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I-TECH Network Presents at End-of-Year Conferences

Post categories: Caryl Feldacker Cote d'Ivoire CSiM DIGI Gabrielle O'Malley Haiti Jan Flowers Kenya Malawi Nancy Puttkammer Stefan Wiktor United States Zambia Zimbabwe
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Yao He at GDHF 2023

It was a busy fall season for teams throughout the I-TECH Network, several of which had robust representation at end-of-year conferences including the International Conference on AIDS and STIs in Africa (ICASA) 2023 the Global Digital Health Forum (GDHF) 2023.

Welcome additions to I-TECH’s regular lineup of conferences were Infectious Disease Week (ID Week) 2023 and the 40th Annual Oregon Rural Health Conference, attended by representatives of I-TECH’s new network partner, the UW Center for Stewardship in Medicine (CSiM).

Representatives from the network presented more than a dozen posters, spoke at panels and discussions, and led an interactive workshop. Read below for more details (links to presentations will be posted as they are made available).

ICASA 2023, 4-9 December, Harare, Zimbabwe

The theme of this year’s conference was “AIDS is not over: Address inequalities, accelerate inclusion and innovation.” I-TECH Network partner the Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH) and its partners Pangaea Zimbabwe AIDS Trust (PZAT) and Zvandiri presented several posters representing their work to innovate and improve access at the training and community levels.

Zim-TTECH:

  • Gloria Gonese at ICASA 2023

    Romana R Katekwe, Edson Chidovi, Frances Petracca, Batsirai Makunike, Gloria Gonese, Kerry Thomson, Zwashe Bangani, Haddi Cham, Mirriam Mugwise, Emmanuel Govha, Stefan Wiktor, “Improving Access to Quality Improvement Training through Off-line Electronic Learning: A Case Study from Zimbabwe”

  • Langalokusa Sibanda, Peace Ntini, Richard Mashapa, Gloria Gonese, Rickie Malaba, Tendayi Mharadze, Ralph Makuyana, Methembe Ndlovu, Ruth Levine, Vivian Bertman, Abigail K. Korn, Kerry A. Thomson, Owen Mugurungi, Tsitsi Apollo, Getrude Ncube, Mirriam Mutseta, Beauty Nyamwanza, Batsirai Makunike-Chikwinya, Stefan Wiktor, “DREAMS Ambassadors Increase HIV Self-Testing Uptake by Male Partners of Young Women in Zimbabwe”
  • Anjali Vasavada, Phibion Manyanga, Sandra Murwira, Lucia Gondongwe, Ponesai Nyika, Batsirai Makunike-Chikwinya, Gloria Gonese, Stefan Wiktor, George Mamire, Kerry A. Thomson, “Acceptance of Free Cervical Cancer Screening Among Zimbabwean WLHIV: Implications for Integration of HPV Testing into Routine HIV Care”
  • Rumbidzai Dhliwayo, Lennox Dziva, Ponesai Nyika, Chiedza Mupanguri, Gloria Gonese, Tsitsi Apollo, Owen Mugurungi, Talent Maphosa, Haddi Jatou Cham, Batsirai Makunike-Chikwinya, Stefan Wiktor, “Assessing Implementation and Outcomes of Screening for Advanced HIV Disease (AHD) Among Persons Living with HIV in Five Provinces of Zimbabwe”
  • Gloria Gonese, “High HIV disease burden among older clients aged ≥50years attending selected health facilities in Zimbabwe, Oct 2020 through March 2023”

PZAT:

  • Precious Moyo, Joseph Murungu, Shamiso Nyakuwa, Casper Hera, Imelda Mahaka, Blessing Mushangwe, Phibion Manyanga, Gloria Gonese, Batsirai Makunike, Takunda Sola, Getrude Ncube, Tendayi Mharadze, Rickie Malaba, Stefan Wiktor, “Key Populations Outreach Activities for Scaling Up HIV Prevention Care and Treatment Services in Harare, Zimbabwe”
  • Precious Moyo, Joseph Murungu, Shamiso Nyakuwa, Casper Hera, Imelda Mahaka, Blessing Mushangwe, Phibion Manyanga, Gloria Gonese, Batsirai Makunike, Takunda Sola, Getrude Ncube, Tendayi Mharadze, Rickie Malaba, Stefan Wiktor, “Layering Enhanced Economic Strengthening Interventions to Reduce Vulnerabilities Among Sexually Exploited Minors and Young Women Selling Sex in Zimbabwe”
  • Sitshengisiwe Ruzibe, Casper Hera, Precious Moyo, Joseph Murungu, Shamiso Nyakuwa, Imelda Mahaka, Langalokusa Sibanda, Peace Ntini, Gloria Gonese, Batsirai Makunike, Mirriam Mutseta, Getrude Ncube, Tendayi Mharadze, Rickie Malaba, Kerry A. Thomson, Stefan Wiktor, “Services for Sexually Exploited Minors and Young Women Selling Sex Enrolled in DREAMS program, Matabeleland North, Zimbabwe”

Zvandiri:

  • Vivian Chitiyo, Tanyaradzwa Napei, Billiart Tapesana, Ann Selberg, Edson Chidovi, Gloria Gonese, Kerry Thomson, Talent Maphosa, Haddi Cham, Ngwarai Sithole, Tsitsi Mutasa-Apollo, Nicola Willis, Stefan Wiktor, “Minimizing Interruption in Treatment (IIT) through Peer Connections of Adolescents and Young People Living with HIV in Zimbabwe”

 

GDHF 2023, 4-6 December, Washington, D.C.

The Digital Initiatives Group at I-TECH (DIGI), and others from I-TECH, presented their work in a number of ways at this year’s Global Digital Health Forum. GDHF is a leading global public health industry conference for technology vendors, donors, researchers, government representatives, and implementing organizations working in low- and middle-income countries.

Hannock Tweya and Caryl Feldacker at GDHF 2023

Posters:

  • Feldacker C, Murethi M, Ndhlovu D, Bisani P, Kathumba D, Samala B, Oni F, Wagaba K, Kagereki E, Wassuna B, Tweya H, “Mobile Electronic Medical Record Systems: The Community-based ART Retention and Suppression (CARES) App Design for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi”
  • He Y, AbuShweimeh R, Kouabenan YR, Assoa PH, Puttkammer N, Gloyd S, Wagenaar BH, Komena P, Kamelan N, Iiams-Hauser C, Pongathie A, Kouakou A, Hoffman N, Flowers J, Abiola N, Perrone LA, “Determinants of Routine Implementation for Electronic Laboratory Information Systems in Côte d’Ivoire: a Mixed-Methods Implementation Science Study”
  • He Y, Kouabenan YR, Assoa PH, Puttkammer N, Gloyd S, Hoffman N, Wagenaar BH, Komena P, Kamelan N, Iiams-Hauser C, Pongathie A, Kouakou A, Flowers J, Abiola N, Perrone LA, “Perceptions and Experiences of Data-Driven Decision-Making and Data Dashboard for HIV Viral Load Testing and Early Infant Diagnosis in Côte d’Ivoire”
  • Gadabu O, Manyiyo B, Yiga H, Chigoriwa C, Chirowodza L, White C, Mankowski P, Mutesasira M, Gita C, Maxwell L, Muserere C, Flowers J, “A FHIR Training Workshop to Facilitate Interoperability Between the IMPILO EHR and the LIMS System in Zimbabwe”
  • Secor, A, presented by Patric Prado, “Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy among Adults and Children Living with HIV in Haiti: A Retrospective Longitudinal Study”

Virtual Panel:

  • “Building Next-Gen Digital Health Solutions On FHIR With Open Health Stack” Presenter: Patric Prado

Individual Presentations:

  • “Efficiently Leveraging Individual-level Health Data For Population-level Data For Decision Making: A Call To Action For FHIR-based Secondary Data Use” Presenter: Piotr Mankowski
  • “Implementation of An Online Course By MOH For Health Workers In Kenya: Strategies And Lessons For Success” Presenter: Robert Oboko
  • “Applying Critical Reflection To Reimagine Global Digital Health Interventions: Introducing The (Re)imaginator” Presenter: Beth Dunbar
  • “Advancing National Health Information Systems Maturity: Lessons Learnt On Implementing The Informatics-Savvy Health Organization (ISHO) Assessment And Action Planning Framework For Health Leaders In Zambia” Presenter: Kendi Mburu
  • “Online Learning as an Innovation And Sustainability Initiative In Digital Health In Low And Middle Income Countries” Presenter: Robert Oboko

Topic Lounge Discussions:

  • “Perceptions On The Quality Of Electronic Medical Records In LMIC” Presenter: Jan Flowers
  • “Bringing Into Production A Health Information Exchange Architecture In Côte D’Ivoire: Using Open Standards And Software To Enable Cross-site Patient Histories And Real Time Dashboarding. Côte D’Ivoire HIE” Presenter: Casey Iiams-hauser

Interactive Workshop:

  • “Creating, Leading, And Managing Informatics-Savvy Health Organizations (ISHO): Concept, Principles, And Application”

 

ID Week 2023, 11-15 October, Boston, Massachusetts

IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP). This year, CSiM presented:

  • “Asymptomatic Bacteriuria Underestimates True Inappropriate Prescribing for Non-Urinary Tract Infections” Presenting author: Whitney Hartlage, PharmD

 

40th Annual Oregon Rural Health Conference, 11-13 October, Sunriver, Oregon

For this year’s Annual Oregon Rural Health Conference, Rupali Jain, PharmD, and Natalia Martinez-Paz, CSiM Manager, shared lessons learned in Cohort 2 of their Intensive Quality Improvement Cohort (IQIC) program and how Critical Access Hospitals can approach QI in the post-COVID-19 healthcare environment.

  • Session title: “Case Study: Asymptomatic Bacteriuria Quality Improvement Projects in Critical Access Hospitals”

Expanding Two-Way Texting for Voluntary Medical Male Circumcision Clients in South Africa

Post categories: Caryl Feldacker Male Circumcision South Africa
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I-TECH, in close partnership with voluntary medical male circumcision (VMMC) implementing partner, the Aurum Institute and technology partner, Medic, is conducting a five-year study funded by the National Institutes of Health to further evidence on the efficiency, safety, and scalability of two-way text-based (2wT) follow-up for VMMC services.

An example of the 2wT tab display options.
An example of the 2wT tab display options. Image Credit: © 2022 Marongwe et al. via PLoS Digital Health, Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe.

2wT is SMS-based telehealth, providing direct patient to provider communication that improves the quality of post-operative VMMC care. A daily educational message is sent to each participant, requesting a response to report potential complications. 2wT allows the nurse to triage men to care when needed or desired while supporting most men to heal independently at home. 2wT-based follow-up dramatically reduces unnecessary post-operative visits, saving patient and provider costs, while improving patient care quality through swift identification and referral for potential adverse events. In South Africa, the 2wT intervention benefits were similar across routine VMMC programs in both rural and urban settings.

This 2wT intervention in South Africa builds on the I-TECH work previously done in Zimbabwe, which found that “2wT reduced client visits by 85%, increased AE identification, and reduced costs.”

I-TECH in Côte d’Ivoire Hosts National HIV QI Conference

Post categories: Caryl Feldacker Cote d'Ivoire Quality Improvement
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On 18-19 May 2022, the International Training and Education Center for Health (I-TECH), in collaboration with the Programme National de Lutte Contre le Sida (PNLS; National AIDS Control Program) under the coordination of the General Directorate of Health, hosted its first national HIV prevention, care, and treatment quality improvement (QI) conference in Abidjan, Côte d’Ivoire. The conference brought together over 100 representatives from the Centers for Disease Control and Prevention, United States Agency for International Development, the Human Resources and Services Administration (HRSA), US President’s Emergency Plan for AIDS Relief (PEPFAR), and PEPFAR implementing partners from around the country to agree on a national approach to QI; update the national strategic plan for improving Quality, Health, and Safety; and learn about the unique QI approach being implemented by I-TECH through the Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) program.

Dr. Nathalie Krou Danho
I-TECH QISSEC Project Director, Dr. Nathalie Krou Danho, describes the QISSEC approach at the National HIV QI Conference. Photo Credit: I-TECH

“This is an historic workshop. [There have been] many conversations and meetings with the PNLS/Ministry of Health and USG agencies [over the years] to gather all the stakeholders to harmonize QI interventions,” says Dr. Jean T. N’Guessan, QISSEC QI Consultant. “This national QI workshop was a success because the leadership was carried by the PNLS, the national Program to fight AIDS, and supported by I-TECH.”

The goal of the conference was to elevate QI practices on a national level and work with stakeholders to adopt and integrate the QISSEC QI approach into their own HIV prevention, care, and treatment programs to improve HIV services while identifying and addressing gaps in care (e.g., viral load monitoring, antiretroviral therapy uptake).

“In Côte d’Ivoire, all hospitals—both public and private—are required to implement continuous quality improvement for all care and services, which can lead to a one-size-fits-all approach to QI,” explains Dr. Nathalie Krou Danho, I-TECH QISSEC Project Director. “This workshop made it possible for us to identify gaps in national standards for the prevention, care, support, and treatment of HIV infection, while also providing an effective QI framework that helps clarify the roles and responsibilities of the stakeholders implementing QI initiatives across the country.”

QI interventions are often applied unilaterally across all sites regardless of analysis of the sites’ specific needs, but I-TECH’s approach tailors each QI intervention and related activities to the needs of the site according to self-identified gaps by the sites. This approach allows sites to be involved in each step of the process, reinforces skills and knowledge, and ultimately creates a sustainable approach to QI. By using the QISSEC approach, HIV programs around Côte d’Ivoire will be able to align their QI work and substantially improve HIV services, while also fulfilling PEPFAR priorities and targets.

“Since I-TECH’s approach works in collaboration with all levels (national, district, and site) of the health system pyramid, we are able to coach sites to develop a QI plan based on the identified gaps, implement it, as well as monitor and evaluate it,” says Dr. Nathalie Krou Danho. “Through data analysis of MER indicators and SIMS data, the approach takes into account the organizational improvement of the quality and the services offered to the patients.”

The QISSEC project, a five-year cooperative agreement with HRSA under PEPFAR, works with local partners to implement customized site-level QI interventions using patient-centered approaches in clinics to ensure a facility-owned and locally led response to the persistent challenges seen in HIV prevention, care, and treatment programs (e.g., HIV testing, retention, suppression, PrEP, TB prevention) and support Côte d’Ivoire in reaching the UNAIDS 95-95-95 targets. The project has initially been focused on 60 priority sites throughout the country but plans to expand to Abidjan’s 75 high-impact sites next year, bringing the total number of sites to 101.

“The QISSEC project aims to strengthen ownership of continuous QI at all levels of the health system pyramid,” says Dr. Nathalie Krou Danho. “To do this, I-TECH collaborates with all national stakeholders, including PEPFAR implementing partners and civil society organizations who can help motivate beneficiaries to take part in QI efforts and extend its QI approach to the community.”

I-TECH’S WORK IN CÔTE D’IVOIRE IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER 1 U1NOA45176-01-00 THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS, OR THE U.S. GOVERNMENT.

I-TECH Presents Posters at AIDS 2020: Virtual

Post categories: Caryl Feldacker Cervical Cancer Gabrielle O'Malley HIV Care and Treatment Malawi Male Circumcision Mental Health Namibia Zimbabwe
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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:

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.

Expanding Two-Way Texting to Reduce Follow-Up Appointments for Male Circumcision Patients

Post categories: Caryl Feldacker Male Circumcision South Africa Zimbabwe
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This piece was first posted on the University of Washington Department of Global Health’s (DGH) website.

A new five-year research project will study two-way texting as a means of communication between healthcare providers and male circumcision (MC) patients in South Africa. It will build on previous research conducted in Zimbabwe.

Caryl Feldacker is the Principal Investigator (PI) on this RO1, which will support research through 2025. The multi-stage implementation science study is based out of the International Training and Education Center for Health (I-TECH), and will be implemented with Dr. Geoffrey Setswe, PI for South Africa partner, Aurum Institute, and with technology partner, Medic Mobile.

“Previous research shows that healthcare workers waste a lot of time and money reviewing MC clients without complications,” Feldacker said. “So, in partnership with Medic Mobile, we developed a two-way texting (2wT) system to identify and refer men with potential medical issues to in-person care while allowing the vast majority to opt-out of routine post-operative visits.”

Programs providing voluntary medical male circumcision (MC) in sub-Saharan Africa are struggling to meet the annual goal of 5 million MCs. However, chronic human and financial resource shortages threaten achievement of MC targets, reducing impact of this effective HIV prevention intervention. Although MC is safe with an adverse event (AE) rate of less than 2% , global MC guidelines require one or more in-person, post-operative visits within 14 days of MC for timely AE identification. With low AE rates, overstretched clinic staff likely waste invaluable resources conducting unnecessary routine reviews for MC clients without complications while men healing well needlessly pay for transport, miss work, and wait for reviews, discouraging MC uptake.

With this background, Dr. Feldacker’s prior randomized controlled trial (RCT) in Zimbabwe tested whether 2wT between patients and providers during the critical 13-day post-operative period (instead of routine in-person reviews) could ensure patient safety while reducing provider workload. 2wT safely reduced client visits by 85%, increased AE identification, and cut follow-up costs, suggesting that 2wT could make a dramatic difference in MC programs operating at scale. Plus, providers and patients found the 2wT follow-up approach highly usable and acceptable. “These daily text exchanges really empowered men to be partners in their healing process, creating a win-win for providers and patients.”

Read the entire story on the DGH website.

I-TECH Zimbabwe Office Transitions to Local Organization

Post categories: Caryl Feldacker HIV Care and Treatment Male Circumcision Scott Barnhart Stefan Wiktor Transition & Sustainability Zimbabwe
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Zim-TTECH staff supports Kowoyo Clinic in Goromonzi District, Mashonaland East Province, Zimbabwe. Photo credit: Macpherson Photographers.

The International Training and Education Center for Health (I-TECH) has transitioned another office to an autonomous entity. The Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) was officially launched on April 1, 2020, as a locally registered health trust. Zim-TTECH is the administrative and managing partner for the two existing I-TECH CDC/PEPFAR funded grants in Zimbabwe, each grant having a consortium of local partners:

  • ZimPAAC (Zimbabwe Partnership to Accelerate AIDS Control) is a partnership between Zim-TTECH, Africaid, Pangaea Zimbabwe AIDS Trust, and I-TECH. ZimPAAC collaborates with the Ministry of Health and Child Care (MoHCC) on context-appropriate health interventions to improve access to, as well as strengthen the quality of HIV prevention, treatment, care, and support services. ZimPAAC provides services at 373 facilities in 17 districts.
  • ZAZIC is a partnership between Zim-TTECH, I-TECH, and two local implementing partners—Zimbabwe Association of Church Related Hospitals (ZACH) and Zimbabwe Community Health Intervention Research Project (ZiCHIRe). ZAZIC supports voluntary medical male circumcision (VMMC) services at 38 static facilities in 13 districts.

“The transition from an I-TECH country office to a fully fledged independent local organization is exciting,” states Dr. Batsirai Makunike-Chikwinya, Zim-TTECH’s Executive Director. “Zim-TTECH is committed to continue to provide high-quality support to the MoHCC and to the health sector as a whole. Special thanks go to management and staff of both I-TECH/UW [University of Washington] and UZCHS-CTRC [University of Zimbabwe College of Health Sciences Clinical Trials Research Centre], who played pivotal roles during this transition.”

I-TECH has worked in Zimbabwe since 2003, collaborating with the MoHCC and other partners to improve clinical services and strengthen health systems.  “It is a pleasure to support the launch of Zim-TTECH, which is the right next step toward country ownership and, importantly, recognizes the high level of skill and professionalism of the prior I-TECH country office and now Zim-TTECH team,” remarks Dr. Scott Barnhart.

Reducing HIV through Voluntary Medical Male Circumcision in Zimbabwe

Post categories: Caryl Feldacker HIV and STI Prevention Male Circumcision Quality Improvement Scott Barnhart Zimbabwe
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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 staff supported by MOHCC with partner staff. The ZAZIC consortium supports:

  • Training using MoHCC approved curricula, health workers in the supported districts are trained on the surgical technique as well as on demand creation
  • Development and implementation of age appropriate demand creation strategies
  • Support service delivery in 13 districts from consent procedures to post-surgical care and linkage to other services
  • Comprehensive monitoring and evaluation including continuous quality improvement and operations research

From 2013-2018, ZAZIC performed over 300,000 VMMCs with a reported moderate and severe adverse event rate of 0.3%. The safety, flexibility, and pace of scale-up associated with the integrated VMMC model appears similar to vertical delivery with potential benefits of capacity building, sustainability and health system strengthening. Although more complicated than traditional approaches to program implementation, attention should be given to this country-led approach for its potential to spur positive health system changes, including building local ownership, capacity, and infrastructure for future public health programming. Over 80% of the circumcisions occur in outreach settings, an approach that ensures wide coverage and expanded services in hard-to-reach locations.

Two-Way Texting for Post-Operative VMMC Follow-Up RCT in Zimbabwe

Post categories: Caryl Feldacker Health Information Systems HIV Care and Treatment Male Circumcision Zimbabwe
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Voluntary medical male circumcision (VMMC) is considered safe and the vast majority of men heal without complication. However, guidelines require multiple follow-up visits, which can burden staff and facilities with clients who are typically healing well. With funding from the National Institutes of Health (NIH), ZAZIC recently conducted a prospective randomized control trial (RCT) to determine if two-way texting (2wT) was as safe as routine post-operative visits and if it reduced workload in two high-volume VMMC sites near Harare, Zimbabwe.

Image of the 2wT App used to support the study.

Both clients and providers felt satisfied with the 2wT system and felt it could be ready for scale. Many clients reported feeling confident, comfortable, satisfied, and safe with text follow-up. Importantly, clients felt that 2wT saved them time and money. Providers also noted 2wT saved them time, empowered their clients to engage in the healing process, and addressed gaps in MC service quality.

The results strongly suggest that 2wT is highly usable and acceptable for providers and patients. Men with concerns appeared confident and comfortable to receive guidance via text and providers noted that men engaged proactively in their healing.

It was recommended in the study that 2wT between providers and patients should be considered for future adaptation in other short-term care contexts. 2wT also appears far less expensive than active follow-up to improve patient safety: on average, post-VMMC follow-up under 2wT was $0.098 compared to $0.955 under routine care. 2wT was both less costly and more effective in identifying AEs relative to the expected rate of AEs.  As such, I-TECH aims to scale 2wT in further testing among rural clients and guardians to improve patient care at lower cost.

The trial is registered on ClinicalTrials.gov, trial NCT03119337, and activated on April 18, 2017. https://clinicaltrials.gov/ct2/show/NCT03119337. This RCT was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.

Increasing VMMC Delivery and Safety in Zimbabwe

Post categories: Caryl Feldacker Male Circumcision Scott Barnhart Zimbabwe
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Employing modern medical male circumcision within traditional settings may increase patient safety and further male circumcision scale up efforts in Sub-Saharan Africa. ZAZIC established a successful, culturally sensitive, partnership with the VaRemba, an ethnic group in Zimbabwe that practices traditional male circumcision. The VaRemba Camp Collaborative (VCC) was created to provide safe, standardized male circumcisions and reduce adverse events (AEs) during traditional male circumcisions. ZAZIC supported the VCC by providing key MC commodities and transport to help ensure patient safety. In 2017, the VaRemba granted permission to ZAZIC doctors to provide oversight of MC procedures and post-operative treatment for all moderate and severe AEs within the Camp setting. Of the Camp residents, 98% chose medical male circumcision.

The multi-year, iterative cycle of meetings and trust building ultimately resulted in the successful VCC, a model that may be replicable for others trying to combine modern male circumcision and traditional practice.

Achieving Targets through Performance-Based Financing in Zimbabwe

Post categories: Caryl Feldacker Health Systems Strengthening Male Circumcision Quality Improvement Scott Barnhart Zimbabwe
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ZAZIC employs an innovative performance-based financing (PBF) system to speed progress towards ambitious voluntary medical male circumcision (VMMC) targets. The PBF schedule, which started at $25 USD and now varies from $6.50-$14 USD depending on the location and the circumcision team, is continually refined to set the program up for sustainable transition. The PBF is an incentive that is intended to encourage underpaid healthcare workers (HCWs) to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports HCWs who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels.

I-TECH conducted a qualitative study to assess the effect of the PBF on HCW motivation, satisfaction, and professional relationships. The study found that the PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace and create divisiveness. To reduce workplace tension and improve the VMMC program, ZAZIC increased training of additional HCWs to share the PBF incentive more widely and strengthened integration of VMMC services into routine care.