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Ensuring High-Quality Service Provision in Zimbabwe

Post categories: Caryl Feldacker Implementation Science Male Circumcision Scott Barnhart Zimbabwe
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Describing Adverse Events within VMMC Programs at Scale

I-TECH works diligently to review and revise procedures to identify, manage, and report adverse events (AEs). I-TECH’s previous publications on AEs reveal efforts to maintain high quality programming and emphasize patient safety alongside achievement of targets.

An evaluation published in the Journal of the International AIDS Society found that AEs were uncommon, with 0.3% of surgical and 1.2% of PrePex (a non-surgical VMMC device) clients experiencing a moderate or severe AE. However, the evaluation also found that younger clients were at greater risk of infection.

Increasing Understanding on the Timing and Type of AEs in Routine VMMC Programs at Scale

As VMMC expands in Sub-Saharan Africa, I-TECH works to ensure program quality matches efforts to increase program productivity. I-TECH ensures patient safety through patient follow-up to identify and treat AEs. The timing of routine follow-up visits in MC programs is designed to ensure patient safety by identifying, treating, and managing complications. Although routine follow-up timing may differ by country, in Zimbabwe, three follow-up visits are scheduled to ensure quality service provision and patient care: Visit 1 (Day 2); Visit 2 (Day 7); and, Visit 3 (Day 42).

I-TECH’s implementation science efforts use routine data collected from clients with AEs and has found that AEs followed distinct patterns over time. Using these findings, ZAZIC has been improving VMMC care by 1) improving counseling about MC complications following initial visits for clinicians, clients, and caregivers ; 2) distributing wound care pamphlets to clients and caregivers; and 3) emphasizing follow-up tracing for younger boys, ages 10-14, and their caregivers to provide additional targeted, post-operative counseling on AE prevention.

Increasing AE Ascertainment through Routine Quality Assurance Efforts

To further increase ascertainment of AEs, I-TECH recently conducted a quality improvement (QI) initiative to improve provider identification and reporting of AEs. ZAZIC Gold-Standard (GS) clinicians prospectively observed 100 post-MC follow-ups per site in tandem with facility-based MC providers to confirm and characterize AEs, providing mentoring in AE management when needed.

The QI data suggested that AEs may be higher and follow-up lower than reported and ZAZIC’s Quality Assurance Task Force is replicating this QA study in other sites; increasing training in AE identification, management, and documentation for clinical and data teams; and improving post-operative counseling for younger clients. Additional nurses and vehicles, especially in rural health clinics, are currently being trained and leveraged to further improve client follow-up and AE ascertainment.

Improving Data Quality

ZAZIC undertakes weekly, monthly, and quarterly data quality audits (DQA) to ensure data correctness and completeness. Intensive DQA processes were documented and availability and completeness of data collected before and after DQAs in several specific sites was assessed with the aim to determine the effect of this process on data quality. ZAZIC found that after the DQA, high record availability of over 98% was maintained and record availability increased. After the DQA, most sites improved significantly in data completeness and ZAZIC continues to emphasize data completeness to support high-quality program implementation and availability of reliable data for decision-making.

Driving Collaboration with Local Implementation Partners in Zimbabwe

Post categories: Caryl Feldacker HIV and STI Prevention HIV Care and Treatment Scott Barnhart Stefan Wiktor Zimbabwe
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I-TECH builds local ownership and sustainability through collaborations throughout Zimbabwe. Under the CDC and PEPFAR awards, I-TECH has formed and leads two consortia – ZAZIC and ZimPAAC.

Continue reading “Driving Collaboration with Local Implementation Partners in Zimbabwe”

Two-Way Texting Study Offers Innovative Model to Reduce Provider Workload while Preserving Patient Safety

Post categories: Caryl Feldacker Health Systems Strengthening HIV and STI Prevention Male Circumcision Uncategorized Zimbabwe
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The two-way texting research team.

This piece was first posted on the University of Washington Department of Global Health’s website.

Voluntary medical male circumcision (VMMC) safely reduces the risk of female-to-male HIV transmission by up to 60%. Few men have any post-operative VMMC complication. However, current practice in Zimbabwe and throughout most of sub-Saharan Africa requires VMMC patients to return for multiple, in-person post-operative visits. With low complication rates, and severe healthcare worker shortages, these required visits are a burden for providers and patients — threatening achievement of critical HIV prevention targets. A two-way texting model studied by University of Washington researchers in Zimbabwe offers a new way to address this barrier by reducing provider workload while also safeguarding patient safety.

“These visits can be a barrier to male circumcision uptake and expansion in countries with severe health care worker shortages, as well as negatively impacting patients who needlessly pay for transport, miss work, and wait for unnecessary reviews,” said Principal Investigator Caryl Feldacker, PhD, MPH, at the International Training and Education Center for Health (I-TECH) in the University of Washington Department of Global Health.

The study included 721 VMMC patients in two locations in urban Zimbabwe. In the study, patients communicated directly with a health care worker through interactive text messaging for the critical 13 days post-VMMC, rather than returning for required in-person visits. By giving men the option to heal safely at home, or return to care when desired or if complications arose, the method dramatically reduced in-person visits by 85%. Texting also reduced follow-up costs by about one-third while improving the quality of care.

As compared to routine in-person care, the study yielded twice the number of reported complications. “This increased identification and reporting is a positive result that is likely attributable to improved counseling and men’s engagement in care. Through texting, men were empowered to observe their healing and report potential issues promptly, before they worsened,” said Feldacker.

Currently, most text-based health care efforts blast pre-defined messages to many people simultaneously, removing patients’ ability to communicate back with health care workers. In contrast, two-way texting between providers and patients provides interactive care, and the short time frame heightened participation: in the study, 93% of men responded to texts. Both providers and clients reported confidence in the texting option, feeling safe and highly recommending it for scale.

“With the current system, Zimbabwe could perform millions of unnecessary follow-up visits over the coming five years. The workload burden for health care workers and time lost for patients who are healing without complication is a significant burden for health care workers and clients alike,” said Feldacker. “Potential gains in efficiency and reduced costs through using two-way messaging are large.”

With funding from the U.S. Centers for Disease Control and Prevention (CDC), and in partnership with the Society for Family Health, the model will soon be tested in urban South Africa. The new, field-based research will further test two-way texting in a different geographical and patient context to better inform the model for adaptation and widespread scale-up.

Feldacker added that “while our findings are grounded in studies on male circumcision, our results are largely attributable to the methods rather than to a specific disease or condition.

“With minimal adaptation,” she continued, “two-way texting could streamline other post-operative care contexts or be re-configured for other similarly acute, episodic conditions where continuity of care within a short period is critical for patients, such as short-course TB treatment, post-operative healing, post-natal care or early childhood illnesses — diarrhea, pneumonia, malaria — laying the foundation for generalizing to other diseases and contexts.”

For more on the study, see the paper pre-published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS):

Reducing provider workload while preserving patient safety: a randomized control trial using 2-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

The study was led by Caryl Feldacker, and co-investigators are Vernon Murenje (International Training and Education Center for Health (I-TECH), Harare, Zimbabwe); Mufuta Tshimanga (Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe); Scott Barnhart, Isaac Holeman, and Joseph B. Babigumira (Department of Global Health, University of Washington); Sinokuthemba Xaba (Ministry of Health and Child Care, Harare, Zimbabwe); and technology partner Medic Mobile (Nairobi, Kenya).

The Zimbabwe 2wT study was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.

Expanding Cervical Cancer Screening in Zimbabwe

Post categories: Cervical Cancer Stefan Wiktor Zimbabwe
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I-TECH began the expansion of cervical cancer screening for women living with HIV aged 25-49 in Zimbabwe in 2019. I-TECH initially identified a provisional list of 89 sites for the implementation of visual inspection with acetic acid and cerviography (VIAC). The team then recruited, trained, and deployed dedicated VIAC nurses to 29 sites. Additionally, in an effort to improve service coverage in hard to reach areas without the necessary equipment, district teams carry VIAC equipment to outreach point facilities who have booked client appointments in advance. Random samples of images from clients are anonymized and sent to a gynecologist from the University of Zimbabwe for quality assurance.

Across all facilities, 9,664 HIV-positive women aged 25-49 years have been screened for cervical cancer with 93% testing negative, 6% testing positive for lesions, and 1% having suspected cancer.

Renewed Awards Totaling $24 Million Help Usher Zimbabwe Toward HIV Epidemic Control

Post categories: Ann Downer HIV Care and Treatment Male Circumcision Scott Barnhart Uncategorized Zimbabwe
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Dr. Batsi Makunike (L), I-TECH ZImbabwe Country Director, presents Dr. Ann Downer, I-TECH Executive Director and former PI of the Zimbabwe Care and Treatment project, with a farewell gift. The batik was made by using sadza porridge to apply the dye to the fabric.

Last Saturday, 1 December 2018, marked the 30th World AIDS Day, with a focus on urging all people to know their HIV status, as well as on ensuring access to prevention, care, and treatment services for those affected by the disease. Two programs at the International Training and Education Center for Health (I-TECH) are working in concert with local partners to help make those goals a reality in Zimbabwe.

A center in the University of Washington (UW) Department of Global Health, I-TECH has worked in Zimbabwe since 2003, starting with a $150,000 grant for an assessment of the need for HIV training in the country. Since then, work in the country has expanded to two awards totaling more than $24 million for the current year—one of which focuses on HIV testing, care, and treatment and the other on voluntary medical male circumcision (VMMC) for HIV prevention.  Both projects are funded by the U.S. Centers for Disease Control and Prevention, through the President’s Emergency Plan for AIDS Relief (PEPFAR), and operate through consortia comprising I-TECH and local partners.

The consortium for the VMMC award, ZAZIC, will continue to be led by Dr. Scott Barnhart, Professor in the UW Department of Global Health and School of Medicine. However, the consortium for the care and treatment award, the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC), has undergone a change in leadership: its new Principal Investigator (PI) is Dr. Stefan Wiktor, Professor in the UW Department of Global Health. Dr. Wiktor was handed the baton by the project’s previous Principal Investigator, Dr. Ann Downer, I-TECH Executive Director and also a Professor in the department, during a ceremony in Harare in October 2018.

“We are all so grateful to Dr. Downer for the past five years; for gently, but firmly leading us through the transition from a training and mentoring grant to a high-impact service delivery grant in five provinces,” said Dr. Batsi Makunike, I-TECH Zimbabwe Country Director. “Looking ahead, we welcome Dr. Wiktor to our team and the opportunity to tap into the wealth of experience that he brings as our new PI.”

Dr. Wiktor expressed hope that, through the continued hard work of the Zimbabwe consortium, the country will achieve its national and global targets. “Zimbabwe is one of the countries in Africa closest to reaching the UNAIDS 95-95-95 targets, and ZimPAAC is a critical partner to the Ministry of Health in that effort,” said Dr. Wiktor. “I am delighted to be working with such an outstanding team of public health professionals.”

Through ZimPAAC, I-TECH provides direct service delivery and site support for care and treatment at 372 public sector health facilities to strengthen health systems and improve the quality of care and treatment services and increase enrollment, initiation and adherence.

The VMMC project has already performed 313,267 VMMCs, as of October 2018, surpassing PEPFAR targets. The new award aims to circumcise 500,000 men over five years, resulting in the prevention of approximately 100,000 new cases of HIV.

“It has been such a privilege to work in Zimbabwe, a country that has a real chance to control the AIDS epidemic—both because of generous funding from PEPFAR and, more importantly, because of the caliber of the Zimbabwean people who live and work here,” said Dr. Downer at the handover ceremony.

“Our Zimbabwe team, consisting of both Harare- and Seattle-based members, is one of the finest I’ve ever worked with,” she continued. “Dr. Wiktor inherits a highly productive consortium that is partnering with ZAZIC and the Ministry of Health to propel Zimbabwe toward a healthier future and an AIDS-free generation.”

I-TECH Attends IAS AIDS 2018 Conference

Post categories: Ann Downer Leadership & Management Male Circumcision Monitoring & Evaluation Transition & Sustainability Zimbabwe
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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 gives a presentation at the AIDS 2018 Conference.
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 Marongwe presents her poster at the AIDS 2018 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.

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
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 ...
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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

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

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.

 

Success Story: WhatsApp, a Potential Warmline for Low-Resource Settings

Post categories: eLearning/Distance Learning Health Systems Strengthening Zimbabwe
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A PMTCT Client Retention training includes tablet-based modules.
A PMTCT Client Retention training includes tablet-based self-study modules.

In Zimbabwe, health care workers often need to build confidence and skills in caring for HIV-positive infants and children. The International Training and Education Center for Health (I-TECH) has employed an innovative approach to support these front-line staff – a case-based, self-study PMTCT Client Retention training.

During the introductory session, participants are oriented to the course, given self-study tips, loaned tablets and instructed on their use, and given a pre-course assessment. Participants also attend a half-day classroom session at the beginning and end of the five-week course.

A WhatsApp discussion group is also set up to send messages of motivation and reminders and for participants to share issues during the course. WhatsApp is widely used in Zimbabwe as an inexpensive mobile phone platform to message individuals and groups.

WhatsApp for collaborative problem solving

Elizabeth is a primary care nurse who was among a cohort of 30 participants in one of these trainings, conducted in Mashonaland Central Province. About one week into the course, Elizabeth faced a situation at work where she was confused about how to apply national guidelines to one of her pediatric patient cases. Elizabeth chose to bring the issue to her training cohort. Below is a sample of the discussion that ensued among several members of the group, showing that a number of the cohort were similarly perplexed:

Elizabeth: A woman came to our clinic. She was ill. She wanted to get tested because she was ill for a long time on and off. The woman tested positive. Because she is breastfeeding an 11-month-old baby l commenced her on Option B+. l tested the baby with antibody RDT [rapid diagnostic test] and tested negative. l commenced the baby on cotrimoxazole prophylaxis. The question is: Was it necessary for the baby to be given NVP [nevirapine] prophylaxis since the baby tested negative and is now 11 months OR should l give the baby NVP prophylaxis for 6wks from now????

Elizabeth received a range of responses from her cohort:

  • NVP is only given from birth up to six weeks. Commence mother on Option B+, baby on cotr prophylaxis collect confirmatory DBS [dried blood spots] for the child.
  • I agree with ~nr
  • Cotr prophylaxis and confirmatory DBS only for the baby. Thanks guys.
  • Baby should still get NVP for six wks since still breastfeeding — meaning baby is still exposed.
  • As per NVP shld be given — the first dose at birth, the second dose 48hrs after first dose, then third dose 96hrs after second dose. Prophylaxis shld be given as soon after delivery as possible. When prophylaxis is delayed the less likely that the infection will be prevented.
  • By age of 14 days, infection already would be established in most infants. So l think it’s not necessary to give NVP as prophylaxis.

One member of the cohort was a district nursing officer (DNO). He shared that he had deliberately delayed responding until others had weighed in. He not only gave advice but also encouraged the group to refresh themselves on the resources available on their tablets:

Sorry for a late response. Remember key things in your scenario: mother is positive, baby is breastfeeding and is 11 months. … Infant is still at risk, therefore cotri prophy, infant feeding counselling and a continuation of routine FCH [family and child health] care will help. Then 6wks after stopping breastfeeding conduct rapid HIV test again. If negative stop cotri prophy and continue routine care. If positive CT cotri prophy, initiate ART.

He then referred Elizabeth to an algorithm in the national ART guidelines, which were included for easy reference in an application on the participants’ tablets.

This exchange showed the potential use of WhatsApp for support in clinical decision making, in the absence of a warmline for consultation. Upon returning to the classroom, participants engaged in discussion around the WhatsApp conversations, with particular attention paid to the case that Elizabeth had brought to the group. Other members of the cohort reported that they had watched the exchange with interest though they did not contribute.

The cohort members reported that the case was educational for them, and many of them indicated that they would like to continue their group for ongoing support.

As for Elizabeth’s young client, a rapid test was collected and returned negative. Results of the DNA test are still being awaited by the group with much interest. As one member wrote: “We cannot afford to lose that child, wherever she is. … She is still our child.”

 

Launch of HIV Programs in Zimbabwe Hits the Right Note

Post categories: Clinical Mentoring Demand Creation eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention Male Circumcision Monitoring & Evaluation Scott Barnhart Zimbabwe
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Zim_launch

To the brass beats of the Prince Edward School Jazz Band, on Feb. 6, a crowd of approximately 150 government officials, health professionals, and members of the press celebrated the launch of three programs in Zimbabwe, two of which are implemented by I-TECH Zimbabwe and partners. These vital programs aim to build local capacity and provide comprehensive services to prevent and combat HIV/AIDS in the country.

Speaking at the festivities were David Bruce Wharton, U.S. Ambassador to the Republic of Zimbabwe; Dr. Owen Mugurungi, director of the AIDS and TB Unit at the Ministry of Health and Child Care (MOHCC); Dr. King Holmes, Chair of the Department of Global Health at the University of Washington; Dr. Ann Downer, Executive Director of the International Training and Education Center for Health (I-TECH); and Dr. Batsirai Makunike-Chikwinya, Country Director of I-TECH Zimbabwe.

“Preventing the spread of HIV/AIDS is important to all of us, as is providing the best level of care to those living with this disease,” said Amb. Wharton. “Today we celebrate the launch of programs that will help us reach these goals together – programs that were designed together, by dedicated teams of collaborating partners from Zimbabwe and from the United States.”

In this spirit of collaboration, the programs, totaling $65 million over five years, support the Zimbabwe MOHCC with grant funding by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), technical support from the Centers for Disease Control and Prevention, and implementation by local and U.S.-based partners. These partners include I-TECH; Zimbabwe Association of Church-Related Hospitals; Zimbabwe Community Health Intervention Research Project; Compre Health Services; The Newlands Clinic and Newlands Clinic Training Centre; Pangaea Global AIDS Foundation, Zimbabwe; and the University of Zimbabwe-University of California, San Francisco Collaborative Research Programme.

The Training and Mentoring Program seeks to develop and deliver in-service training on antiretroviral therapy, including the medical management of HIV/AIDS, women’s reproductive health, tuberculosis (TB), and TB/HIV co-infection to 8,000 health care workers across the country over five years. A mentorship component will also provide health care workers with access to ongoing learning and feedback on clinical issues. Health workers will receive refresher trainings via distance learning technologies, and the effectiveness of the program will be measured through a training database.

Also celebrated – and accompanied by a ribbon-cutting and presentation of 17 new vehicles – was the launch of the Voluntary Medical Male Circumcision Program. The program, building on work that started last spring, seeks to deliver services to 412,000 men in Zimbabwe between the ages of 15 and 49 years over the next five years. Medical male circumcision has proved very effective in preventing the spread of HIV. Randomized controlled trials in Uganda, Kenya, and South Africa have shown that this intervention reduces the risk of female-to-male sexual transmission of HIV by approximately 60%.

“Together, these two programs will improve the effectiveness and quality of prevention, treatment, and care services for those affected by HIV/AIDS – and create better health systems for all Zimbabweans,” said Dr. Holmes.