Joint Meeting in St Kitts.
Tuberculosis Management and Laboratory Diagnosis in the Carbbean:
The 2010 edition of the Caribbean Guidelines for Prevention, Treatment, Care and Control of Tuberculosis and TB/HIV, jointly produced by CHART, i-TECH, PAHO and the Francis J. Curry National Tuberculosis Centre were presented at the meeting. Although the TB/HIV cases vary within
the Caribbean region, TB is a leading killer of people infected with HIV worldwide and hence, TB programmes need strengethening. Laboratory issues in TB diagnosis highlighted at the meeting were ones that are just simply against the codes of good laboratory practice. GAP-CDC is providing support to strengethen TB diagnosis programmes in Barbados and the Eastern Caribbean.
The Meeting from the Delegates' Perspective:
Delegates were asked to evaluate each presentation in the programme except the Caribbean country reports. A total of 70 meeting evaluation forms and 16 daily evaluations from the medical students were completed and returned. Persons were asked to evalutate each presentation in the programme by day, using the following scoring approach: 1 - Poor, 2 - Mediocre, 3 - Average, 4 - Good, 5 - Very good, 6 - Did not attend. If a score was not assigned, it was assumed that the delegate did not attend. See below for a graphical representation of the overall meeting and the plenary and workshop sessions:
The CCAS Website and Members Database:
The CCAS database now has 350 members from varied health care disciplines and each member has their own unique email address. There are plans to use this website for tracking inventory in the Caribbean, for biomedical equipment management and also to assist with the laboratory referral network. The close parternship between the Caribbean Med Labs Foundation and the CCAS aims to work out these logistics. Meeting presentations will be made available to members of the CCAS database along with access to the presenter's forum. In the future, a digital library will be made available to members with a variety of useful articles from the scientific literature, where persons will be able to enter a search term and all related articles will be found.
Networking:
The Caribbean Regional Offices for the s for Disease Control and Prevention (CDC) under the leadership of Director Dr Shirley Lee Lecher and efforts of Laboratory Advisor Dr George Alemnji arranged for a number of CDC representatives who will play major roles once PEPFAR II officially launches in the region, to participate in the meeting. PEPFAR Coordinator William Conn gave insight to the beneficiaries of the PEPFAR grant. The Caribbean Epidemiological (CAREC) was represented at the meeting by Dr Victoria Morris-Glasgow and her team. Sheila Sameil, Public Health Advisor for the Pan American Health Organisation (PAHO) office for Barbados and the Eastern Caribbean countries, described PAHO's role in HIV/AIDS management in the Caribbean. The leading ladies for quality management and accreditation in the region, Valerie Wilson and Wendy Kitson-Piggott from the Caribbean Med Labs Foundation (CMLF) engaged in further discussions with members of the steering committee Drs Francis Mandy, Abe Schwartz and Maurice O'Gorman to take on regional leadership in the laboratory quality management area. Other stakeholders include the International Training & Education for Health (i-TECH) with Dr Chris Behrens representing from the University of Washington, the OECS Secretariat's HIV/AIDS Programme Unit (HAPU) with Dr James St Catherine from St.Lucia.
'Great Thoughts Result in Great Actions and Lead to Great Outcomes':
The success of the CHART-CCAS-CDC 2nd Joint Meeting would be impossible 
without the foresight and leadership qualities of the heads of the three organisations.
The Biomed Battle Team comic series HIV Hysteria, an educational tool to teach children and interested persons on the HIV battle through a comic book funded by the NIH, was distributed to various island representative and others at the meeting and can be ordered by email: e [dot] fernandez [at] upr [dot] edu.
In the Caribbean the crucial role of laboratory technologists has been overlooked and undermined by many. The distinguished lecture as well as other presentations during the meeting highlighted the role of the laboratory. Several delegates pointed out their satisfaction in the meeting evaluations for being acknowledged as playing an important role being a
laboratarian.
The meeting highlights will be incomplete without acknowledging our in-house musician Dr Jeanne Beckles, who in a few short versuses entitled I'm serving God makes us all realise the reason for our efforts: The bottom line is through our intentions, motivations and dedication we are serving us, our fellow beings and in essence all serving God.
The 8th CCAS HIV/AIDS Workshop:
Dr Michele Hamilton, the CCAS country representative for Jamaica, won the bid to host the CHART/CCAS/CDC 3rd Joint meeting and 8th CCAS HIV/AIDS workshop. It will be held in Jamaica from the 21st to 26th of August 2011. More information will be made available on the CCAS website in due course.
Finally:
The success of this meeting is attributed to the dedication, participation, strength and support rendered from our various stakeholders, faculty speakers, organisers, delegates, sponsoring companies, philanthropists and other humanitarians. We would like to thank you all, who participated and supported the 2nd joint meeting of CHART-CCAS-CDC and CCAS in its 7th year.
