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Category: Namibia

Zim-TTECH’s Innovative Programs Increase Male Circumcision Uptake for HIV Prevention

Post categories: Gabrielle O'Malley HIV and STI Prevention Male Circumcision Namibia Uncategorized
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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.

[1] https://www.cdc.gov/mmwr/volumes/72/wr/mm7210a2.htm

 

 

 

I-TECH Presents at CROI 2022

Post categories: Index Testing/Partner Notification Mozambique Namibia
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The International Training and Education Center for Health (I-TECH) presented findings from two I-TECH-supported programs during the 2022 Conference on Retroviruses and Opportunistic Infections (CROI). The annual conference took place virtually this year, from 12-16 February 2022, and brought together researchers, academics, and experts to discuss and present on scientific achievements and new research.

During the “Shifting Paradigms in HIV Testing” oral abstract session that was held on 16 February 2022, representatives from I-TECH presented two abstracts (full text linked below) that focused on findings from two HIV partner notification programs in Mozambique and Namibia:

To learn more about CROI, download conference resources, or to peruse the 2022 CROI program, please visit the CROI 2022 website.

Note: Bold name indicates presenting author.

I-TECH Supports First VACS in Namibia

Post categories: Gabrielle O'Malley Gender/Women & Girls HIV Care and Treatment Namibia
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The International Training and Education Center for Health (I-TECH), under the leadership of Government of Namibia ministries overseeing child welfare and health and in close collaboration with the Namibia Statistics Agency (NSA), UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC), supported the implementation of Namibia’s first Violence Against Children and Youth Survey (VACS).

Cover of Namibia VACS Report
The final Namibia VACS report was published by the Government of Namibia and Together for Girls, a global partnership working to end violence against children, on 28 September 2021. Photo Credit: Together for Girls: www.togetherforgirls.org/.

VACS are national surveys that measure the prevalence and impact of violence on children and youth around the world. The survey results help inform future program decisions and policy approaches to ensure the safety of children and youth. On 28 September 2021, the Day of the Namibian Child, the Government of Namibia published the final Namibia VACS report.

The survey, funded by the U.S. President’s Emergency Plan for AIDS Relief and led by the Ministry of Gender Equality, Poverty Eradication and Social Welfare (MGEPESW), interviewed households with children aged 13-24 years in all 14 regions of Namibia from March 2019 through June 2019.

Survey operations—including data collection by field teams, data generation, and analysis—were carried out by the NSA, the central statistical authority responsible for all official statistics in Namibia. “It has been a pleasure working together with the Ministry of Gender Equality, the University of Washington, I-TECH, and CDC on this important survey,” says Ottilie Mwazi, Namibia’s Deputy Statistician General. “Our team has learned a lot from the process and is very proud to have contributed important data that will help to improve child welfare in Namibia.”

Prior to data collection, I-TECH alongside CDC colleagues hosted a two-week training for 130 enumerators, focused on best practices for data collection, interview techniques, and key aspects of the survey protocols. In addition to supporting VACS training, I-TECH and the Ministry of Health and Social Services (MoHSS) ensured all selected enumerators were trained and certified by the Namibia Institute of Pathology to conduct HIV rapid testing so any survey respondent aged 14-24 years who did not know their HIV status and wanted a test during their interview could immediately be tested.

In total, 5,191 individual interviews among 6,042 households (86.35% overall response rate) and 3,232 HIV rapid tests were conducted as part of data collection. Any respondent testing positive for HIV during the survey was linked to psychosocial and HIV/AIDS care and support in line with well-established MoHSS guidelines and the survey protocol.

Expanding Post-Violence Clinical Care

The survey results have informed important initiatives across Namibia’s wider social welfare and health systems. MGEPESW has moved forward with drafting the National Action Plan on Violence against Children and has accelerated the training of various child welfare stakeholders such as police officers and social workers, while operationalizing the establishment of more child shelters in several regions.

“The data coming out of Namibia’s VACS have really brought home how prevalent and serious violence against children and adolescents really is,” says Helena Andjamba, Director for Child Welfare at MGEPESW. “Having these hard facts readily available has helped greatly during our policy and planning engagement with multiple stakeholders during the past year. We are now moving forward with the Ministry of Justice in drafting a new Child Justice Bill, and at the same time we are engaged with the Ministry of Education on strengthening the National School Safety Framework.”

Following the completion of the survey, the MoHSS convened a technical working group with I-TECH, the World Health Organization, UNFPA, Project Hope, and other stakeholders to coordinate and strengthen first-line post-violence clinical care in primary health care facilities across Namibia. I-TECH also supported the compilation of clinical guidance on emergency care for survivors of sexual violence and its inclusion in the 2021 edition of the Namibia Standard Treatment Guidelines published by the MoHSS.

Much of the focus during the second half of 2021 was on integrating post-gender-based violence (GBV) clinical care in MoHSS HIV/AIDS clinics and antiretroviral therapy (ART) services throughout Namibia. As part of this work, I-TECH conducted a mentorship training-of-trainers for 28 HIV clinical providers, nurses, and testing services staff. These mentors now provide ongoing technical guidance and supportive supervision to frontline health workers through monthly facility visits.

To further improve post-violence care in clinics, I-TECH compiled a GBV care implementation guide for Namibian healthcare providers. This includes elaboration of best practices, as well as a suite of materials including posters, pamphlets, job aids, and a pocket booklet for communities, clients, health workers, and health facility managers, respectively. An intimate partner violence/GBV screening tool to be administered to ART patients with persistent high viral loads is also currently being piloted in ten health facilities.

Finance, Operations, and HR Leaders Across the I-TECH Network Share Experiences

Post categories: Cote d'Ivoire Kenya Malawi Namibia
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By Chelsea Elkins

Operations management, including general operations, finance, and human resources (HR) work, are vital to any organization. They are particularly important in the complex landscape of public health programming, where they form the backbone of life-saving services. The International Training and Education Center for Health (I-TECH) network is grateful for the expertise and leadership of finance, HR, and operations professionals across the globe who keep the organization running smoothly and responsibly. We asked several I-TECH Finance, Operations, and HR Managers to share a little bit about what drives their work, as well as their experiences as leaders within the public health field.

Yves-Alain Tanoh

Yves-Alain Tanoh
Finance Manager, I-TECH Côte d’Ivoire

I have been working in the I-TECH Côte d’Ivoire Finance Department for more than 3 years. Prior to I-TECH, I worked on several development projects in Côte d’Ivoire for 14 years.

I am really dedicated to this work.

Since my childhood, I have always had compassion for people in need. I have been affected by the way refugees were struggling for life during the Liberia and Sierra Leone wars. This led me to work with a development non-governmental organization (NGO). Already working in the humanitarian field, I told myself that I could make my modest contribution in a health NGO. I got the opportunity to join I-TECH and have really enjoyed my job since.

Being a leader is not easy. In addition to having a full to-do list, I face many unforeseen circumstances every day. Being competent does not mean knowing everything, but you need to understand each topic well enough to be able to make informed decisions and ask the right questions if information is missing.

I am focusing more and more on building the right team, along with a sustainable human strategy and a culture of innovation. This will be their contribution to I-TECH.

Tannia Toivo

Tannia Toivo
HR Manager, I-TECH Namibia

I joined the HR field because of my love of working with and helping people. Naturally, I was drawn to the public health field and specifically to I-TECH because of its work in addressing the challenge we are facing with HIV in Namibia.

I first joined I-TECH Namibia as an HR Officer for a short period in 2012 and 2013. I was very fortunate to join the team again in May 2016 as an HR Manager.  It has been so rewarding as I interact with professionals and experts from diverse backgrounds and experiences, therefore learning every day.

Generally, the HR field is woman-dominated, and it is great to see the impact that women have in the corporate world. It is a challenging field that is always growing and changing; requiring one to work very hard and to have strong job knowledge in order to succeed. My work as an HR Manager also means that I am involved in Affirmative Action activities, which place an importance in making sure that women are provided equitable employment, training, and job advancement opportunities amongst others. Through my work, I play a part in empowering other women. 

Angela Amondi

Angela Amondi
Operations Lead, I-TECH Kenya

My operations work was initially with general nonprofits, but as I evolved in my field, I began specializing in public health nonprofits.

I have found that being the Operations Lead for the I-TECH Kenya office has been extremely fulfilling. The organization provides professional support and development to help employees learn on the job and enhance their professional skills. A few of my I-TECH career highlights include when I supported the startup for the Kenya office and led the subsequent scale-up when we received additional funding. Within a period of two years, the office grew from having six employees to 17. While leading the operations scale-up, I set up the business operations support and created all operational policies and procedures.

I-TECH practices and emphasizes work/life balance, including having policies that support new mothers and, even before the onset of the COVID-19 pandemic, including telecommuting as part of the organizational policies. These policies have allowed for peace of mind to focus on the work and achieve the objectives at hand.

Gerald Hiwa

Gerald Hiwa
Finance Manager, I-TECH Malawi

The public health sector needs to be occupied by personnel who have a strong background in finance and can provide strong leadership to oversee financial and grants management. Working in the public health field allows me to answer that call of providing strong leadership so that donors and funders become more confident on how the funds are being utilized and that the intended beneficiaries are benefitting from various health programs.

Analyzing the impact of health interventions compared to the funding investment has been another factor that has enabled me to remain in the public health space for the past 9 years.

My role at I-TECH Malawi as a Finance Manager has been quite educative and impactful. Educative in the sense that I have gained additional knowledge by working with a diverse group of people with different backgrounds. I have also learned to appreciate other people’s perspective regarding work culture. The experience working with I-TECH senior management in Malawi and at headquarters has taught me to focus on the core objective of the various programs and link deliverables to budget monitoring.

My role has been impactful in the sense that I supervise two Finance Officers. Together we have managed to have clean audits with no findings for the past 5 years during annual external audits. Our Finance Department has maintained the first position for three consecutive years during the Global Finance Excellence award, a rating used to gauge policy compliance and accurate financial reporting. My role has had an impact by ensuring that all payments are in compliance with policy and reporting deadlines are met.

Candida Angula

Candida Angula
Senior Finance Manager, I-TECH Namibia

I was introduced to finance work within the public health field by accident, you might say. I started work as an accountant at an IT company, where I mostly did bank reconciliations and invoices and also worked with debtors. After 8 years I felt like I was stagnating and not really growing much as a professional; then the opportunity to join I-TECH Namibia presented itself. I saw the job ad in the paper, decided to go for it, applied, and the rest is history…

I have had so many wonderful experiences, including when I went to work in the South African country office’s Finance Department. I was tasked with assisting them to set up their systems and sharing my expertise and experiences. I liked working in a different set-up, learning the different South African cultures, and interacting with new people.

Another favorite experience is working with people from all over the world, networking and learning from their experiences, as well as sharing mine with them. Back home in the Namibian office, I also like that I get to interact with field staff, which is rare; finance people in general tend to be more office-based. But every now and then I go out into the field and conduct fiscal inventory verifications where I get to learn more about the operations in the field and interact with my fellow colleagues.

A highlight in my work was when I acted as Finance Director for over six months. The experience really shaped my career and confidence and challenged me in ways that made me grow as a professional.

Even though the finance field is generally male-dominated (especially here in Namibia), I’m not conscious of being a woman in my position as a Senior Finance Manager. Instead, I see my position as both an opportunity and a challenge; an opportunity to inspire more young women to join the field, and a challenge to demonstrate that women can excel in any field.

 

I-TECH Network Minimizes Disruptions in Treatment Access for PLHIV During COVID-19

Post categories: COVID-19 Gabrielle O'Malley HIV Care and Treatment India Jeff Lane Namibia Pamela Collins Stefan Wiktor Zimbabwe
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By Chelsea Elkins

Members of a Community Adherence Refill Group in Zimbabwe

In a time of increased barriers, disruptions, and restrictions due to the COVID-19 pandemic, the International Training and Education Center for Health (I-TECH) and its network partners have implemented new approaches and adapted existing programs to support continued access to antiretroviral therapy (ART).

As a result of the pandemic, many organizations and health systems have had to shift to offering virtual care, which allows ART initiation and other HIV services to persist while minimizing patients’ risk of exposure to COVID-19. However, not all patients have access to the technology that makes virtual services possible, and additional approaches are needed to support ART treatment access during this time.

“Globally, the pandemic has generated innovative responses from communities and health systems that are striving to keep people connected to care,” says Dr. Pamela Collins, I-TECH Executive Director. “One challenge is to recognize how (or when) some adaptations increase disparities in access. We’ve learned that the right combinations of technological and no-tech solutions can also be innovative if they help provide the care that’s needed.”

One way I-TECH has helped to provide innovative care during the pandemic is by centering solutions within the affected communities themselves. A few of the community-oriented approaches that the I-TECH network has implemented include decentralized ART centers, community outreach, home delivery, community adherence refill groups (CARGs), and multi-month dispensing (MMD) of antiretroviral (ARV) medication.

Decentralized ART Refill Sites and Community Outreach

Decentralized refill sites have been an essential strategy during lockdown restrictions for I-TECH’s network partners because they allow ART to be distributed at more convenient locations, minimizing travel and treatment interruptions. Some programs have also started providing mobile outreach to improve ART access during the pandemic, at times even providing doorstep delivery to those who are unable to go to a clinic or refill center.

I-TECH’s network partner in India, the UW International Training & Education Centre for Health Private Limited (I-TECH India) launched the ARTMitra helpline in Mumbai, an outreach effort designed to map the location of unreachable PLHIV and aid in planning decentralized ART refill sites. SMS messages were delivered to 13,103 PLHIV who had missed appointments during the pandemic, resulting in the identification of 42 decentralized ART refill centers in Mumbai in 2020. A similar helpline was launched in five districts of the state of Mizoram in partnership with the State AIDS Control Society. In total, I-TECH India, in close coordination with government partners in the PEPFAR states in Northeast India and in Mumbai, has ensured uninterrupted ART delivery through 145 decentralized ART refill sites.

Through outreach efforts, clients were notified about how they could access medication, and which decentralized ART refill site they should visit. Additionally, ART home delivery was provided to 255 PLHIV living in Mumbai who were unable to pick up their medication.

Thank you for calling and informing me about the availability of medicine at the nearby ART Centre, as I had no idea whom to contact and how to collect medicine.

—an ARTMitra client in Mumbai

I-TECH network partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) has also utilized community outreach to support PLHIV during the pandemic. Zim-TTECH has supported the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium—along with PEPFAR partners, the U.S. Centers for Disease Control and Prevention (CDC) and in close collaboration with national efforts—to provide mobile HIV care, including prevention services and integrated services at ART events. In the Harare District, 8,257 clients were supplied ART during outreach events from 28 March through 17 July 2021.

Community Adherence Refill Groups and Multi-Month ART Dispensing

Through CARGs, a community of PLHIV access treatment more easily by sending a representative to receive ARVs for the entire group. The I-TECH network implements CARGs in a number of countries, using the person-centered approach to simplify HIV care and reduce the need for in-person services. This approach is often used in tandem with MMD, allowing a group to access multiple months of medication at a time.

While ARVs have traditionally been prescribed monthly, MMD allows patients to pick up medication for 2 to 6 months and reduces traditional barriers, such as access to transportation and taking time off work, as well as barriers specific to COVID-19, such as lockdown restrictions and limited capacity of health care facilities. I-TECH and its network partners have scaled up MMD in many programs during the COVID-19 pandemic, effectively minimizing the number of in-person visits and encouraging ART adherence.

In response to COVID-19 and in partnership with CDC, the Ministry of Health and Social Services (MoHSS) in Namibia introduced a new MMD policy in April 2020 for eligible ART patients, making more people eligible for this service than ever before. In addition to policy support, I-TECH Namibia is engaged in technical support to the national HIV/AIDS program through clinical mentors who work in more than half of Namibia’s health districts. This national engagement has contributed to a rapid increase in the number of eligible ART patients who now receive between 2 to 6 months’ supply of ARVs at a time.

‘’As the number of ART patients on MMD increased, waiting areas in Namibia’s health facilities have rapidly decongested, enhancing COVID-19 infection prevention and control measures,” says Dr. Norbert Forster, I-TECH Namibia’s Country Director. “At the same time, our HIV clinicians now have more time to focus their care on patient engagement and on enhancing viral load suppression and other interventions.”

I-TECH’S WORK IN INDIA 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.

Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination

Post categories: Cervical Cancer COVID-19 Gabrielle O'Malley Gender/Women & Girls Jeff Lane Linda Eckert Malawi Mozambique Namibia Stefan Wiktor Uncategorized Zimbabwe
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The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.

However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.

Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.

Record-breaking cervical cancer screening in Namibia

The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia’s national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.

In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.

From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).

“As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Lead Physician in Namibia. “Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening.”

Mentoring and training continues in Mozambique via videoconferencing technology

In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® “superhub” for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.

“Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies,” says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. “The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them.”

In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.

While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.

Access to services increase through health communication in Malawi

Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.

To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.

I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.

In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.

Zimbabwe consortium takes measures to blunt the impact of COVID-19

I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.

By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:

  • Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
  • Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
  • Procurement and distribution adequate PPE for use by health care workers at facilities.

I-TECH Presents Posters at IAS 2021 Conference on HIV Science

Post categories: COVID-19 Differentiated Care HIV and STI Prevention HIV Care and Treatment Index Testing/Partner Notification India Malawi Monitoring & Evaluation Namibia Surveillance Tanzania Zimbabwe
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The International AIDS Society (IAS) virtually hosted the 11th Conference on HIV Science on 18-21 July 2021. The conference also included a “local partner hub” in Berlin, the original host city, for local experts to gather in person. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.

Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters:

Representatives from I-TECH’s partner network organizations and the Centers for Disease Control and Prevention (CDC) also presented data from I-TECH-supported programs in Malawi, India, and Zimbabwe.

I-TECH Team Contributes to New WHO Recommendations for Cervical Cancer Screening and Treatment

Post categories: Botswana Cervical Cancer Health Policy Health Systems Strengthening Linda Eckert Malawi Namibia
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After two years of collaborative work, the World Health Organization (WHO) today launched a critical publication to aid health care workers in the march toward cervical cancer elimination: The WHO Guidelines for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention.

The guidelines contain evidence-based recommendations for cervical cancer screening and were created in the context of the WHO global strategy to accelerate the elimination of cervical cancer, as well as the need to provide screening and prevention services to all women around the globe.

Dr. Linda Eckert–University of Washington (UW) Professor of Obstetrics & Gynecology, Adjunct Professor of Global Health, and technical advisor to I-TECH’s cervical cancer programs in Namibia, Malawi, and Botswana–served as one of the lead consultants coordinating the WHO guidelines.

“It has been a true privilege to join with WHO colleagues to collect and synthesize data and work with cost effectiveness modelers and our 60-member multinational Guideline Development Group, who shared their immense experience and knowledge to create these evidence-based guidelines,” said Dr. Eckert. “It is so hopeful for women around the globe, and I feel inspired thinking about how many women can be spared the suffering of cervical cancer through implementation of these guidelines.”

Dr. Laura Muzingwani, the lead physician for I-TECH’s Cervical Cancer Prevention Program in Namibia, was also an active member of the Guideline Development Group. Her experience and expertise in cervical cancer screening and treatment in Namibia enabled her to offer valuable guidance in the crafting of these recommendations.

In addition to the UW, contributing partners in the project included McMaster University, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and Unitaid, among others.

I-TECH Supports Critical TB Prevention, Screening, and Treatment for PLHIV

Post categories: Gabrielle O'Malley Malawi Mozambique Namibia Tuberculosis
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The global health community recognizes March 24 as World Tuberculosis (TB) Day to raise awareness of this deadly, yet preventable and curable, disease. The 2021 theme, “The Clock Is Ticking,” underlines the importance of acting now to end the global TB epidemic. According to World Health Organization, the probability of developing active TB disease is 18 times higher in people living with HIV (PLHIV), and in 2019 TB killed 1.4 million people worldwide, which includes 208,000 people who were HIV-positive.

Photo Credit: I-TECH

According to the U.S. Centers for Disease Control and Prevention, TB is one of the leading causes of death worldwide for PLHIV. To help treat and combat the spread of TB, particularly among PLHIV, the International Training and Education Center for Health (I-TECH) supports TB prevention, care, treatment, monitoring, and policy activities across the I-TECH global network. Current I-TECH work includes TB interventions in Mozambique, Namibia, and Malawi.

I-TECH supports the National TB Program in Mozambique by using the Warm Line—a telephone consultation line that supports clinicians—to deliver results for suspected drug-resistant TB cases to clinicians located at health facilities throughout the country. This collaboration with the Ministry of Health’s National TB Reference Lab allows for more timely identification and better management of drug-resistant TB cases. During 2019, 9,103 (83%) of results were delivered via the Warm Line. I-TECH’s team also engaged providers and clinicians in 383 interactions via the Warm Line to support mentoring and to monitoring complicated TB cases.

In addition to supporting clinicians with TB care and diagnosis, I-TECH supports TB prevention, diagnosis, and care among clients attending HIV clinics throughout seven regions and across 150 public health facilities in Namibia. The I-TECH team screens for active TB; monitors drug interactions for TB/HIV co-infection; provides TB screening, prevention, and management of TB/HIV co-infection for HIV-positive clients; tests for HIV at TB clinics for clients with unknown HIV status; and assesses eligibility, previous initiation, and completion of TB Preventive Therapy (TPT) to ensure no clients are missed. As of January 2021, approximately 90% of HIV-positive patients on antiretroviral therapy at supported facilities initiated their TPT course and 80% have completed their TPT course. I-TECH also works closely with healthcare workers and facilities to improve recording keeping of TPT course initiation and completion as well as the use of this data to focus day-to-day clinical efforts.

Since 2015, I-TECH has been providing technical assistance support to the Malawi National TB Program to improve the quality of TB services at all health facilities throughout Malawi. I-TECH continues to train program monitors to interpret and act on data collected using the TB Standard of Care Monitoring Tool. The tool, designed by I-TECH, collects data for case detection, treatment outcome monitoring, TB/HIV status ascertainment, and TB infection control and contact investigation. Using the collected data, I-TECH identifies performance gaps and create action plans for health facilities to improve the quality of TB services. Even with a loss of momentum due to the impact of COVID-19 pandemic, by September 2020, 85% of presumptive TB cases—those who were suspected of TB and referred for testing—knew their HIV status.

 

I-TECH’S WORK IN MOZAMBIQUE 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.

I-TECH’s Work Supports WHO’s First-Ever Strategy to Eliminate Cervical Cancer

Post categories: Botswana Cervical Cancer Namibia
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The International Training and Education Center for Health (I-TECH) is proud to support today’s launch of the World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer. I-TECH has supported interventions for education, testing, and treatment of cervical cancer since 2014.

In Namibia, I-TECH currently supports screening and treatment at 31 health facilities and 11 outreach sites in seven regions. As of August 2020, the program had performed more than 14,000 screenings and 1,700 treatment procedures for HIV-positive women.

The Namibia team has also launched a campaign to raise awareness of the importance of screening for and treatment of cervical pre-cancer in women aged 20–49. The campaign has been crucial during the COVID-19 pandemic, as patients may be less likely to visit their health care provider for preventive care, including cervical cancer screening and treatment.

I-TECH’s network partner in Botswana, the Botswana Training and Education Center for Health (B-TECH), will soon begin work on a national cervical cancer and treatment program, focused on women living with HIV. Activities will include providing quality routine cervical cancer screening and treatment for all eligible women living with HIV at high-volume ART sites in 12 districts, as well as raising awareness among this population.

B-TECH — in conjunction with I-TECH, University of Botswana, and the National Cervical Cancer Prevention Program (NCCPP) — will align national screening and treatment guidelines with WHO standards to ensure sustainability. B-TECH will also work closely with National Laboratories to increase capacity for quality cervical cancer screening services.

Dr. Linda Eckert, UW Professor of Obstetrics & Gynecology as well as Global Health, is lead coordinator for updating WHO recommendations on cervical cancer screening and treatment and serves as technical advisor to I-TECH in this work in Namibia and Botswana. She notes that the time has come for the WHO strategy.

“The WHO’s Cervical Cancer Elimination Strategy will literally save millions of women’s lives around the globe,” says Dr. Eckert. “Each year, over 300,000 women die of cervical cancer, and the number of deaths is projected to increase by over 20% in the next decade.

“Almost all cervical cancer can be prevented—making these deaths even more tragic,” she continues. “This is the first time WHO has launched a cancer elimination strategy, calling on the global community who care for women to say ‘enough’ to cervical cancer, ‘enough’ to these preventable deaths.”