On June 17, the International Training and Education Center for Health (I-TECH) and the U.S. Centers for Disease Control and Prevention (CDC) South America Office, in collaboration with the Ministry of Health in Peru (MINSA), launched the Informatics and Data Science for Health (IDASH) fellowship in South America. The program was first implemented in the Eastern Europe and Central Asia with support from WHO EURO, with the first cohort graduating in April 2024, and adapted to the South American context.
The 12-month training will focus on developing a health workforce that is well-trained in digital health and understands health informatics and data system requirements to support public health functions. Thirty-four fellows from government agencies from Brazil, Colombia, Ecuador, Paraguay, and Peru are together in Lima, Peru, for two weeks for the first in-person workshop.
During the opening ceremony, Peru’s Vice Minister of Health Ricardo Peña Sánchez and Secretary of Government and Digital Transformation César Vílchez Inga reaffirmed the importance of this initiative to support advancing digital strategies for health in Peru, including interoperability of information systems. The development of a skilled workforce in health informatics and data science is also aligned with PAHO’s efforts to advance digital health in the region, as highlighted by Sebastian García, Director of the Evidence and Intelligence for Health Action Department of the Pan American Health Organization (EIH/PAHO) during the opening.
During the second week of the in-person workshop, fellows will be joined by mentors from each participating country. The support from experienced mentors will enhance their learning experience and the application of the knowledge and skills acquired during the program.
Valdirene Montalvão, Information Systems Technician at the Brazilian Ministry of Health, has high expectations for her participation in the program. Through IDASH, “I will be able to learn and expand my skills to contribute more effectively to the process of monitoring, managing and evaluating for public health decision-making,” she says.
The event included a final in-person workshop and a certificate ceremony, celebrating 12 months of intensive learning and collaboration. The fellowship program included in-person workshops, mentorship, and communities of practice to support applied learning, as well as completion of capstone projects that aligned with respective countries’ health priorities.
“IDASH has been a novel training approach to bridge the gap between public health informatics and data science to improve population health,” says Jennifer Gilvydis, INSIGHT Project Director. “The fellowship is a unique blend of applied learning and supports multidisciplinary workforce development.”
The final workshop covered topics such as evaluating surveillance system performance, public health informatics communication, developing effective poster presentations, and maintaining connections with fellow program graduates. Fellows presented their capstone projects, showcasing the application of newly acquired skills and knowledge.
Each interdisciplinary country team included members from Ministry of Health (MOH) units responsible for digital health and disease surveillance and response, such as mid-senior level epidemiologists, informaticians, data scientists, IT specialists, and public health policy personnel. This diverse mix of disciplines was integral to the fellows’ experience and the success of their capstone projects.
“What was unique [about this fellowship] was that this scholarship included the integration of systems as well as public health and technology,” says Nuraiym Zhumakunova, a fellow and epidemiologist with the Department of Disease Prevention and State Sanitary-Epidemiological Surveillance in Kyrgyzstan. Her team was working on a unified platform for disease surveillance data analysis.
“Overall, [the program] was good because we understood the work as analysts and as IT specialists,” she continues.
Stacey Lissit, Senior Technical Advisor for the IDASH fellowship, agrees that collaboration across disciplines was key to the program’s success: “The fact that IDASH brought together professionals from disciplines that may not typically collaborate and communicate with each other – public health/epidemiologist and IT/Data scientists – was an integral part of the fellowship,” she says. “It enabled fellows to get out of their silos and understand the priorities, needs, and ‘language’ of their colleagues, and see how communication and collaboration are so vital to achieving the desired public health outcomes. The relationships and community that was built among the fellows from different countries was an invaluable component of the program.”
The fellowship not only enriched the participating professionals but also had tangible benefits for their agencies and organizations. “We trained health workers on how to maintain quality data,” said Farhod Akbarov, First Deputy CEO at IT-Med LLC under the MOH of Uzbekistan, whose team was working on reporting, mapping, and forecasting of infectious disease. “These are already new skills for us. We can already filter, sort, and show better quality data.”
As the COVID-19 pandemic has demonstrated, robust information systems that can collect, analyze, interpret, and act on high-quality data are critical to public health. The IDASH fellowship program aims to close knowledge gaps in the global public health workforce, better preparing regions for future health threats.
The fellowship program is set to launch in five countries in South America this June, expanding its reach and impact on global health initiatives.
At a February 5-8 meeting in Bogotá, the International Training and Education Center for Health (I-TECH) convened with global health leaders from 5 countries to inform the adaptation of the Informatics and Data Science for Health (IDASH) training program to South American contexts.
IDASH–part of I-TECH’s Integrated Next-generation Surveillance in Global Health: Translation to Action (INSIGHT) project–is a training program for current and future leaders in public health that aims to strengthen regional capacity to use public health information and data systems to improve health outcomes at the population level, detect and respond effectively to threats to public health, and promote health equity.
The objectives of the intensive, weeklong Executive Committee meeting included identifying priorities and key capabilities; adapting the structure of the IDASH course to local needs as well as government priorities and initiatives; and identifying government and academic resources to support teaching.
IDASH South America Director Fernanda Freistadt addresses the participants on Day 1 of the meeting. Photo courtesy of Maíra Pessoa/FVS-RCP.
In a a website post of IDASH partner Fundação de Vigilância em Saúde do Amazonas – Dra. Rosemary Costa Pinto, INSIGHT Regional Director for South America Fernanda Freistadt said: “This initiative has the potential to create health professionals who have advanced knowledge in both epidemiology and information technology, an area in which there is a great lack today. Furthermore, IDASH can strengthen technical relations and collaborations in the area of surveillance between countries.”
The Executive Committee Meeting included representatives from Colombia, Brazil, Paraguay, Peru, and Ecuador, as well as international partners including Georgia’s National Center for Disease Control and Public Health (which has been an important partner in the IDASH training program for Eastern Europe/Central Asia). It is anticipated that the South America expansion implementation to happen later this year.
Representatives from the network presented more than a dozen posters, spoke at panels and discussions, and led an interactive workshop. Read below for more details (links to presentations will be posted as they are made available).
Romana R Katekwe, Edson Chidovi, Frances Petracca, Batsirai Makunike, Gloria Gonese, Kerry Thomson, Zwashe Bangani, Haddi Cham, Mirriam Mugwise, Emmanuel Govha, Stefan Wiktor, “Improving Access to Quality Improvement Training through Off-line Electronic Learning: A Case Study from Zimbabwe”
Langalokusa Sibanda, Peace Ntini, Richard Mashapa, Gloria Gonese, Rickie Malaba, Tendayi Mharadze, Ralph Makuyana, Methembe Ndlovu, Ruth Levine, Vivian Bertman, Abigail K. Korn, Kerry A. Thomson, Owen Mugurungi, Tsitsi Apollo, Getrude Ncube, Mirriam Mutseta, Beauty Nyamwanza, Batsirai Makunike-Chikwinya, Stefan Wiktor, “DREAMS Ambassadors Increase HIV Self-Testing Uptake by Male Partners of Young Women in Zimbabwe”
Anjali Vasavada, Phibion Manyanga, Sandra Murwira, Lucia Gondongwe, Ponesai Nyika, Batsirai Makunike-Chikwinya, Gloria Gonese, Stefan Wiktor, George Mamire, Kerry A. Thomson, “Acceptance of Free Cervical Cancer Screening Among Zimbabwean WLHIV: Implications for Integration of HPV Testing into Routine HIV Care”
Rumbidzai Dhliwayo, Lennox Dziva, Ponesai Nyika, Chiedza Mupanguri, Gloria Gonese, Tsitsi Apollo, Owen Mugurungi, Talent Maphosa, Haddi Jatou Cham, Batsirai Makunike-Chikwinya, Stefan Wiktor, “Assessing Implementation and Outcomes of Screening for Advanced HIV Disease (AHD) Among Persons Living with HIV in Five Provinces of Zimbabwe”
Gloria Gonese, “High HIV disease burden among older clients aged ≥50years attending selected health facilities in Zimbabwe, Oct 2020 through March 2023”
PZAT:
Precious Moyo, Joseph Murungu, Shamiso Nyakuwa, Casper Hera, Imelda Mahaka, Blessing Mushangwe, Phibion Manyanga, Gloria Gonese, Batsirai Makunike, Takunda Sola, Getrude Ncube, Tendayi Mharadze, Rickie Malaba, Stefan Wiktor, “Key Populations Outreach Activities for Scaling Up HIV Prevention Care and Treatment Services in Harare, Zimbabwe”
Precious Moyo, Joseph Murungu, Shamiso Nyakuwa, Casper Hera, Imelda Mahaka, Blessing Mushangwe, Phibion Manyanga, Gloria Gonese, Batsirai Makunike, Takunda Sola, Getrude Ncube, Tendayi Mharadze, Rickie Malaba, Stefan Wiktor, “Layering Enhanced Economic Strengthening Interventions to Reduce Vulnerabilities Among Sexually Exploited Minors and Young Women Selling Sex in Zimbabwe”
Sitshengisiwe Ruzibe, Casper Hera, Precious Moyo, Joseph Murungu, Shamiso Nyakuwa, Imelda Mahaka, Langalokusa Sibanda, Peace Ntini, Gloria Gonese, Batsirai Makunike, Mirriam Mutseta, Getrude Ncube, Tendayi Mharadze, Rickie Malaba, Kerry A. Thomson, Stefan Wiktor, “Services for Sexually Exploited Minors and Young Women Selling Sex Enrolled in DREAMS program, Matabeleland North, Zimbabwe”
Zvandiri:
Vivian Chitiyo, Tanyaradzwa Napei, Billiart Tapesana, Ann Selberg, Edson Chidovi, Gloria Gonese, Kerry Thomson, Talent Maphosa, Haddi Cham, Ngwarai Sithole, Tsitsi Mutasa-Apollo, Nicola Willis, Stefan Wiktor, “Minimizing Interruption in Treatment (IIT) through Peer Connections of Adolescents and Young People Living with HIV in Zimbabwe”
GDHF 2023, 4-6 December, Washington, D.C.
The Digital Initiatives Group at I-TECH (DIGI), and others from I-TECH, presented their work in a number of ways at this year’s Global Digital Health Forum. GDHF is a leading global public health industry conference for technology vendors, donors, researchers, government representatives, and implementing organizations working in low- and middle-income countries.
Hannock Tweya and Caryl Feldacker at GDHF 2023
Posters:
Feldacker C, Murethi M, Ndhlovu D, Bisani P, Kathumba D, Samala B, Oni F, Wagaba K, Kagereki E, Wassuna B, Tweya H, “Mobile Electronic Medical Record Systems: The Community-based ART Retention and Suppression (CARES) App Design for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi”
He Y, AbuShweimeh R, Kouabenan YR, Assoa PH, Puttkammer N, Gloyd S, Wagenaar BH, Komena P, Kamelan N, Iiams-Hauser C, Pongathie A, Kouakou A, Hoffman N, Flowers J, Abiola N, Perrone LA, “Determinants of Routine Implementation for Electronic Laboratory Information Systems in Côte d’Ivoire: a Mixed-Methods Implementation Science Study”
He Y, Kouabenan YR, Assoa PH, Puttkammer N, Gloyd S, Hoffman N, Wagenaar BH, Komena P, Kamelan N, Iiams-Hauser C, Pongathie A, Kouakou A, Flowers J, Abiola N, Perrone LA, “Perceptions and Experiences of Data-Driven Decision-Making and Data Dashboard for HIV Viral Load Testing and Early Infant Diagnosis in Côte d’Ivoire”
Gadabu O, Manyiyo B, Yiga H, Chigoriwa C, Chirowodza L, White C, Mankowski P, Mutesasira M, Gita C, Maxwell L, Muserere C, Flowers J, “A FHIR Training Workshop to Facilitate Interoperability Between the IMPILO EHR and the LIMS System in Zimbabwe”
Secor, A, presented by Patric Prado, “Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy among Adults and Children Living with HIV in Haiti: A Retrospective Longitudinal Study”
Virtual Panel:
“Building Next-Gen Digital Health Solutions On FHIR With Open Health Stack” Presenter: Patric Prado
Individual Presentations:
“Efficiently Leveraging Individual-level Health Data For Population-level Data For Decision Making: A Call To Action For FHIR-based Secondary Data Use” Presenter: Piotr Mankowski
“Implementation of An Online Course By MOH For Health Workers In Kenya: Strategies And Lessons For Success” Presenter: Robert Oboko
“Applying Critical Reflection To Reimagine Global Digital Health Interventions: Introducing The (Re)imaginator” Presenter: Beth Dunbar
“Advancing National Health Information Systems Maturity: Lessons Learnt On Implementing The Informatics-Savvy Health Organization (ISHO) Assessment And Action Planning Framework For Health Leaders In Zambia” Presenter: Kendi Mburu
“Online Learning as an Innovation And Sustainability Initiative In Digital Health In Low And Middle Income Countries” Presenter: Robert Oboko
Topic Lounge Discussions:
“Perceptions On The Quality Of Electronic Medical Records In LMIC” Presenter: Jan Flowers
“Bringing Into Production A Health Information Exchange Architecture In Côte D’Ivoire: Using Open Standards And Software To Enable Cross-site Patient Histories And Real Time Dashboarding. Côte D’Ivoire HIE” Presenter: Casey Iiams-hauser
Interactive Workshop:
“Creating, Leading, And Managing Informatics-Savvy Health Organizations (ISHO): Concept, Principles, And Application”
ID Week 2023, 11-15 October, Boston, Massachusetts
IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP). This year, CSiM presented:
40th Annual Oregon Rural Health Conference, 11-13 October, Sunriver, Oregon
For this year’s Annual Oregon Rural Health Conference, Rupali Jain, PharmD, and Natalia Martinez-Paz, CSiM Manager, shared lessons learned in Cohort 2 of their Intensive Quality Improvement Cohort (IQIC) program and how Critical Access Hospitals can approach QI in the post-COVID-19 healthcare environment.
The theme of this year’s World AIDS Day is “Let Communities Lead.” This is not only a call to action, but also a recognition of the irreplaceable contribution of community members in the success of global programs and their critical role in their own health care.
We had the honor of capturing a brief interview between two of our wonderful I-TECH colleagues in Trinidad and Tobago–Alana Lum Lock Cardinez, Program Advisor, and Conrad Mitchell, Program Manager. Here, Alana asks Conrad for his perspective as both a community member and project lead, as well as about the lessons learned when communities aren’t engaged (4:15).
IDASH fellows engage in group work during an October workshop in Almaty, Kazakhstan. Photo credit: Jamey Gentry/CDC.
Last month, the International Training and Education Center for Health (I-TECH), in collaboration with the U.S. Centers for Disease Control (CDC) and with support from the World Health Organization (WHO), facilitated the second of three in-person workshops for the Informatics and Data Science for Health (IDASH) fellowship.
Held in Almaty, Kazakhstan, the workshop marked the mid-point of the 12-month fellowship—and a chance for participants to come together to advance their ability to apply public health informatics and data science concepts and approaches.
“This workshop included a lot of hands-on practical exercises, and it was fun to observe how engaged the participants were with these activities and with the learning in general,” said Stacey Lissit, MPH, MS, Senior Technical Advisor for the IDASH program.
Content included all things data (quality, cleaning, analysis, visualization, governance, security, privacy, and confidentiality); interoperability; project management; business process analysis; and systems architecture. Sessions were a mix of didactic lecture, small group activities to practice application of skills and concepts, peer feedback, and guided hands-on learning in R and PowerBI. Over the course of the two weeks, participants collaborated to develop a data dashboard, a database schema, and a data quality workplan.
The first cohort of the IDASH fellowship, with I-TECH instructors. Photo credit: Jamey Gentry/CDC.
The current fellowship, launched in April 2023, comprises a cohort of four participants each from Georgia, Kazakhstan, Kyrgyzstan, Ukraine, and Uzbekistan—a total of 20 fellows. Each four-person team includes a mix of mid-senior level epidemiologists, informaticians, data scientists, IT, and public health policy personnel.
Fellow Zhanibek Yerubayev, Director of Public Health Emergency Operations at the Kazakhstan Ministry of Health’s National Center of Public Health, says the team mix is an integral part of IDASH’s impact. “[IDASH] connects people from the public health side with people from the IT side,” he says. “These people have a lot of projects to do [together], but they are not always well connected, and they do not always understand each other well.”
“It was exciting to see the relationships and community that are being built through the IDASH Fellowship – both within the country teams where fellows can collaborate closely with colleagues outside of their typical ‘work silos,’ and across countries within the region,” said Lissit. “That peer learning element is such an important part of the fellowship.”
And all efforts were made to ensure multi-directional collaboration. The Ukrainian team did not receive permission to travel to the workshop, so I-TECH made arrangements for them to participate via Zoom. A location was identified in southwest Ukraine where the team could attend the workshop together remotely, experience fewer daily safety issues related to the war, and avoid the distractions of being in their own workplace. A simultaneous translator for the Ukrainian language was provided on the Zoom call.
While remote participation is not ideal, the Ukraine team was able to attend and hear most of the workshop sessions and engage in the group work in meaningful ways. “A lot of effort went into setting up the technology that enabled this participation,” said Lissit. “At one point the Ukraine team was participating in a peer feedback activity with two country teams in Almaty—there were live cameramen, screen sharing, Zoom translators…and it worked mostly seamlessly!”
Fellow Durbek Aliyev, Deputy CEO at IT-Med LLC, which works under the Uzbekistan Ministry of Health, was especially appreciative of the chance to learn from a wide range experts across the region. “The digitalization of health care cannot be done by only one country itself,” said Aliyev. “The advantage of IDASH over other programs is that it brings [together] specialists from neighbor countries. We are talking to each other….We are learning from each other directly.”
And these relationships will be a lasting benefit of the program, he continued. “IDASH is a place where we can establish very good networking with other countries,” said Aliyev. “Any time I can contact them and learn from their expertise.”
IDASH is a project within the Integrated Next-Generation Surveillance in Global Health: Translation to Action (INSIGHT) program. In addition to acquiring new skills and knowledge in public health informatics and data science, IDASH country teams are developing and will implement a collaborative team project that demonstrates key competencies and is aligned with their country’s needs and priorities.
Index testing is a is a key strategy to identify and support those most at risk of acquiring HIV.1 Within the index testing framework, exposed contacts (i.e., sexual partners, biological children and anyone with whom a needle was shared) of an HIV-positive person (i.e., index client), are elicited and offered HIV testing services.
From 2019 to 2021, the I-TECH team in Ukraine provided increased technical assistance for 39 state healthcare facilities in 11 high HIV-burden regions to advance assisted partner notification/services and index testing.
In a recently published study in BMJ Open, the I-TECH team—along with representatives from the Public Health Center at the Ukrainian Ministry of Health—describe the success of this scaled program in index testing.
“Index case testing is crucial in reaching out to exposed contacts of individuals living with HIV, notifying them, and offering HIV testing,” said Anna Shapoval, I-TECH Ukraine Country Representative. “This approach is particularly important and effective in the context of Ukrainian national HIV response where, despite numerous successes, we still struggle to close HIV testing gap and reach out to people living with HIV earlier rather than later with proper treatment and support.”
I-TECH developed exhaustive standard operating procedures for index testing; thoroughly trained healthcare teams on the index testing algorithm; as well as provided consistent and regular methodological support as part of its index testing program.
The study includes clients enrolled in index testing services in 2020, who had with both recent (<6 months) and previously established (≥6 months) HIV diagnoses. Ukraine’s physician-led model involves a cascade of steps including voluntary informed consent, partner elicitation, selection of partner notification method and follow-up with clients to ensure partners are notified, tested for HIV, and linked to HIV prevention and treatment services, as needed.
“Ukraine’s index testing services were rolled out as a standard part of Ukraine’s HIV service package at the targeted governmental health facilities, and carried out by existing physicians,” said Alyona Ihnatiuk, Strategic Information Lead for I-TECH Ukraine and lead author of the study. “At each supported facility, one or two staff members were designated as focal persons for case management and follow-up. This integrated, physician-led model was streamlined to target index cases with both recent and established HIV diagnosis, to arrive at a high number of new cases of HIV identified.”
There were 976 new cases of HIV identified through the study period, representing a yield of 19.3%, and 1,408 people living with HIV (PLHIV) have been identified throughout the two-year index testing program.
Of 14,525 index clients offered index testing, 51.9% accepted, of whom 98.3% named at least one sexual partner, injection partner, or biological child. Clients named 8,448 unique partners; HIV case finding was highest among clients with recent HIV diagnosis and among people who inject drugs (PWID), and lower among clients with established HIV diagnosis. More than 90% of all partners with new HIV diagnoses were linked to care.
“The BMJ Open study confirms that comprehensive assisted partner notification services and index testing are highly effective in identifying people living with HIV,” says Ms. Shapoval, “as well as tracing previously diagnosed partners and supporting their linkage to care. I-TECH was honored to contribute to the design and implementation of this vital intervention in Ukraine early on and see it gradually rolled out across the country with multiple partners successfully implementing it now.”
Golden M, et al. Partner notification for sexually transmitted infections including HIV infection: an evidence-based assessment. Sexually transmitted diseases. 4th edn. McGraw-Hill; New York, NY: 2007.
THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.
The Center for Stewardship in Medicine (CSiM) has joined the International Training and Education Center for Health (I-TECH) Network as a partner, operating within the University of Washington’s Department of Global Health. CSiM is a collaborative of over 80 rural hospitals across nine states in the U.S. working together on stewardship challenges through education, quality and process improvement, and mentoring.
I-TECH and CSiM will mutually benefit from collective decades of experience tackling rural health challenges – including workforce shortages, staff who wear “many hats,” and disparities in services – in the U.S. and around the world.
“CSiM is a collaborative of physicians, nurses, laboratory professionals, and pharmacists working to bridge bi-directional knowledge gaps between academic medical centers and rural health care facilities,” said John Lynch, MD, MPH, co-director of CSiM. “Like I-TECH, we value collaborative, anti-hierarchical work that honors expertise and experience at all levels of the health care system, and from all sectors.” Dr. Lynch leads the center with Chloe Bryson-Cahn, MD, and Zahra Kassamali-Escobar, PharmD.
The CSiM team with guest speakers at the center’s conference in Spokane, WA, May 2023. Photo courtesy of CSiM.
CSiM works in antimicrobial stewardship and infection prevention, building sustainable quality improvement programs, and providing customized, long-term technical assistance to rural health facilities. The center’s main activities include leading the UW Tele-Antimicrobial Stewardship (TASP ECHO®) project, a telementoring program; coordinating Intensive Quality Improvement Cohorts; and providing resources and tools to support facilities in reaching their goals and improving the quality of healthcare.
“I-TECH and CSiM share a dedication to finding innovative and local solutions to provide ongoing education and mentoring to health care workers in resource-limited settings,” said Pamela Kohler, BSN, PhD, I-TECH co-director. “We are incredibly excited about the opportunity to learn from each other.”
Currently, CSiM has projects in Arizona, Idaho, Illinois, Louisiana, Maine, Montana, Oregon, Utah, and Washington and is exploring opportunities to extend its model globally.
“CSiM’s inclusive, team-based approach results in work that really matters to communities in need – particularly those in underserved, hard-to-reach, rural areas,” said Ivonne Ximena “Chichi” Butler, MPH, I-TECH co-director. “This approach makes it a perfect fit within the I-TECH Network.”
Voluntary medical male circumcision (VMMC) decreases the risk of female-to-male HIV transmission by about 60%.[1] I-TECH Network partner the Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH) supports innovative VMMC engagement solutions that are tailored to the populations they serve.
Caravans Allow for Mobile Services and Door-to-Door Outreach
VMMC Mobilizers engage with men at a farm compound in Goromonzi District. Photo credit: Zim-TTECH
Makumbe Hospital in Goromonzi District, Zimbabwe, serves a population of more than 100,000 people, including the rapidly expanding population of surrounding townships. Zim-TTECH-led consortium ZAZIC has run the Makumbe Hospital site since October 2018 and supports the VMMC team there.
This population within the hospital’s catchment area primarily comprises informal traders selling necessities such as groceries, garden produce, or second-hand clothes, while others run at-home small businesses that manufacture furniture, iron and steel products, and other wares.
“It’s difficult for economically active young men to leave their businesses and attend to VMMC at a venue away from their premises or market,” said Lewis Masimba, VMMC Program Manager at Zim-TTECH.
In light of this challenge, the team implemented a mobile caravan, which could increase the number of men receiving circumcisions by taking services out of the medical facility and bringing them closer to the concentrated settlements of Domboshava Showground, Mungate, and Mverechena townships and nearby farm compounds.
The caravan has been in use in the district since January 2023, and it has vastly shortening the period between client engagement and service delivery. In most cases, two mobilizers at a time will engage with potential clients within the townships, while another three will conduct intensive door-to-door visits in residential areas.
Mobilization efforts include one-on-one and small group discussions at market stalls, small businesses, and drinking spots, where mobilizers will answer questions and distribute information about VMMC. Sometimes the caravan is supported by a roadshow van and dancers who disseminate VMMC information through edutainment.
“The caravans have so many advantages,” said Mr. Masimba. “Men are able to access the VMMC services near their workplaces, minimizing disruptions to their daily routines. The caravan has also brought convenience and privacy to those who did not feel comfortable being ferried in program vehicles to and from the hospital.”
Fig 1: Outputs three months before receiving the caravan and three months after receiving the caravan
Since the site started utilizing the caravan, the number of men who have received VMMC each month has increased from 159 to 233 (Fig. 1).
On the heels of this success, the ZAZIC teams will continue exploring other combination approaches involving engagement activities such as pool/snooker, soccer, and music roadshows to reach hard-to-convince men in their localities.
Peer-to-Peer Learning Takes Center Stage in Performing Arts Program for Adolescents
Eight secondary schools enrolled in the drama competition. Photo credit: Zim-TTECH
The performing arts have been used since time immemorial as motivators to rally communities toward common goals, to relieve stress, and as an effective teaching tool across diverse cultures and religious settings. They are a particularly effective method for engaging adolescents both in and out of schools. As teens seek independence from their parents, the influence of peers becomes increasingly important, and performing arts are a fantastic way to employ peer-to-peer learning strategies.
Harnessing these strategies, ZAZIC uses drama in several districts to complement efforts already made by VMMC teams and teachers who have previously used sporting events and lectures to communicate with students.
In a particularly successful case, Hurungwe District chose to use a drama competition to communicate VMMC and other health messages to adolescents. The goals of the competition included effective peer-to-peer learning, outreach to a large audience, and the demystification of VMMC.
Roadshows to promote the competition were held at major townships to create awareness of the event and invite members of the public to attend. Eight secondary schools enrolled in the competition, and teams of adolescents led the process of writing and directing short, 30-minute performances incorporating messages in a provided guide.
The guide emphasized use of appropriate language, the need to double-check facts; and encouragement of uptake of VMMC and related services, such as HIV testing and counseling and cervical cancer screening.
More than 1,000 people attended, including students, parents, and staff from all competing schools.
“Matawu Secondary School ultimately won the drama competition, but all of the schools did a wonderful job explaining VMMC and its benefits,” said Mr. Masimba. “Messaging also emphasized abstinence for adolescents, the importance of the HPV vaccine for girls, and details about the VMMC procedure. The level of accuracy of information was extremely high.”
Importantly, two of the performances highlighted communities that reject medical interventions and stressed the need for participation by all.
A total of 182 VMMCs were attained by adolescents aged 15 to 19 years old immediately after the competition. Those who were not ready were booked for the procedure and will be followed up with by school health masters and community mobilizers.
On May 26, the International Training and Education Center for Health (I-TECH) bids a fond farewell to its Executive Director, Pamela Collins, MD, MPH. Dr. Collins joined I-TECH in July 2020, seeing the center through the height of the COVID-19 pandemic; a new brand; continued localization of I-TECH offices to independent organizations; and a strategic shift toward an increased focus on mental health, digital health, and One Health programming.
“I am privileged to have worked with this talented and compassionate group of colleagues from around the world for the past 3 years,” said Dr. Collins. “As I entered I-TECH, I discovered a network ready manage the demands of health care delivery during the COVID-19 pandemic and one whose capabilities are aligned with contemporary public health priorities—from workforce development, emerging infectious diseases, digital health, to mental health. While I am sad to leave this community, I am extremely excited for I-TECH’s future.”
While Friday was Dr. Collins’ last day leading I-TECH, she will remain through June as a faculty member in the University of Washington (UW) Departments of Global Health and Psychiatry & Behavioral Sciences. Dr. Collins will then transition to her new role as the Bloomberg Centennial Chair of the Department of Mental Health at Johns Hopkins University’s Bloomberg School of Public Health—the only school of public health in the country with a department dedicated to mental health.
Dr. Collins will be succeeded in leadership at I-TECH by Ivonne Ximena “Chichi” Butler, MPH, and Pam Kohler, PhD, MPH, BSN. Ms. Butler and Dr. Kohler will serve as interim co-directors of the center, with Ms. Butler overseeing business and administration and Dr. Kohler leading science and assuming a technical advisor role for faculty and staff. The co-directors will work together to represent and pursue collaborations and partnerships within and outside the UW; engage stakeholders to invest in I-TECH; and liaise with country leadership, principal investigators, and staff on program implementation.
Dr. Kohler brings experience as co-director of the UW Center for Global Health Nursing and has been a faculty member with I-TECH for 11 years. In that time, she has led a field epidemiology training program in Tanzania and evaluated STD/HIV treatment and prevention programs and policies in Eastern and Southern Africa. Her research is focused on de-stigmatizing adolescent HIV prevention and treatment service delivery.
“I’m excited about this new leadership structure, which emphasizes and acknowledges both the role of nurses in global health and the profound administrative efforts it takes to lead an organization of this size,” said Dr. Kohler. “I look forward to getting to know our many teams and projects on a deeper level over the coming year.”
Ms. Butler’s 17 years at I-TECH have seen her in various leadership, program management, and technical roles, supporting multiple countries and a diverse project portfolio from health systems strengthening to prevention and clinical treatment programs. She was most recently Associate Center Director.
“I will miss Pamela’s insightful, thoughtful, and inclusive leadership,” said Ms. Butler. “She was the right person to lead us through a uniquely challenging time. Moving forward, I am motivated to broaden our reach beyond HIV and AIDS care and delivery and intentionally put individuals and communities at the center of the care they receive. There is much to learn, and the I-TECH network is well-positioned to do this with the expertise and care that our global teams and partners bring.”
