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I-TECH Attends 25th IAS International AIDS Conference

Post categories: Cote d'Ivoire DIGI Gender/Women & Girls HIV Care and Treatment India Lydia Chwastiak Nancy Puttkammer Quality Improvement Stefan Wiktor Ukraine Zimbabwe
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Representatives from I-TECH, I-TECH Ukraine, I-TECH India, and Zim-TTECH attend the 25th IAS AIDS Conference in Munich, Germany.
Representatives from I-TECH HQ, I-TECH Ukraine, I-TECH India, and Zim-TTECH attend the 25th IAS AIDS Conference in Munich, Germany. Photo Credit: I-TECH

The International AIDS Society (IAS) hosted the 25th International AIDS Conference on 22–26 July 2024 in Munich, Germany, and virtually. The theme this year was “put people first” to emphasize the importance of “thinking of solutions from the point of view of those most affected.” The conference brings together HIV researchers and experts for presentations and discussions on a wide range of HIV- and AIDS-related topics.

This year, representatives from the International Training and Education Center for Health (I-TECH) presented findings from I-TECH-supported programs in Côte d’Ivoire and Ukraine:

Côte d’Ivoire

Ukraine

Additionally, representatives from I-TECH India, PLC, and the Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH)—two of I-TECH’s partner network organizations—as well as their program partners presented findings from I-TECH-supported programs being implemented in India and Zimbabwe:

India

Zimbabwe

Note: Bolded names represent I-TECH authors and an asterisk (*) indicates the presenting author

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”

I-TECH Presents at 2023 IAS Conference on HIV Science

Post categories: Gabrielle O'Malley HIV Care and Treatment India Key Populations Malawi PrEP Quality Improvement Stefan Wiktor Surveillance Tuberculosis Zimbabwe
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The 2023 IAS Conference on HIV Science logo. Read the full background and inspiration behind the 2023 IAS Logo. Image credit: IAS

The International AIDS Society (IAS) hosted the 12th IAS Conference on HIV Science on 23 – 26 July 2023 in Brisbane, Australia, and virtually. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.

This year, representatives from the International Training and Education Center for Health (I-TECH), I-TECH’s partner network organizations, and the Centers for Disease Control and Prevention (CDC) shared findings from I-TECH-supported programs in India, Malawi, and Zimbabwe. Read the ePoster abstracts below.

India:

Malawi:

Zimbabwe:

I-TECH and Zim-TTECH Publish Paper on Transitioned Programs

Post categories: Best Practices Health Systems Strengthening Integrating Research and Practice Scott Barnhart Stefan Wiktor Transition & Sustainability Zimbabwe
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Faculty and staff from the International Training and Education Center for Health (I-TECH) and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) have published a new paper in the journal PLOS One.

Working toward sustainability: Transitioning HIV programs from a USA-based organization to a local partner in Zimbabwe catalogs the challenges and lessons learned as I-TECH laid the groundwork to transition the voluntary medical male circumcision (VMMC) and HIV care and treatment programming in Zimbabwe to the newly established Zim-TTECH, a fully independent local organization.

“I-TECH prides itself on working collaboratively with our international partners. We held the principle from day one that the most successful programs happen when the locus of control sits in-country,” said Marrianne Holec, Senior Program Manager at I-TECH. “We had the foundation in place with our local staff, what was missing was the organizational structure to allow the team in-country to truly lead the project. With the formation of Zim-TTECH, I’m happy to say we are there.”

Among USG funders, it’s recognized that future models for sustainable healthcare rely on local country ownership and leadership.[1] But making the transition from US-based ownership to country ownership isn’t a one-time event, added Holec, “It’s a process that takes time. We wanted to document our process so that other international organizations who are looking to pursue decolonizing global health programming can learn from our experience.”

Through 16 key informant interviews, the team gathered views on transition planning, implementation, and technical support, ethics, and success. Five themes emerged from the data collected:

  • Develop a vision and empower leadership for change by delegating clear roles and supporting local ownership;
  • Plan and strategize for transition in a manner that accounts for historical context;
  • Communicate with and inform stakeholders to understand transition perceptions, understand barriers to transition, and enable open communications related to risks and benefits;
  • Engage and mobilize staff by constructing necessary infrastructure and providing technical assistance as needed; and
  • Define short-term and long-term success.

“Sustainability of successful donor funded public health programs is critical if we want to maintain the important gains that have been made over the years,” says Dr. Batsi Makunike, Executive Director of Zim-TTECH. “Strong local organizations with good governance, management, and technical capacities are an important cornerstone of sustainability.

“The process of transitioning from an international to a local organization is daunting,” she continues. “We hope that this study is helpful to other organizations in their efforts to transition.”

[1] Goosby E, Von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the Bar: PEPFAR and New Paradigms for Global Health. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;60.

From Beneficiaries to Mentors: Three Women Pass Their DREAMS On to Others

Post categories: Gender/Women & Girls HIV and STI Prevention Stefan Wiktor Zimbabwe
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A group of DREAMS ambassadors in Zimbabwe. Photo credit: Zim-TTECH

After facing incredible obstacles, three resilient 22-year-old women from Tsholotsho District, Zimbabwe, found their lives intersecting: Sitheni, Clemencia, and Faith are DREAMS ambassadors, equipping adolescent girls and young women with skills to reduce their vulnerability to contracting HIV–and helping them to find their own strengths.

DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is a PEPFAR-funded program that aims to reduce HIV infections among adolescent girls and young women through not only prevention and treatment, but also a core curriculum that addresses HIV prevention, financial literacy, and gender-based violence (GBV). Participants can also access services such as HIV testing, family planning, pre-exposure prophylaxis (PrEP), counseling, and screening for GBV.

The International Training and Education Center for Health (I-TECH) has been supporting the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) and its ZimPAAC consortium to implement the DREAMS program since 2020. To date, nearly 20,000 girls and young women in Zimbabwe have completed the primary DREAMS curriculum, Health for Life.

Sitheni, Clemencia, and Faith were initially enrolled in the DREAMS program as beneficiaries, having turned to transactional relationships (trading sex for money or necessities) to survive poverty amid the deepening economic crisis in Zimbabwe. They now use their own experiences to give back to young women who face similar choices.

Sitheni had to abandon her life-long goal of attending university to support her parents and four siblings; carrying the burden of sole provider for her family took a toll on her. When earnings from her part-time jobs weren’t enough, she became involved in sexual relationships with older, cross-border traders—known as omalayitsha—to make extra money.

Once enrolled in the DREAMS program, she thrived within the Health for Life courses, which cover financial literacy, social asset building, condom education, and violence and HIV prevention. “I encourage young girls in my community not to depend on men, but to use their skills instead of waiting to be given money by men who will abuse them,” Sitheni says.

Training and services are often provided in a safe space such as a school or community center, where participants meet with a mentor trained to deliver the Health for Life curriculum.

“At the moment I mentor 140 adolescent girls and young women aged 15-24 in the district,” says Faith, who also dated older men for money in order to make ends meet. “It is my duty to link adolescents with the district clinical nurse to access services at health facilities and safe spaces. I also encourage women to support people living with HIV/AIDS in the community. I teach them about human rights and encourage them to utilize their talents to make a living.”

Another part of Faith’s job is enrolling and following up on beneficiaries as well as supporting community-based facilitators who teach social asset building. This includes facilitating relationships and connections within DREAMS safe spaces to share encouragement and survival skills.

These safe spaces were critical to providing hope and new options for Clemencia. “After my father passed away, there was no one to pay for my school fees,” she says. “I came to my wits’ end, and I ended up exchanging sex for livelihood. At that time, it seemed the only viable option.”

Clemencia traded sex for two-and-a-half years, placing her among those at highest risk for HIV acquisition in Zimbabwe.[1] “Luckily for me, I did not get infected with HIV,” she says. “Ever since joining DREAMS, I have become empowered, and I know how to protect myself from sexual violence.”

Thanks to what she learned in her financial literacy sessions, Clemencia has started a small business of breeding hens and selling them to community members. “I also sell clothes for extra income,” says Clemencia, who now encourages other young women to complete their financial literacy sessions so they can start their own businesses and become independent.

Faith is thrilled to be able to foster this independence, as well. “Little did I know that I could make an honest living without anyone having expectations from me,” she says. “I am now able to encourage other girls and young women to stop engaging in transactional relationships. I am able to do this because I have been mentored and I have knowledge about HIV/AIDS and violence against women.”

 

[1] Chiyaka T, Mushati P, Hensen B et al. Reaching young women who sell sex: Methods and results of social mapping to describe and identify young women for DREAMS impact evaluation in Zimbabwe. PLoS One. 2018 Mar 15;13(3):e0194301. doi: 10.1371/journal.pone.0194301. eCollection 2018.

 

I-TECH Network Minimizes Disruptions in Treatment Access for PLHIV During COVID-19

Post categories: COVID-19 Gabrielle O'Malley HIV Care and Treatment India Jeff Lane Namibia Pamela Collins Stefan Wiktor Zimbabwe
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By Chelsea Elkins

Members of a Community Adherence Refill Group in Zimbabwe

In a time of increased barriers, disruptions, and restrictions due to the COVID-19 pandemic, the International Training and Education Center for Health (I-TECH) and its network partners have implemented new approaches and adapted existing programs to support continued access to antiretroviral therapy (ART).

As a result of the pandemic, many organizations and health systems have had to shift to offering virtual care, which allows ART initiation and other HIV services to persist while minimizing patients’ risk of exposure to COVID-19. However, not all patients have access to the technology that makes virtual services possible, and additional approaches are needed to support ART treatment access during this time.

“Globally, the pandemic has generated innovative responses from communities and health systems that are striving to keep people connected to care,” says Dr. Pamela Collins, I-TECH Executive Director. “One challenge is to recognize how (or when) some adaptations increase disparities in access. We’ve learned that the right combinations of technological and no-tech solutions can also be innovative if they help provide the care that’s needed.”

One way I-TECH has helped to provide innovative care during the pandemic is by centering solutions within the affected communities themselves. A few of the community-oriented approaches that the I-TECH network has implemented include decentralized ART centers, community outreach, home delivery, community adherence refill groups (CARGs), and multi-month dispensing (MMD) of antiretroviral (ARV) medication.

Decentralized ART Refill Sites and Community Outreach

Decentralized refill sites have been an essential strategy during lockdown restrictions for I-TECH’s network partners because they allow ART to be distributed at more convenient locations, minimizing travel and treatment interruptions. Some programs have also started providing mobile outreach to improve ART access during the pandemic, at times even providing doorstep delivery to those who are unable to go to a clinic or refill center.

I-TECH’s network partner in India, the UW International Training & Education Centre for Health Private Limited (I-TECH India) launched the ARTMitra helpline in Mumbai, an outreach effort designed to map the location of unreachable PLHIV and aid in planning decentralized ART refill sites. SMS messages were delivered to 13,103 PLHIV who had missed appointments during the pandemic, resulting in the identification of 42 decentralized ART refill centers in Mumbai in 2020. A similar helpline was launched in five districts of the state of Mizoram in partnership with the State AIDS Control Society. In total, I-TECH India, in close coordination with government partners in the PEPFAR states in Northeast India and in Mumbai, has ensured uninterrupted ART delivery through 145 decentralized ART refill sites.

Through outreach efforts, clients were notified about how they could access medication, and which decentralized ART refill site they should visit. Additionally, ART home delivery was provided to 255 PLHIV living in Mumbai who were unable to pick up their medication.

Thank you for calling and informing me about the availability of medicine at the nearby ART Centre, as I had no idea whom to contact and how to collect medicine.

—an ARTMitra client in Mumbai

I-TECH network partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) has also utilized community outreach to support PLHIV during the pandemic. Zim-TTECH has supported the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium—along with PEPFAR partners, the U.S. Centers for Disease Control and Prevention (CDC) and in close collaboration with national efforts—to provide mobile HIV care, including prevention services and integrated services at ART events. In the Harare District, 8,257 clients were supplied ART during outreach events from 28 March through 17 July 2021.

Community Adherence Refill Groups and Multi-Month ART Dispensing

Through CARGs, a community of PLHIV access treatment more easily by sending a representative to receive ARVs for the entire group. The I-TECH network implements CARGs in a number of countries, using the person-centered approach to simplify HIV care and reduce the need for in-person services. This approach is often used in tandem with MMD, allowing a group to access multiple months of medication at a time.

While ARVs have traditionally been prescribed monthly, MMD allows patients to pick up medication for 2 to 6 months and reduces traditional barriers, such as access to transportation and taking time off work, as well as barriers specific to COVID-19, such as lockdown restrictions and limited capacity of health care facilities. I-TECH and its network partners have scaled up MMD in many programs during the COVID-19 pandemic, effectively minimizing the number of in-person visits and encouraging ART adherence.

In response to COVID-19 and in partnership with CDC, the Ministry of Health and Social Services (MoHSS) in Namibia introduced a new MMD policy in April 2020 for eligible ART patients, making more people eligible for this service than ever before. In addition to policy support, I-TECH Namibia is engaged in technical support to the national HIV/AIDS program through clinical mentors who work in more than half of Namibia’s health districts. This national engagement has contributed to a rapid increase in the number of eligible ART patients who now receive between 2 to 6 months’ supply of ARVs at a time.

‘’As the number of ART patients on MMD increased, waiting areas in Namibia’s health facilities have rapidly decongested, enhancing COVID-19 infection prevention and control measures,” says Dr. Norbert Forster, I-TECH Namibia’s Country Director. “At the same time, our HIV clinicians now have more time to focus their care on patient engagement and on enhancing viral load suppression and other interventions.”

I-TECH’S WORK IN INDIA 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.

Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination

Post categories: Cervical Cancer COVID-19 Gabrielle O'Malley Gender/Women & Girls Jeff Lane Linda Eckert Malawi Mozambique Namibia Stefan Wiktor Uncategorized Zimbabwe
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The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.

However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.

Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.

Record-breaking cervical cancer screening in Namibia

The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia’s national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.

In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.

From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).

“As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Lead Physician in Namibia. “Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening.”

Mentoring and training continues in Mozambique via videoconferencing technology

In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® “superhub” for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.

“Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies,” says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. “The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them.”

In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.

While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.

Access to services increase through health communication in Malawi

Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.

To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.

I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.

In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.

Zimbabwe consortium takes measures to blunt the impact of COVID-19

I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.

By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:

  • Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
  • Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
  • Procurement and distribution adequate PPE for use by health care workers at facilities.

COVID-19

I-TECH provides technical assistance on the prevention and control of COVID-19 that ranges from training health care workers and facilities in infection prevention and control best practices to supporting the development of national policies and standard operating procedures. During the COVID-19 pandemic, I-TECH continues to work with ministries of health and other key stakeholders to ensure that laboratories, health facilities, and clinics are implementing and being trained in procedures to prevent and control the spread of COVID-19.

In addition to directly supporting COVID-19 prevention and control efforts, I-TECH has been working with governments and the ministries of health to ensure the continuity of HIV care and treatment by supporting clinicians via telephone consultations, developing messaging campaigns to connect people living with HIV (PLHIV) with pharmacies and clinics stocked with antiretroviral therapy (ART) medications, and helping PLHIV form community ART refill groups.

Program Highlights

National COVID-19 Emergency Response in Malawi

In collaboration with the Malawi Ministry of Health (MOH) and Centers for the Disease Control and Prevention (CDC), I-TECH has ...
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Optimizing the COVID-19 Testing Process at the Airport in Mauritius

As a measure to help stop the spread of COVID-19, the Government of Mauritius began requiring that all arriving passengers ...
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Creating a Data Warehouse to Support COVID-19 Surveillance in Mauritius

The Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to implement ...
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COVID-19 Sentinel Surveillance in Malawi

Despite establishing  COVID-19 monitoring measures within the existing routine national surveillance system and significant efforts to conduct testing, contact tracing, ...
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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.

Pre-exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is a medication to prevent HIV infection in HIV-negative people. PrEP can stop HIV from taking hold and spreading throughout the body, and when taken daily, oral PrEP is highly effective for preventing HIV from sex or injection drug use. Additionally, expectant mothers who are HIV-negative can take PrEP to prevent infection, and thus prevent mother-to-child transmission (MTCT), during the critical periods of pregnancy and breastfeeding.[1] PrEP and the prevention of MTCT greatly contribute to the UNAIDS “fast-track” targets for prevention, which aims to reduce the number of new HIV infections in 2030 to fewer than 200,000.[2]

Despite scale-up of HIV testing and treatment in Africa, adolescent girls and young women (AGYW), as well as individuals in sero-discordant relationships, have high incidence of HIV. I-TECH supports PrEP delivery at HIV care and treatment clinics for partners of individuals receiving antiretroviral therapy (ART). In addition, I-TECH’s work in PrEP coincides with its efforts to support programs that provide for the physical and mental health of AGYW.

In partnership with the Elizabeth Glaser Pediatric AIDS Foundation, I-TECH faculty Jeff Lane and Aaron Katz prepared the briefs in the sidebar, which outline policy considerations for the scale-up of PrEP for adolescent girls and young women (AGYW) in Kenya, South Africa, and Uganda.

  1. World Health Organization (WHO). WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP). Policy Brief. November 2015.
  2. UNAIDS. Understanding Fast-Track: Accelerating Action to End the AIDS Epidemic by 2030. June 2015.

Program Highlights

Expanding HIV Care and Treatment in Zimbabwe
The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary ...
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HIV Pre-Exposure Prophylaxis (PrEP) in Ukraine
The Government of Ukraine prioritized pre-exposure prophylaxis (PrEP) as part of combination prevention for HIV in 2019.1 Since 2020, I-TECH ...
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Pre-Exposure Prophylaxis for HIV Prevention in Namibia
I-TECH began supporting the implementation of pre-exposure prophylaxis (PrEP) as part of Namibia’s combination HIV prevention strategy in 2017 ...
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