HIV Positive Teens in Namibia Gather for Weekend of Fun and Support

Posted on September 19, 2017September 19, 2017

HIV-positive teens gathered at B2Gold’s Otijikoto Mine Nature Reserve for a weekend of team-building exercises, support, and discussions about the importance of adherence to treatment.

All teens need consistent opportunities to build self-worth, explore their gifts, and feel the support of peers and adults. For teens who are HIV positive, the everyday pressures and fears of adolescence (rejection, bullying, gossip) can be amplified, making these opportunities especially important. In Namibia, adolescents and young people, especially girls and young women, continue to be disproportionately affected by HIV.

In response to these realities, in late August, a three-day Teen Club Retreat was organized by the Katutura Hospital Paediatrics Communicable Disease Clinic (PCDC) team, in collaboration with B2Gold, Champions for Life, and the International Training and Education Center for Health (I-TECH).

Fully funded by B2Gold and hosted at its Otjikoto Mine Nature Reserve, the retreat included 49 teens from the clinic (31 girls and 18 boys), who were joined by clinic doctors, nurses, and counselors as well as facilitators from Champions for Life, a psychosocial-spiritual program for children, adolescents, and young adults with the challenges of being infected or affected by HIV.

Through team exercises, game drives, inspiring films such as “Hacksaw Ridge” and “The Soul Surfer,” lectures, and small group sessions, the retreat aimed to:

strengthen bonds and networks;
create enthusiasm about the future;
develop self-respect;
instill the values of a healthy environment, teamwork, and responsibility; and
keep teens engaged in care.

“I enjoyed the movies, as they motivated me. I realized that I am not the only one facing challenges. When I courageously tackle my challenges, I remain strong even if I may not win them all.” – Teen Club member

I-TECH Namibia’s Sharon Mambo, an HIV Pediatric Expert Nurse, served as a chaperone and as one of the key organizers of the retreat. Mambo led a discussion on the importance of treatment adherence and viral load suppression. In addition, she tasked one of the teens with facilitating a discussion on “transitioning,” the process during which adolescents move from paediatric HIV care to more independent adult care. At Katutura hospital, this means accessing health services at an adult ART clinic.

Addressing the teens’ fears of waiting too long for services and meeting unfamiliar faces, Mambo assured the group that a specific health worker has been assigned to work with them and they would be “fast tracked.”

“It’s a matter of changing consultation rooms when you transition to the adult clinic,” said Mambo. “You will still meet the happy, friendly staff on the other side, so lay your worries aside.”

Teen Club members enjoyed a tour of the B2Gold facility, as well as nature and wildlife walks.

Highlights of the retreat also included a tour of the B2Gold mine and a game drive, where the kids were thrilled to see reserve animals including giraffes, springboks, wildebeests, and zebras at close range. “I got to see some of these animals for the first time,” said one teen. “I never knew that some animals could be as clever as human beings.”

The team from Champions for Life also held a full-day seminar titled “NICHE,” focused on self-image, identifying gifts and abilities, and creating one’s vision for the future. This was done through music, dance drama, group presentations, and poetry.

“I enjoyed the team-building activities because we got to work as a group and had the opportunity to come up with ideas together as a team.” – Teen Club member

“A major success of this trip was the close bond, mutual respect, and trust that developed between the staff and adolescents during the three days,” says Mambo. “The shared experience and willingness of the staff to participate fully in all sessions of the program really lowered some of the barriers and discomfort that normally exist between teens and adults.”

Mambo has also been working with teen leaders from the group to support other facilities in Windhoek to establish their own Teen Clubs.

Site-level Data Improvement and Use in Namibia

Gabrielle O'Malley Monitoring & Evaluation Namibia Quality Improvement

Posted on July 24, 2017July 3, 2019

I-TECH continues to focus efforts on the improvement of data quality and use of data to improve clinical decision making. I-TECH works at the site level to build awareness and buy-in for data quality and use among site-level management and health care workers.

On-site I-TECH Monitoring and Evaluation (M&E) Officers and Program Assistants monitor completeness and accuracy of service delivery documentation from the point of patient encounter to the point of final data capture in Ministry of Health and Social Services electronic databases. M&E Officers promote the use of data by clinicians and facility management for systems improvement and performance enhancement.

Cervical Cancer Screening and Treatment in Namibia

Cervical Cancer Gabrielle O'Malley Gender/Women & Girls Health Policy Monitoring & Evaluation Namibia

Posted on July 24, 2017August 28, 2019

I-TECH supported the Ministry of Health and Social Services in 2017 and 2018 in the development and dissemination of the national Cervical Cancer Prevention Guidelines including algorithms for screening, referral, and post cryotherapy instrument disinfection, and monitoring and evaluation tools. Continue reading “Cervical Cancer Screening and Treatment in Namibia”

Training through Distance Learning in Namibia using the Project ECHO Model

Clinical Mentoring eLearning/Distance Learning Gabrielle O'Malley HIV Care and Treatment Human Resources for Health Namibia

Posted on July 24, 2017July 3, 2019

I-TECH in Namibia spearheaded use of distance learning for HIV care and treatment through the establishment of a digital video conferencing network to link Windhoek with training sites and hospitals throughout the country starting in 2008. Building off that foundation, Namibia became the first country in Africa to implement the Project ECHO model, a tele-health platform started at the University of New Mexico, whereby clinicians in remote areas connect with rotating subject matter experts and clinicians a robust virtual community of practice to build health care worker capacity, support peer-to-peer cross-facility learning and reduce feelings of professional isolation.

Continue reading “Training through Distance Learning in Namibia using the Project ECHO Model”

Strengthening National Health Systems through Task Shifting and Training in Namibia

Ann Downer HIV Care and Treatment Human Resources for Health Integrating Research and Practice Namibia

Posted on July 24, 2017July 3, 2019

Working with the Ministry of Health and Social Services (MoHSS) to roll out treatment in the country, I-TECH supported the training of physicians to provide antiretroviral therapy (ART) soon after the first national ART guidelines were published in 2003. I-TECH subsequently began supporting the training of nurses in both ART (2006) and Integrated Management of Adolescent and Adult Illness (IMAI, 2007) to increase health system capacity to expand delivery of ART services.

In 2010, I-TECH implemented a task shifting demonstration project to determine whether nurse-initiated management of antiretroviral treatment (NIMART) is a feasible alternative to doctor-led models. I-TECH subsequently supported an evaluation of this project which confirmed its feasibility for use in certain countries. In Namibia, NIMART was adopted by the MoHSS for use nationwide in 2013. I-TECH continues to hold NIMART trainings: five were held in 2016, with 125 health care workers trained.

VMMC for HIV Prevention in Namibia

Demand Creation Gabrielle O'Malley HIV and STI Prevention Male Circumcision Namibia Quality Improvement Scott Barnhart

Posted on July 24, 2017July 24, 2019

I-TECH assists the Ministry of Health and Social Services with the expansion and provision of voluntary medical male circumcision (VMMC) as an HIV prevention option. This support started in 2008 with the development of national guidelines and training materials, followed by national trainings of health care workers. In 2015, this support expanded to include direct service delivery in the Oshana and Zambezi regions, as well as Karas region from 2017 onward. Since 2016, I-TECH has also supported demand creation with a network of community-based mobilizers and recruiters using a human-centered design approach to actively engage communities and stakeholders to increase the number of men voluntarily electing medical circumcision. The program has performed over 36,000 VMMCs in Namibia.

I-TECH has trained physicians, nurses, and community counselors to ensure that adequate skills and experience are in place to deliver safe, high-quality male circumcision services.

Support for Pediatric HIV Care and Treatment in Namibia

Gabrielle O'Malley HIV Care and Treatment Human Resources for Health Integrating Research and Practice Key Populations Namibia

Posted on July 24, 2017July 3, 2019

I-TECH works to strengthen the quality of pediatric HIV care and treatment in Namibia through the development of a “model” pediatric HIV clinic and supporting decentralization of quality pediatric care to other facilities. In collaboration with the Ministry of Health and Social Services, I-TECH developed an innovative, structured, culturally-relevant intervention to help guide health care workers and caregivers of HIV-positive children through the process of disclosing a child’s HIV-positive status to the child.

An evaluation of the disclosure program showed that it increased health care worker and caregiver confidence and communication in pediatric disclosure, as well as demonstrating improved viral suppression, adherence, and HIV knowledge among pediatric patients. I-TECH clinicians have also worked at the site level to support the development, implementation, and monitoring of strategies to improve adolescent HIV services and transition of adolescents from pediatric to adult care.

Strengthening the HIV Care Continuum and ART Adherence in Namibia

Gabrielle O'Malley Health Information Systems HIV Care and Treatment Namibia Quality Improvement

Posted on July 24, 2017July 3, 2019

In accordance with the HIV Care Continuum, I-TECH supports direct HIV care and treatment service delivery as well as on-site clinical mentoring and technical assistance in 81 facilities in five regions of Namibia. I-TECH supports key evidence-based strategies such as provider-initiated HIV counseling and testing, eMTCT, and decentralization of ART services to the clinic.

In collaboration with the MoHSS, I-TECH is implementing “Treatment for All” guidelines (December 2016), an HIV care and treatment approach that initiates patients on lifelong antiretroviral therapy as soon as they test HIV-positive. I-TECH has developed an interactive education and counseling intervention, ARVs and Healthy Me, for health care workers to support HIV-positive patients in attaining good adherence and engagement in care.

To improve the quality of data for use in clinical decision-making, I-TECH actively participates in national technical working groups and advisory committees, and conducts rigorous monitoring and evaluation (M&E) to build awareness and buy-in for data quality and date use among site-level managers and health care workers.

Scott Barnhart

Scott Barnhart, MD, MPH, has an extensive background as Professor of Global Health and former Director of Global Health Programs for I-TECH at the University of Washington. He has had responsibility for leading nine country offices, projects in 14 countries, and more than 500 staff. This experience and training has included extensive clinical work, research and program management in pulmonary and environmental and occupational medicine, and more than eight years as Medical Director of a safety net/Level 1 Trauma Center hospital.

Ensuring health systems can quickly detect and respond to emerging health threats is a critical challenge in both domestic and global health. Dr. Barnhart’s major implementation projects include scale-up of voluntary medical male circumcision (VMMC) in Zimbabwe and Malawi, OpenMRS, and laboratory information systems. Dr. Barnhart deploys his expertise in multiple African countries and Haiti to strengthen health systems and health care.

A goal of Dr. Barnhart’s work is to promote country-led, country owned sustainable development. Consistent with the principles of the Paris Declaration, the goal is to transition the bulk of development work and the associated leadership, ownership, technical direction and control of funding into the countries where development occurs. This approach ensures that the entire continuum of skills necessary for development (technical expertise, administration (human resources, operations, and management and accountability for funds) is transitioned to local partners. A key indicator is to have 75% or more of a grant’s funding expended in-country on local programs and local citizens and to support the local economies in these highly resourced constrained countries. Dr. Barnhart has worked closely to advance this model through projects in Haiti with a goal to shift the majority of a project to a local organization and in Zimbabwe where the VMMC program is largely run through local partners.

Program Highlights

Layering Research and Practice in Haiti

The EMR iSanté enables research on population health in Haiti, including the implementation of Option B+. This work was presented at the International AIDS Society Conference in 2015 ...
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Reducing HIV through Voluntary Medical Male Circumcision in Zimbabwe

Since 2013, the ZAZIC Consortium has been implementing Voluntary Medical Male Circumcision (VMMC) as part of a combination HIV prevention package approved by the Ministry of Health and Child Care (MoHCC) in Zimbabwe. Unlike other VMMC programs in the region, the ZAZIC model uses an integrated approach, blending local clinic ...
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VMMC for HIV Prevention in Namibia

Workforce Development in Haiti

It is critical that health care providers receive the necessary training to empower them to improve patient outcomes CHARESS supports both pre-service and in-service training efforts in Haiti. In particular, CHARESS is a key partner of MSPP in maintaining its national clinical guidelines. ...
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CUGH 2017: Text Messaging and Tablets for Training

eLearning/Distance Learning Health Systems Strengthening HIV Care and Treatment Namibia Tanzania Zimbabwe

Posted on April 10, 2017September 5, 2017

On April 6, the International Training and Education Center for Health (I-TECH) headed to the 8th Annual Consortium of Universities for Global Health (CUGH) Conference in Washington, D.C. I-TECH Zimbabwe presented among many colleagues in the University of Washington’s Department of Global Health, including staff of the department’s E-Learning Program (eDGH), which has worked closely with I-TECH on a number of e-learning and blended learning training programs.

This year’s conference theme was “Healthy People, Healthy Ecosystems: Implementation, Leadership & Sustainability in Global Health,” and I-TECH’s entries highlighted its sustainable workforce development work worldwide.

I-TECH Zimbabwe presenter Vivian Bertman (front) and eDGH presenters — and Zimbabwe co-authors — Leslie Wall and Anya Nartker (back)

I-TECH Zimbabwe’s Vivian Bertman shared results on the use of text messaging as a low-cost, sustainable platform for building health care worker skills and knowledge to care for children and adolescents with HIV.

The research, titled “Health Worker Text Messaging for Training Peer Support, and Mentoring in Pediatric and Adolescent HIV/AIDS Care: Lessons Learned in Zimbabwe,” assessed the use of WhatsApp in a blended learning program. Participants used the app for peer-to-peer learning and support, generating over 300 entries, continuing discussions after course completion, and creating spin-off groups, including a support group for teens.

Highlighting the flexibility of cost-effective e-learning approaches was an oral presentation by eDGH’s Leslie Wall and Anya Nartker titled “No internet? No problem! Creative approaches to cost-effective e-learning delivery in resource-constrained settings.” The research looked at five tablet-based training programs developed by eDGH, in partnership with I-TECH, and delivered in Namibia, Tanzania, and Zimbabwe.

For participants, time spent off the job decreased from four days to less than one day, and within training programs that used text messaging to keep learners engaged, all participants finished in the time allotted. The team plans to expand learning activities and incorporate additional real-time interactions via text-message-based discussion groups or added face-to-face interactions.

Caitlin O’Brien-Carelli, an MPH graduate from the UW Global Health program, explored additional sustainable training models. O’Brien-Carelli presented her MPH thesis work on behalf of I-TECH: “Training Healthcare Workers on the Use of Electronic Medical Records in HIV Clinics in Kenya: An Evaluation of Three Training Models.”

During I-TECH Kenya’s first years of training health care workers to use the KenyaEMR system, the team adjusted its training from 5 days to 3 days, and moved the training from off-site to on-site, to increase sustainability and maintain effectiveness. Results confirmed that with the adjustments, training quality was maintained, more people in more facilities were trained, and costs were reduced significantly.

Detailing innovations on the operations front, I-TECH HQ Managing Director Rob Lindsley presented at a conference satellite session titled “Global Operations 2017: Tools for Faculty & Administrative Leaders.” Lindsley’s presentation, “It’s About How Hard You Can Get Hit and Keep Moving Forward: Global Support and PLC Registration in India,” outlined I-TECH’s complicated, creative pathway to country office registration in India.