In collaboration with the Malawi Ministry of Health (MOH) and Centers for the Disease Control and Prevention (CDC), I-TECH has supported the national COVID-19 response in Malawi since March 2020. Technical assistance has focused on laboratory capacity, supporting quality COVID-19 surveillance and data management, and implementing a COVID-19 population-based survey with oversight from the Public Health Institute of Malawi (PHIM), under MOH.
In June 2020, I-TECH seconded a Technical Advisor (TA) to PHIM to support COVID-19 activities. The I-TECH TA acts as secretariat for the national Public Health Emergency Operations Center (PHEOC), supporting the coordination of the multi-sectoral COVID-19 response, developing and revising strategies and procedures, facilitating communication, and ensuring access to and sharing of COVID-19 data and information between partners.
I-TECH has also assisted with data management and reporting at the district level, as well as with contact tracing and adherence to infection prevention and control measures.
I-TECH has been able to leverage use of its platform for HIV laboratory activities to provide critical lab support for COVID-19 activities and provide key support to the National Health Reference Laboratory, focusing on building or increasing laboratory capacity including with genomic sequencing, maintaining quality assurance, and improving communication and coordination among laboratory stakeholders.
The I-TECH Team also coordinated a population-based survey to evaluate the extent of spread of COVID-19 in five high-burden districts in Malawi.
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.
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.
The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection by integrating point-of-care testing for recent infection into routine HIV testing services (HTS). A rapid test for recent infection is given to consenting clients 13-years-and-older who screen HIV positive within routine HTS across participating health facilities. Between April 2019-2020, I-TECH and MOH activated 485 testing points at 155 facilities in Malawi. All 155 facilities implemented recent HIV infection surveillance and reported data. The project has reached 11 of 28 districts to date.
These data allow the detection and characterization of recent HIV infection among newly diagnosed individuals and identify geographic areas associated with recent HIV-1 infection to inform geographic prioritization of HIV prevention and treatment strategies. The project has demonstrated high uptake and allowed characterization of recent infections according to socio-demographic and geographic factors. PEPFAR implementers in Malawi will collaborate with MOH to further investigate the reasons for high recent infection prevalence in identified clusters. Based on the findings of these responses, Malawi may focus on interventions such as youth-focused programs that aim to limit HIV acquisition and transmission among young people.
In March, the Botswana Ministry of Health and Wellness (MoHW), launched an online self-registration platform to allow eligible citizens to register for COVID-19 vaccination. The registration portal was developed by the International Training and Education Center for Health (I-TECH), in conjunction with the MoHW and the National COVID-19 Task Force. Since the launch, more than 60,000 people have registered for vaccination through the platform, and more than 45,000 people have received their first dose of the COVID-19 vaccine.
Screenshot of the COVID-19 registration portal
I-TECH assisted the MoHW to develop the following modules for the platform:
A DHIS2 tracker module tracks vaccinated clients for a follow-up dose. I-TECH trained MoHW health informatics and M&E officers to provide remote and on-site support to frontline health care workers across the country on application use. An interactive and intuitive dashboard shows vaccination trends across age and gender bands, geographical area and clinics/health facilities. The tracker module sends automated SMS reminders to clients regarding vaccination date, location, and time. Clients also receive a post-vaccination acknowledgment message.
An adverse events tracking module records any adverse events (AEs) due to COVID-19 vaccines. The module also automates reports on AEs and the correlation between AEs and any underlying conditions as disclosed by the clients.
A stock management module tracks the vaccine stock at facility, district, and national levels. This module is particularly helpful in projecting the vaccine demands at the clinics and vaccine availability against the vaccination bookings. The MoHW team closely monitors daily opening and closing stocks, to ensure optimal supply. Automated data checks and validations are built in to alert the facility management of any misappropriations in the vaccine stocks.
Available reports within the COVID-19 registration portal
Currently, I-TECH is working on a scheduling application that will be integrated into the portal for online booking of vaccination appointments. This will considerably reduce the number of “walk-in clients,” increase efficiency, and assist frontline workers in managing the workload at vaccination sites.
I-TECH will continue supporting this initiative until the end of the current funding cycle, while simultaneously capacitating the MoHW to take over the day-to-day management and maintenance of the portal.
This online, DHIS2-based platform is available here.
I-TECH’s work in Botswana 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 authors’ 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 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.
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.”
The International Training and Education Center for Health (I-TECH), in collaboration with the Namibian Ministry of Health and Social Services (MOHSS) and with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), has launched a campaign to raise awareness of the importance of screening for and treatment of cervical pre-cancer in women aged 20–49.
This awareness campaign is the most recent expansion of the Namibian Cervical Cancer Screening and Treatment Program, which was rolled out in 2018 following the adoption of national cervical cancer guidelines by the MOHSS in March 2018.
MoHSS Health extension worker and data clerk capturing data for the National Cervical Cancer Program.
The rollout of this awareness campaign and expansion of the program has been especially important during the COVID-19 pandemic because patients may be less likely to visit their health care provider for preventive care, including cervical cancer screening and treatment.
“This campaign will bring a much-needed awareness to not only screening but also the different treatment options that are available,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Prevention Lead Physician in Namibia. “We want to ensure that all women, particularly HIV-positive women, are empowered to take action and get screened for cervical cancer. We also want to inform women that they can still be safely screened despite the ongoing COVID-19 pandemic.”
Screening and treatment are available to anyone who needs it, but the I-TECH program has focused its efforts on HIV-positive women. Women living with HIV are five to six times more likely to develop cervical cancer than HIV-negative women, even if they are on antiretroviral therapy (ART). Currently, the I-TECH program supports screening and treatment at 31 MOHSS health facilities and 11 outreach sites in seven regions across Namibia. As of August 2020, the program had performed more than 14,000 screenings and 1,700 treatment procedures for HIV-positive women.
“The cervical cancer program has achieved a lot of success within a short period,” says Dr. Laimi Ashipala, MOHSS Chief Medical Officer HIV/AIDS and STI Control subdivision. “With these additional outreach and awareness efforts, we hope to reach 100,000 HIV-positive women in the next two years.”
As part of the campaign’s outreach efforts to reach HIV-positive women, I-TECH is contacting women receiving ART to offer cervical cancer screenings during their routine medication pick-up visits. The team is also reaching out to community-based ART refill groups as a way to bring screening services to HIV-positive women at community meeting points.
Expanding and Adapting the Health Care Provider Training Program
VIA provider providing VIA services.
In addition to awareness and outreach, the program has expanded cervical cancer screening and treatment training for health care providers (e.g., doctors, registered and enrolled nurses).
“Key aspects of the program have been the training and uptake of our health care providers,” explains Dr. Ashipala. “We are scaling up our efforts to train and certify health care providers in using VIA and ablative treatments throughout the country. In addition to VIA and ablative treatments, we have also expanded training and certification to include LLETZ and cervical biopsies, which allows us to treat patients who may not be eligible for ablative treatments.”
The COVID-19 pandemic has led to adjustments in the way trainings are provided for the safety of facilitators and participants and to aid in pandemic control efforts. In response, I-TECH supported a virtual MOHSS VIA (visual inspection with acetic acid or VIA) screening training for nine, newly recruited cervical cancer screening health care providers. Since the program began in 2018, I-TECH and MOHSS have trained 249 health care providers.
Creating a Suite of Informational Materials
This Cervical Cancer Prevention brochure is one of several pieces in a suite of materials created by I-TECH.
I-TECH, in collaboration with stakeholders, has developed a suite of materials—flyers, brochures, and posters—for patients and providers to complement the outreach and training efforts.
The materials highlight the importance of screening, encourage women to make an appointment, explain the method of screening, and provide information about the treatment options that are offered through the program.
The materials will be used by health care providers during health education sessions with patients, distributed to women when they visit their health care facility or ART clinic, and following screening and/or treatment appointments. Some of the materials will also be displayed at health facilities and referral hospitals to advertise screening availability.
“We applaud the Ministry for highlighting the need for cervical cancer prevention, screening, and treatment despite the ongoing COVID-19 pandemic and taking action by collaborating in the development of resources, adopting guidelines for providers, and supporting training for health care providers,” says Dr. Muzingwani.
The B-TECH team implements innovative, high-yield testing approaches to increase HIV case identification and yield.
On October 1, the International Training and Education Center for Health (I-TECH) celebrated the launch of the local and independent Botswana Training and Education Center for Health (B-TECH) and Caribbean Training and Education Center for Health (C-TECH).
For more than 17 years, these teams have worked within the regional Botswana and Caribbean offices of I-TECH to respond to the health needs of individuals and communities infected and affected by HIV. B-TECH and C-TECH, as locally registered non-governmental organizations, will continue to build on those years of experience implementing innovative, locally driven HIV prevention, care, and treatment programs, as well as expand their work to tackle other pressing health issues within the Batswana and Caribbean communities.
As part of the I-TECH network, B-TECH and C-TECH are able to access the academic depth and regulatory structures of UW and, together with local and regional clinical and programmatic expertise, scale up best practices and strengthen health systems. As local entities, B-TECH and C-TECH will also be able to take advantage of expanded partnership opportunities.
The C-TECH team also has broad experience with clinical mentoring at HIV treatment sites.
Both teams have supported pioneering work in their regions to provide comprehensive, patient-centered care for the most vulnerable populations. The C-TECH team has implemented a groundbreaking preceptorship program to improve provider communication with key populations affected by HIV in Jamaica and Trinidad and Tobago. It has also implemented a successful telementoring program through a Project ECHO®-based platform and model, reaching 465 providers. The program connects groups of providers to form communities of practice throughout the region to facilitate clinical updates, case consultations, and strengthened practice in HIV treatment and care and, recently, COVID-19.
“We look forward to remaining within the I-TECH family,” said Natalie Irving-Mattocks, Executive Director of C-TECH. “But our team is equipped and ready to move into this next chapter, deepening our local relationships, expanding our reach throughout the Caribbean, and building on our commitment to support access to high quality health care for the region’s most vulnerable.”
For its part, the B-TECH team has made an enormous impact on the health systems of Botswana, enabling the policy environment for HIV clinical case management; developing and implementing an interoperable, standards-based health information system; and enhancing the capacity of the health workforce at all levels. The team has also implemented innovative, high-yield testing approaches to increase HIV case identification. Targeted HIV testing strategies include partner testing services; HIV self-testing; testing among presumptive tuberculosis cases; and the expansion of afterhours and weekend testing to target men.
“We are excited to begin this new endeavor to promote innovative, locally driven, and effective programs to respond to the HIV epidemic in Botswana,” said Dr. Odirile Bakae, Executive Director of B-TECH. “With a high level of technical assistance from I-TECH, combined with B-TECH’s boots-on-the-ground approach, we are a winning team. We look forward to a fruitful partnership with both I-TECH/UW and the Government of Botswana.”
I-TECH has worked closely with UW Global Operations Support over the past decade to inform the internal procedures and structures necessary for international office registrations. This work has promoted operational effectiveness by enabling a safe, compliant, and legal environment for conducting international work. I-TECH’s close work with Global Operations Support has also helped to create the administrative and policy structures necessary to enable the successful launch of B-TECH and C-TECH.
Over the past two years, three other I-TECH offices – in Haiti, India, and Zimbabwe – have launched local organizations, signaling I-TECH’s bedrock commitment to transition, sustainability, and country ownership.
“These new organizations reflect our shared goals of serving communities, building capacity, and supporting expert leadership across the I-TECH network,” said Dr. Pamela Collins, I-TECH Executive Director. “We look forward to continued strong collaboration that saves lives.”
Read more about the B-TECH and C-TECH leadership teams below.
Dr. Odirile Bakae, Executive Director, B-TECH
Dr. Bakae is a physician with over 15 years of clinical experience in providing services to people living with HIV, as well as a deep understanding of structuring health programs to optimize client outcomes. He has several years of experience practicing medicine in public health settings in Botswana, including the management of the Infectious Disease Control Centers (IDCC), specializing in ART failure clients, complicated TB and HIV cases, and cervical cancer patients.
In addition to his role as B-TECH Executive Director, Dr. Bakae is the Principal Investigator for the CDC funded Cervical Cancer (GH20-2009) and Strategic Information Services (GH20-2007) awards.
He joined I-TECH Botswana in 2015 and led one of the most successful HIV testing programs in the country, focusing on a client-centered approach. Under his leadership, the country program performed exceptionally well, in terms of quality of service delivery and in meeting donor targets and expectations.
Ms. Kauta is a seasoned operations management professional with over 20 years of experience across a wide range of industries. She joined I-TECH Botswana in April 2009 and, as the Deputy Executive Director for B-TECH, she oversees operations, finance, and human resources, and is responsible for design and implementation of internal controls and compliance oversight at all levels of the organization.
In her management role, Ms. Kauta provides planning and coordination of efficient and effective support services to enable delivery of quality work to B-TECH clients and stakeholders. A key function of her role is to identify solutions to address operational challenges within B-TECH as well as ensure the implementation and adherence to the organization’s operational systems, policies and procedures.
Ms. Irving-Mattocks is a public health program director with extensive experience in managing projects focusing on health systems strengthening. She is also a business development practitioner with 13 years of experience in the field of social development. Her expertise includes financial management, budget management, project proposal writing, program design/development, planning, implementation and monitoring, strategic planning, and institutional development.
To her role as C-TECH Executive Director, Ms. Irving-Mattocks also brings deep experience and a proven track record in mobilizing and managing grants from international funding agencies such as United States Department of Human Services Health Resources and Services Administration (HRSA), PANCAP Global Fund, United States Agency for International Development (USAID), Clinton Foundation and National Institutes of Health (NIH).
Dr. Clive Anderson, Board Chair and Technical Advisor, C-TECH
Dr. Anderson has 30 years of experience as a primary care physician, specializing in HIV and STI care and prevention, as well as dermatology. He comes to his role as Board Chair and Technical Advisor after serving as Country Director of I-TECH Jamaica for the past three years.
He remains Technical Advisor to I-TECH Jamaica, where his experience also includes extensive experience as Technical Lead of the Caribbean Quality Improvement Collaborative (CareQIC), Lead HIV Project ECHO® Facilitator and Mentor, and clinical mentor at HIV treatment sites throughout Jamaica.
Dr. Anderson is currently a Clinical Assistant Professor in the Department of Global Health, University of Washington.
The International AIDS Society (IAS) virtually hosted their 23rd International AIDS conference (AIDS 2020: Virtual) on 6-10 July 2020. The AIDS 2020: Virtual theme was resilience, to celebrate and acknowledge the strength of the HIV community and the significant advances in treatment, while also addressing gaps in treatment, prevention, and care.
Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters with accompanying audio recordings:
Malango Msukwa, BSc, MPHc, I-TECH Malawi Monitoring, Evaluation, and Data Manager, received a scholarship from IAS to attend AIDS 2020: Virtual and presented a late-breaker e-poster on a study that evaluated the uptake of a new HIV surveillance system and described which populations have continued HIV transmission titled, “Characterizing recent infections among persons with new HIV-1 diagnoses in Malawi.”
In addition to the I-TECH representatives presenting their posters, representatives from the Centers for Disease Control and Prevention (CDC) and Health Alliance International (HAI) also presented data from I-TECH programs in Malawi and Mozambique.
