Expanding HIV Care and Treatment in Zimbabwe

Posted on November 22, 2019December 2, 2019

The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:

Diagnose 95% of all persons living with HIV through integrated testing
Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained in care, and are virally suppressed using differentiated service delivery models

Using a Differentiated care model, a patient-centered model of service delivery designed to meet the diverse needs and expectations of all people living with HIV, ZimPAAC oversees activities such as:

facility and community-based HIV testing;
HIV self-testing, index case testing;
ART initiation; and
ART delivery through multi-month refills for stable patients, Family ART Refill Groups, and Community ART Refill Groups (CARGs). CARGs benefit group members—through decreasing health center visits, offering peer support, and allowing clients to take responsibility for their health—and staff, by decreasing workload and allowing greater time for patient care.

I-TECH Zimbabwe Care and Treatment Sites and Districts — A map of I-TECH’s Care and Treatment Sites and Districts in Zimbabwe.

In addition to differentiated service delivery, ZimPAAC conducts site-level mentoring at health facilities to strengthen health service delivery towards the “95-95-95” UNAIDS targets by improving patient linkages between HIV testing, initiation on treatment, and retention in care rates. This is accomplished in part by several hundred dedicated HIV testers and nurses who support ART initiation and management of opportunistic infections alongside MoHCC staff.

ZimPAAC also supports index testing through community linkages activities that help clients access HIV testing, especially sexual partners and biological children of existing HIV-positive clients who present to the health facilities. In an effort to improve index testing within MoHCC health facilities, ZimPAAC has implemented an assisted partner service model, known as Enhanced Index Case Testing. This program emphasizes reaching clients recently diagnosed with HIV and those whose blood tests show a high HIV viral load. Quality Improvement activities are a key part of ZimPAAC’s approach to improving outcomes for index testing. In 2019, a “change package” describing the interventions that have improved index testing was developed by ZimPAAC for national scale-up of the model.

ZimPAAC program activities also support retaining people living with HIV in care. Programs engage community linkage facilitators who work with facilities and communities to identify patients who have defaulted from treatment and return them to services.

In addition to HIV care and prevention for adults, ZimPAAC supports increased access to services for children and adolescents through Africaid’s community adolescent treatment supporters (CATS). CATS are HIV positive 18-to-24-year-olds trained to provide peer support, conduct demand-creation activities, build community engagement, and mobilize targeted HIV testing and outreach activities to bring services to this hard-to-reach group.

In addition to the first two objectives, ZimPAAC collaborates with MoHCC towards two additional objectives:

Strengthen and expand access to cervical cancer screening and treatment of precancerous cervical lesions among women living with HIV
Increase uptake of pre-exposure prophylaxis (PrEP) services through training, technical assistance and direct client support

In 2019, ZimPAAC began the expansion of cervical cancer screening for women living with HIV, beginning with a situational analysis to identify sites for implementation of a program serving women with visual inspection with acetic acid and cerviography.

Under the direction of PZAT, ZimPAAC also works closely with the MoHCC to support key-population-friendly programming in the public health sector facilities in Harare. PZAT supports health worker training at selected facilities and builds demand and knowledge of these services through community champions and engagement with vulnerable populations and advocacy and civil society organizations. PZAT also works to promote PrEP services for adolescent girls and young women in Mazowe district and among key populations in Harare.

Using Innovative Technology for Better Data in Zimbabwe

eLearning/Distance Learning Health Information Systems Stefan Wiktor Zimbabwe

Posted on November 22, 2019

The ZimPAAC consortium has supported high-quality health care worker (HCW) knowledge and skills in Zimbabwe with technologies such as applications with clinical resources for clinicians, tablet-based data collection, and self-study modules. Through the use of self-study courses, HCWs complete learning activities using case scenarios in either prevention of mother-to-child transmission client retention, HIV testing services for children and adolescents, or viral load testing. ZimPAAC also uses WhatsApp messaging groups as a training intervention during self-study for peer-to-peer learning and support. Tablet-based data collection has now become the norm for most sites.

ZimPAAC also continually works to strengthen its program monitoring systems, such as the deployment of TrainSMART as the national training database. Recently, ZimPAAC developed and introduced the ZimPAAC Data Improvement Plan (ZDIP)—a new system of electronic data collection tools that will improve reporting and give facility and district staff better access to data. The new digital forms in ZDIP offer built-in data quality checks, the ability to view graphs, and provides faster feedback to sites so they can use the data for facility-based improvements.

Driving Collaboration with Local Implementation Partners in Zimbabwe

Caryl Feldacker HIV and STI Prevention HIV Care and Treatment Scott Barnhart Stefan Wiktor Zimbabwe

Posted on November 19, 2019November 19, 2019

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”

Expanding Cervical Cancer Screening in Zimbabwe

Cervical Cancer Stefan Wiktor Zimbabwe

Posted on August 16, 2019August 21, 2019

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.

I-TECH Launches In-Service Skills Development Program for Health Workers in South Africa

Nursing/HCW Cadres South Africa Stefan Wiktor

Posted on June 10, 2019June 10, 2019

In South Africa, the International Training and Education Center for Health (I-TECH) has begun facilitating an in-service skills development training program for community health workers (CHWs) and their supervisors in their roles on the Ward-Based Primary Health Care Outreach Team (WBPHCOT). To maximize the impact of this training, I-TECH is working with two PEPFAR District Support Partners across seven of South Africa’s nine provinces to reach an estimated 20,000 CHWS, which is approximately half of the country’s CHW workforce. Training began in February 2019 and will continue through September 2019.

The WBPHCOT In-Service Skills Development Package aims to strengthen the capacity of CHWs to provide high-quality health services in the community. The program emphasizes development of core, cross-cutting service delivery skills, including communication, screening, psychosocial support, ethics, and confidentiality that enable CHWs and their supervisors, known as Outreach Team Leaders (OTLs), to effectively carry out their work.

During training, CHWs and OTLs build their skills in both classroom and on-the-job settings using group discussions, case presentations, scenario-based role play, small group activities, and interactive presentations. Priority health conditions and related clinical topics are included, and the realistic scenarios cover all components of the CHW scope of work.

I-TECH SA CHW Training App — Snapshot of the app used to capture training data.

Leveraging Technology to Improve Training
All training data collected for the skills development program will be captured via a mobile application and stored using the CommCare platform, a mobile data collection system developed by Dimagi. The app allows I-TECH access to real-time data, which can inform targeted measures to ensure that all CHWs are receiving high-quality trainings.

To tailor the program to the needs and realities of the field, I-TECH has implemented a blended tablet and paper-based data collection approach.

“There is such a large number of CHW trainees in the field that using this blended approach allows the OTLs to dedicate their time to training CHWs rather than focus on paperwork,” says Ilyse Jacobson, I-TECH South Africa Technical Director of Programs. “This flexibility allows for more in-depth and efficient training.”

Dashboard used by stakeholders and implementing partners to track the progress of the program.

Due to its role as the sole repository for all training-related data, the CommCare database will also generate reports linked to an interactive stakeholder dashboard.

“The dashboard not only brings I-TECH’s data visualization and dissemination approach into the 21st century,” says Jacobson, “it allows project stakeholders access to the data that helps with decision-making both in and outside of this program.”

The design of the Stakeholder Dashboard allows donors, implementing partners, and the National Department of Health to track current progress against training targets on a weekly basis.

Best Practices

To address the UNAIDS Sustainable Development Goals for elimination of HIV/AIDS, tuberculosis, malaria and other diseases by 2030, and the PEPFAR 3.0 goals, I-TECH leverages the technical expertise of its universities and partners, the broad experience of its funders, and best practices from 15 years of implementing programs.

Transition & Sustainability

The International Training and Education Center for Health (I-TECH) works in partnership with host country governments, universities, professional associations, non-governmental organizations, private sector groups and funding agencies to strengthen local capacity and build sustainable health systems.

I-TECH follows a partnership model that guides the provision of technical services and technical assistance toward local ownership and sustainability, creating projects and programs that can be readily transitioned into national systems.

Based at the University of Washington, I-TECH draws upon a strong global network of public health professionals. The approach described in this document is customized in each country to respond to local needs and priorities. In addition, each I-TECH country office team aligns the model with the unique Partnership Framework Implementation Plans of the partner host government.

1. IDENTIFY NEEDS in consultation with host country governments

I-TECH works with host country governments to assess existing health systems and identify specific areas where the delivery of health care could be improved. This early collaboration helps to ensure that technical assistance accurately reflects the country’s specific health strategies and priorities.

2. STRUCTURE PARTNERSHIPS that integrate projects into existing systems

In each partnership, I-TECH develops roles, responsibilities, and timelines based on a long-term vision of integrating projects into existing national systems. As part of this vision, I-TECH recognizes and leverages the strengths and resources of national systems, building on and maximizing these efficiencies. The partnerships that emerge are attuned to the needs, realities, and structure of host country systems. Thus, they build and maintain lasting capacity within host country systems, maximize cost-effectiveness, and produce projects that can be more readily scaled up to meet national goals.

3. SECURE TECHNICAL RESOURCES from affiliated universities, partners, and the I-TECH network

As a center based at the University of Washington, I-TECH has direct access to a wide variety of technical specialists. In addition, I-TECH draws upon a robust global network of locally based public health professionals. These specialists provide a wide range of technical expertise to meet project needs.

4. PROVIDE TECHNICAL ASSISTANCE AND SERVICES tailored to actual needs and resources

I-TECH is committed to technical services and technical assistance approaches that build upon and support the existing strengths of local health systems. In addition, I-TECH prioritizes the use of local and regional expertise, an approach that builds the capacity of local experts to meet locally determined needs.

5. MONITOR PERFORMANCE; evaluate achievement of objectives and measure outcomes

I-TECH implements projects within a quality improvement framework designed to track progress in institutional capacity building and guide successful implementation. Using the framework, implementers monitor the progress of each project against specific benchmarks of success; for example, the progressive transfer of skills and capacity to local institutions. This methodology ensures that objectives are met and provides data to adjust approaches as projects evolve.

6. TRANSITION PROJECT into national systems to ensure sustainability

The ultimate goal of I-TECH’s partnership model is to improve health outcomes by strengthening local capacity and building sustainable health systems. I-TECH’s technical services and technical assistance are tailored from the initial planning stage to produce projects that can be successfully absorbed into national systems within mutually determined and realistic timeframes. Recognizing that a successful transition takes time, I-TECH offers transition support in a variety of technical areas including quality improvement and grant management.

HIV Care and Treatment

I-TECH provides technical assistance on the clinical care and treatment of HIV and related opportunistic infections on a continuum that ranges from direct patient service delivery, to training and mentoring health care workers, to the development of national policies and health systems infrastructure. In particular, together with ministries of health and other key stakeholders, I-TECH has developed numerous curricula and clinical mentoring programs to train health care workers to safely and effectively treat patients who have HIV and TB or other opportunistic infections at a level of care commensurate with national and international standards.

I-TECH has also assisted ministries of health to create national prevention and care and treatment guidelines for infectious diseases, which has lead to standardized care and treatment for HIV, including antiretroviral therapy (ART) dosing for adults and children.

Program Highlights

Driving Collaboration with Local Implementation Partners in Zimbabwe

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 ...
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eLearning Programs for Health Care Workers in Trinidad and Tobago

I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) of the Office of the Prime Minister, and other local organizations to make accessible learning and capacity-building opportunities for all cadres of health care workers.

Learning Management System (LMS): ...
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eLearning Programs in the Caribbean

I-TECH has partnered with universities and ministries of health (MoH) in the region to develop accessible in-service training opportunities for HIV providers using distance and blended learning ...
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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 HIV epidemic control objectives:

Diagnose 95% of all persons living with HIV through integrated testing
Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained ...
Read More

Human Resources for Health

The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated health care workforce, and sustainable systems to educate and train those workers. I-TECH uses a systemic approach to build the skills and knowledge of, and foster attitude changes in, health care staff and those who train and educate them.

The following model outlines I-TECH’s human resources for health-based approach to achieving comprehensive patient-centered care. Each component of the model, including a strong enabling environment, supports an optimized health workforce as the foundation of an effective service delivery system.

Program Highlights

Field Epidemiology Training Program (FETP) in Tanzania

For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country. To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and ...
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Field Epidemiology Training Program in Malawi

The Frontline Field Epidemiology Training Program (Frontline FETP) enhances the capacity of HIV and AIDS surveillance and strengthens health systems. The program contributes to a sustainable response to HIV by training health professionals in basic field epidemiology that can support responsiveness to HIV surveillance needs. ...
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Global Health Security Agenda in Kenya

I-TECH Kenya’s Global Health Security Agenda (GHSA)-funded programs aim to advance the GHSA goals of preventing , detecting, and responding to disease threats to health security. For the past 8 years, I-TECH Kenya has had a cooperative agreement with US Centers for Disease Control and Prevention (CDC) to work closely ...
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Health Information Systems in Haiti

Electronic medical record (EMR) systems have the capacity to improve clinical decision making and quality of care at site level but can also be leveraged to make data-driven, population-level public health decisions. At the request of the MSPP ...
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Mozambique

Mozambique has one of the fastest growing economies in sub-Saharan Africa. Since the end of a 17-year civil war in 1992, leaders have worked to leverage country resources to build infrastructure and improve the quality of life for Mozambican citizens. Despite this promising growth, many public-sector programs are under-resourced, and much of the population still has limited access to quality health care.

With a population of 24 million, Mozambique has fewer than four physicians for every 100,000 inhabitants. More than 1.4 million people are estimated to be infected with HIV. The population also has high rates of tuberculosis and other respiratory diseases, malaria, and diarrheal diseases such as endemic cholera, all of which worsen the impact of HIV and AIDS when there is co-infection.

Drawing on expertise from its global network, including the University of Washington and the University of California, San Francisco, I-TECH began working in Mozambique in 2005. Since then, its technical support to the Ministry of Health (MISAU) has been focused on addressing the shortage of health care providers in the country through clinical training and curriculum revision and development. I-TECH also works to improve the quality of HIV prevention, care and treatment services, including antiretroviral treatment (ART) and voluntary medical male circumcision (VMMC). Ongoing monitoring and evaluation (M&E) activities, including technical assistance to MISAU, measure the effectiveness of health care programs and provide quality data for decision-making and program improvement.

Program Highlights

VMMC for HIV Prevention in Mozambique

I-TECH assists the Mozambique Ministry of Health (MISAU) to improve the quality, safety and performance of the VMMC sites through external quality assurance visits and mentoring of site staff. I-TECH has helped to design and conduct an evaluation of demand creation activities that were designed to motivate men age 15-49 ...
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