In honor of National Women’s Day in South Africa on 9 August, members of the International Training and Education Center for Health (I-TECH) team in South Africa organized a personal donation to faith-based organization Participate, Empower, Navigate (PEN), which provides services and support to at-risk populations such as the homeless, sex workers, and orphaned children.
Members of I-TECH South Africa organized a personal donation to the Participate, Empower, Navigate (PEN) Organization in honor of National Women’s Day on 9 August 2018.
“We were interested in supporting a program that works with women and we were introduced to the Ladies Arise program at PEN,” explains Lebogang Ntswane, I-TECH South Africa program manager.
Ladies Arise is a community support program for homeless women provided through PEN. Many of the women seeking support from the program have been forced into sex work to make an income. Through Ladies Arise, the women can access a drop-in center where they can use the facilities to shower, do laundry, and eat a meal.
The drop-in center also coordinates activities for the women like art classes, crochet, and Bible study. In addition to the fun and sometimes income-generating programs, Ladies Arise provides the women with social and mental health services, such as counseling with PEN’s volunteer social worker.
PEN is a donor-funded non-profit organization and relies on donations of all kinds to continue offering much-needed services in Pretoria. In addition to fundraising events and a major supermarket that donates food to the center on a monthly basis, PEN also relies on donations of clothing, toiletries, and shoes from the community.
“One of our colleagues had seen the idea of filling handbags with toiletries in a magazine,” says Ntswane, “and we decided it would be a great way to commemorate National Women’s Day and assist the women in our community.”
I-TECH South Africa staffers donated the bags filled with new toiletries, as well as clothing and new packs of underwear, a particularly high-need item at the center.
In addition to donations, I-TECH team members had the chance to sit down with recipients over breakfast to learn about their stories. “One woman reported that she met with the center coordinator and was introduced to the Ladies Arise program. She is now attending a cosmetology course,” says Ntswane. “We are so glad that we found this organization, and we look forward to continuing our personal support of PEN whenever possible.”
The International AIDS Society (IAS) held their 22nd international AIDS conference (AIDS 2018) in Amsterdam 23-27 July 2018. This year, the conference objectives focused on advancing knowledge of HIV through research findings, promoting evidence-based HIV responses tailored to key populations, activating and galvanizing political commitment and accountability, addressing gaps in and highlighting the critical role of HIV prevention, as well as spotlighting the epidemic and HIV response in Eastern Europe and Central Asia.
Representatives from I-TECH were at the conference to present and discuss their posters:
Ann Downer presents her abstract, “Lessons Learned from Sustained Global Health Investments” at AIDS 2018.
In addition to the two presentations above, I-TECH staff and faculty had a number of other abstracts accepted to the conference:
Phiona Marangwe discusses her poster, “Trust but Verify: Is There a Role for Active Surveillance in Monitoring AEs in Large-Scale VMMC programs?” at AIDS 2018.
“Aligning Botswana’s National HIV Testing Services Guidelines to the Era of Treat All.” (Botswana, Jenny Ledikwe)
This abstract explores Botswana’s experience of adapting the WHO HIV Testing Services (HTS) Guidelines, a significant step in reaching epidemic control of HIV, demonstrating the nation’s commitment to rigorous strategies that ensure all Batswana know their status and have timely access to prevention and treatment services.
Recent public health care reform in Ukraine has called for the growing role of primary health care, task shifting, and decentralization of HIV services while providing care and treatment for people living with HIV (PLWH). In June 2018, the International Training and Education Center for health (I-TECH) Ukraine conducted two back-to-back, five-day in-service training programs on HIV testing services for two cohorts of participants from twelve regions across Ukraine.
Dr. Serhii Rabokon, Head of the Treatment Programs at the CPH of the MoH of Ukraine, delivers a presentation on the nurse’s role in achieving UNAIDS 90-90-90 targets. Photo source: I-TECH Ukraine.
The concept and design of these unique pilot training programs were influenced by the recent reform to actively involve general practice/primary care nurses into the process of achieving UNAIDS 90-90-90 targets in Ukraine.
A group of 10 national HIV and health care reform experts, I-TECH’s international consultant-nurse practitioner, and the I-TECH Ukraine training development team carefully designed the learning objectives and content of the training program with consideration of the specifics of the national HIV epidemic, participant backgrounds, as well as anticipated task shifting. Together, these experts synthesized and presented international and national clinical and nursing best practices in the area of serving PLWH.
Training participants included nurses from primary care facilities, specialized HIV clinics, as well as faculty of seven local nursing colleges, including I-TECH Ukraine’s national partners – Ternopil State Medical University and the Nursing College of Poltava Ukrainian Medical and Dental Academy.
The training programs outlined roles for general practice/primary care nurses in achieving UNAIDS 90-90-90 targets, taught HIV basics, helped develop skills for HIV testing services with rapid HIV test kits, and coached participants on conducting counseling for PLWH using a non-discriminatory, patient-centered approach.
Participants in the second pilot training work in small groups. Photo source: I-TECH Ukraine.
Facilitators used interactive training tools and approaches during the program to fully engage participants and strengthen the capacity of the nursing college’s faculty to teach up-to-date HIV content in an appealing and efficient way.
One of the central elements of the program was to educate the participating nurses about the challenges surrounding HIV-related stigma and discrimination with a major goal to overcome it in the nursing community and encourage respectful delivery of services for PLWH.
“[I-TECH Ukraine and its partners are] doing such a[n] important thing,” says Valentyna Borysova, lecturer of Zaporizhzhia Nursing College. “Educating nurses on HIV has been so much underestimated and under-invested in Ukraine.”
In addition to feeling as though this training addressed a critical gap in education, participants also provided positive feedback about the content and facilitation of the training, especially the parts of the training that were facilitated by the international and national peer nurses.
Participants in the first pilot training focus on a presentation about HIV Fundamentals. Photo source: I-TECH Ukraine.
“The knowledge on testing and post-exposure prophylaxis are badly needed at our clinic,” says Liudmyla Samolelis, Senior Nurse of the Psychiatric Clinic in Poltava, Head of Poltava Oblast Nurse Association. “I plan to conduct an on-the-job training for the nurses, using the materials from the training.”
Due to the success of the pilot trainings, I-TECH Ukraine intends to finalize training materials, institutionalize the course through its local partners, and develop a manual that could be used in different training formats, including state-owned colleges and medical universities. In addition, an ambitious regional rollout of the training program is anticipated during the next year of the project.
On June 1, 2018, the University of Washington’s International Training and Education Center for Health (I-TECH) country office in Haiti officially became a local non-governmental organization (NGO). The office will be rebranded as the Centre Haïtien pour le Renforcement du Système de Santé (CHARESS) and will continue to implement programs to improve HIV services via a trained health workforce, robust health information systems (HIS), and clinical mentoring.
CHARESS will be responsible for maintaining, training, and deploying HIS such as iSantéPlus and the Système d’Echange d’Information de Santé d’Haïti (SEDISH), a national health information exchange, across Haiti and ensure the sites receive on-site and remote technical assistance. The team will also oversee clinical mentoring activities at 20 sites and provide technical assistance to the Ministry of Public Health and Population (MSPP) and other implementing partners in Haiti.
“I-TECH has a mission to support sustainable development,” says Scott Barnhart, MD, MPH, Professor in the Department of Global Health and an I-TECH Principal Investigator overseeing programs in Haiti. “The conversion of the I-TECH country office and launch of a fully independent NGO to take up those activities is testament to I-TECH’s commitment to fostering locally owned and led development.”
The announcement of the shift to local ownership comes after two years of strategic planning by key stakeholders and partners to successfully transition I-TECH Haiti’s country office into an independently functioning NGO. As such, CHARESS will aim to allocate more of its funding to program activities, as well as pursue local funding opportunities restricted to Haitian organizations.
“The programs that are shifting to CHARESS have already proved to have had a dramatic impact on the health care landscape in Haiti,” remarked Jean-Guy Honoré, MD, I-TECH Haiti’s Country Director. “Transitioning of the key programs, specifically our HIS work, to a local ownership will allow CHARESS to become a leader in sustainability on the global stage. We are proud of the work that we have accomplished and look forward to the future.”
For 16 years, I-TECH has helped develop strong national health systems in low- to middle-resource countries while promoting the importance of local ownership as a way to sustain those effective health systems. I-TECH will continue to be a close partner in supporting CHARESS and looks forward to continued collaboration.
Facing Ashitenga Primary School students at the VMMC certificate ceremony are, from left to right: Levi Vries, Education Inspector for Oluno Circuit; Lusia Ndemuweda, I-TECH Demand Creation Coordination Nurse; Ashitenga Principal Edward Asser; Frieda Mupetami, a representative of Okatyali Constituency office; and Life Skills teacher Teopolina Mupetami (in red).
In Namibia, the prevalence of HIV infection among adults aged 15 to 49 is nearly 14%.[1] A key component of national efforts to prevent the spread of HIV is voluntary medical male circumcision, or VMMC, which has proved to reduce the rate of male-to-female transmission by upwards of 60%.
Since 2010, the International Training and Education Center for Health (I-TECH) has supported the VMMC efforts of the Namibian Ministry of Health and Social Services (MOHSS) in the Oshana and Zambezi regions. I-TECH not only supports health care worker training in the provision of VMMC, it is also engaged in critical efforts to create demand for the procedure.
A key element of these efforts is the recognition of schools and school leadership who are supportive of VMMCs. In February, Ashitenga Primary School in Oshana Region was awarded a platinum certificate by I-TECH Namibia for achieving 96% saturation of boys receiving a VMMC. Platinum is the highest honor, with bronze signifying 55-69% saturation, silver awarded for 70-79% saturation, and gold given for 80-89% saturation.
Present at the event was the Oluno Circuit Education Inspector Levi Vries. In his remarks, Mr. Vries encouraged other schools to emulate Ashitenga’s good example. He emphasized the importance of student health to attaining educational goals and urged students to spread the VMMC message to others in their families, villages, and neighborhoods.
As part of the Life Skills curriculum, older boys are instructed on HIV prevention, while the younger boys are taught personal hygiene – messages that are reinforced by I-TECH community mobilizers. Teopolina Mupetami, the Life Skills teacher at Ashitenga, encouraged Life Skills teachers at other schools in the area to support the VMMC program. Ashitenga principal Edward Asser echoed the importance of the school’s recognition; he promised to display the certificate proudly in his office.
Three of the circumcised students were interviewed by the Ministry of Information Communication and Technology, which is charged with spreading the message about “the smart cut” in the government media. The boys responded that “they feel clean and protected from sexual related disease,” said Helena Ferdinand, I-TECH community mobilizer. The students prompted boys at other schools to enroll in the VMMC program and expressed their satisfaction with the service.
“The atmosphere at the handover was joyful and a lot of excitement,” said Ms. Ferdinand. “The principal indicated that they will continue to work hard to get a second platinum certificate.”
Nancy Puttkammer of I-TECH and Rose Boulay of Haiti’s MSPP/PNLS standing next to I-TECH’s poster on MMS of ART at CROI 2018.
Nancy Puttkammer, PhD, MPH, presented a poster at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston on 4-7 March 2018. She was joined by Rose Boulay, a representative from the Haiti Ministry of Health (MSPP) National HIV Program (PNLS). Madame Boulay works on data quality assessment, training for clinical sites, and decision making using data from the iSanté electronic medical record (EMR) system.
The poster, titled “Multi-Month Scripting (MMS) and Retention on HIV Antiretroviral Therapy (ART) in Haiti,” reflected the collaboration between I-TECH and MSPP to analyze national policies using iSanté data from 85 ART clinics. They examined the MSPP-led MMS initiative to prescribe longer intervals of ART for stable patients. The goal of the MMS approach is to improve patient retention on ART by reducing the burden to patients of coming into the clinic monthly to pick up their ART prescription.
“Our analysis showed impressive uptake of MMS across all health facilities, suggesting that longer intervals are welcomed by providers and patients,” explained Dr. Puttkammer. “Patients prescribed ART for two months or more were 18% more likely to be retained, after adjusting for various patient and facility factors, compared to patients on monthly ART regimens. This is a promising result in terms of the goals of the MMS approach.”
Haiti’s national EMR system allows for the MSPP to conduct data analysis to evaluate the success of health interventions across the entire network of clinics and hospitals in a timely manner. “We are very pleased that we have been able use the iSanté data system to measure the progress of our national HIV and AIDS response, and to share our results with an international audience at CROI. It has been a great experience,” stated Madame Boulay.
Logo courtesy of the Consortium of Universities for Global Health (CUGH): https://www.cugh.org/.
Representatives from the International Training and Education Center for Health (I-TECH) are headed to New York for the 9th Annual Consortium of Universities for Global Health (CUGH) Conference. The conference—held on March 16-18, with satellite sessions on March 15—will be co-hosted by Columbia University, Stellenbosch University, and the University of Peradeniya.
Featured speakers include Richard Horton, Editor of The Lancet, and Natalie Kanem, Deputy Executive Director of the United Nations Population Fund.
Building on the theme of “Health Disparities: A Time for Action,” staff and faculty from I-TECH will be presenting on the following topics:
King Holmes, MD, PhD, founding chair of the Department of Global Health and a co-Principal Investigator of I-TECH’s IAETC award, will join a morning plenary session and discussion about global health disparities. The discussion will be moderated by Director of the Fogarty International Center Roger Glass. Dr. Holmes will be joined for the discussion by Rose Leke, Gairdner Foundation Global Health Committee member and Emeritus Professor at Universite de Yaounde, and K. Srinath Reddy, President of the Public Health Foundation of India.
Kate Wilson, PhD, Clinical Assistant Professor, is presenting a poster titled “Evaluation of a New Field Epidemiology Training Program (FETP) Intermediate Course to Strengthen Public Health Preparedness in Tanzania.” The locally adapted course significantly improved trainee knowledge and skills in field epidemiology, and the evaluation also showed evidence of improvement in data quality and performance at trainees’ workplaces and districts.
Lindsay Mumm, MPA, Program Manager, is presenting a poster titled “Creating Relevant Change towards Reaching the UNAIDS 90-90-90 Target with High-Impact Leadership Training – Afya Bora Fellowship in Global Health Leadership.”
In addition to the research being shared at CUGH, I-TECH was represented earlier this month at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston. Nancy Puttkammer, PhD, MPH, presented a poster titled “Multi-Month Scripting (MMS) and Retention on HIV Antiretroviral Therapy (ART) in Haiti.” The retrospective study used data from the iSanté electronic medical record system in Haiti and found promising results that MMS for ART in virally suppressed patients improved retention and engagement in treatment.
About CUGH
The mission of CUGH is to build interdisciplinary collaborations and facilitates the sharing of knowledge to address global health challenges while promoting mutually beneficial, long-term partnerships between universities in resource-rich and resource-poor countries, developing human capital and strengthening institutions’ capabilities to address these challenges. Read more about CUGH: https://www.cugh.org/.
About CROI
Established in 1993, The Conference on Retroviruses and Opportunistic Infections (CROI) was provides a forum for scientists and clinical investigators to present, discuss, and critique their research. The goal of the conference is to provide a forum for researchers to translate their laboratory and clinical findings into tangible progress against the HIV pandemic. Read more about CROI: http://www.croiconference.org/.
I-TECH Haiti’s Dr. Marinho Elisma works with clinician Belhamie Ketleen on the iSanté electronic medical record system.
To mark the 10th year of the iSanté electronic medical record (EMR) system, the International Training and Education for Health (I-TECH) team in Haiti embarked on an analysis of the EMR’s implementation, the results of which were published as a case study last month in Health Policy and Planning.
The study focuses on factors of success, contributing to the industry’s understanding of what it takes to sustain and transition an EMR system in a low- and middle-income country (LMIC) like Haiti. The team found that while functionality and technical factors continue to be relevant as EMR implementations mature, other factors also become significant over time, including governance and leadership, ongoing user capacity, data quality, integration within a larger eHealth framework and financing.
The team assessed factors for success in eight categories: functionality, technical, organizational, training, political, ethical, financial, and sustainability. Seven of these were determined by the work of Fritz et al. in a review of factors contributing to EMR system success in low-resource settings.[1] However, one of the main findings was the eighth category the Haiti team added to the list of factors: sustainability.
Why sustainability is critical
When a system like iSanté is implemented at scale for so many years, the definition of success shifts from design, planning, and rollout to financing, governance, maintenance, and long-term ownership of the system by Haitian stakeholders. Transition planning, including long-term financial sustainability of the system, needs to begin at the start of any implementation.
“iSanté is a part of the legacy of the HIV information system, a model that will be used from generation to generation especially in terms of sustainable HIV/AIDS interventions,” said Nirva Duval, M&E Lead at the National AIDS Control Programme of the Ministry of Public Health and Population (MSPP) in Haiti, a case study author who has been involved in the iSanté implementation since its beginning in 2005. She went on to add, “Use of iSanté data is a major asset and an opportunity to better understand issues and contribute to decision-making at all levels.”
Ultimately, the goal is for iSanté to be fully owned, managed, and maintained in Haiti and wholly integrate into clinical practice. In 2016, I-TECH, the U.S. Centers for Disease Control and Prevention (CDC), and the MSPP undertook an overhaul of iSanté, including moving all servers and the majority of software development to Haiti.
Lessons learned pave the way for integration
The rebuild, known as iSantéPlus, uses an OpenMRS platform, which is supported by a growing global community. The phased national rollout of iSantéPlus is under way and will continue during 2018. I-TECH is also supporting the creation of a new national health information exchange known as “SEDISH” (Système d’Echange d’Information de Santé d’Haïti in French).
SEDISH will ensure a seamless flow of data between the community level to sites to the national level and back, improve clinicians’ ability to see patient history from other sites, and maintain a continuity of care document for patients who move between care sites. SEDISH uses international data standards and a Master Person Index to facilitate harmonization and information sharing between the EMR and other health data systems like lab and supply chain systems, transitioning the Haiti HIS landscape from multiple disparate systems to an interconnected network. Both iSantéPlus and SEDISH will promote collaboration between MSPP and CDC- and USAID-funded partners to improve how health care providers serve individual patients and populations across these systems.
Many of the lessons learned during the implementation of iSanté were applied in the design and execution of iSantéPlus and SEDISH. “iSanté has kept Haiti on the leading edge of HIS implementation in resource-constrained countries,” said Dr. Scott Barnhart, Principal Investigator and Professor in the University of Washington’s Departments of Medicine and Global Health. “The changes under way will have broad global applicability — integrating across direct patient care, lab, pharmacy, as well as supply chain. We have an exciting opportunity to come together and build on our success to respond to the challenges of local ownership, financing, cost-effectiveness, and governance so that these important tools are sustainable.”
Once the team completes and assesses the results of the iSantéPlus and SEDISH pilot, the new systems will be deployed throughout Haiti. It will be critical that the MSPP, CDC, and I-TECH’s partners in Haiti come together to assess the sustainability of iSantéPlus and SEDISH and their impact on the HIS landscape in Haiti.
[1] Fritz F, Tilahun B, Dugas M. 2015. Success criteria for electronic medical record implementations in low-resource settings: a systematic review. Journal of the American Medical Informatics Association 22: 479–88.
Treats served at an end-of-course celebration in Kenya, 2016
Training on leadership and management is a critical component of the University of Washington (UW) International Training and Education Center for Health’s (I-TECH’s) health systems strengthening efforts. To that end, I-TECH has worked closely with the UW Department of Global Health E-Learning Program (eDGH) since 2012 to offer a heavily subscribed online course on leadership and management to health care workers in low- and middle-income countries.
Designed and taught by I-TECH Executive Director and UW Professor of Global Health Ann Downer, Leadership and Management in Health (LMIH) is a 12-week course focusing on the practical leadership and management skills required for working in complex global health environments. Weekly modules include content on team building, accountability, supervision and delegation, conflict management, financial management, use of data for decision-making, and effective communication.
“I want to express my gratitude for giving me the opportunity to do the UW course on Leadership Management in Health. …I find myself going back to these documents again and again to understand and imbibe what is given. I feel that the simple narrative of the course material has made all the difference.”
–2016 course participant from India
Participants from Tunisia, 2015
The course consists of recorded lectures, required readings, a weekly online discussion forum, quizzes, self-reflection assignments, and a final verbal presentation. It is targeted to practicing health care professionals and public health specialists who already have some experience managing people. In most cases, LMIH participants gather in weekly site-specific, in-person discussion groups led by a volunteer facilitator to discuss the material and apply it to their particular linguistic, cultural, social, and political environment.
“We just finished our site discussion this afternoon and the level of contribution and application to our various office settings was wonderful. …I have told my Chief Executive … about the course and he is thinking of asking all Management Staff to do it compulsorily in the next episode.”
–2017 course site facilitator
Due to high enrollment, the course is now offered twice a year, with a completion averaging 84%. Approximately 4,500 individuals are enrolled in the latest offering of the course, representing a nine-fold increase in five years. More than 10,000 health workers in 65 countries have graduated from LMIH since 2012.
Participants from Myanmar, 2017
According to a survey conducted by eDGH, more than half of graduates from the spring 2016 cohort now mentor colleagues on leadership and management-related job tasks. In addition, 67% said they were given new responsibilities or projects as a result of course completion, and 74% reported that they had maintained contact with other students from their sites.
“We consistently hear that how empowering the course is,” said Anya Nartker, E-Learning Project Manager with eDGH. “The course uses a blended model, where participants are required to meet with their local site each week to apply what they are learning in the course, and share problems that they support each other in solving.”
I like the idea of all students teaming together and working together despite their backgrounds and level of education. There were many who were highly educated and some who were moderately [educated], and we all understood and accommodated each other.
–2016 course participant from Kenya
Course graduates have requested a deeper exploration of certain topics introduced in LMIH. As a result, a certificate series of three online courses is being developed that will include LMIH; a new course titled Global Project Management; and a third online course, Fundamentals of Implementation Science.
The Global Project Management online course will be offered as a stand-alone course from July-September 2018, co-taught by Dr. Downer; I-TECH Deputy Director, Chichi Butler; and I-TECH Senior Program Manager, Harnik Gulati. The certificate will be offered in 2018.
