On June 11, Dr. Ann Downer, Executive Director of the International Training and Education Center for Health (I-TECH), received the University of Washington’s (UW) 2015 Award for Distinguished Contributions to Lifelong Learning.
“I am truly honored to be recognized by the university,” said Dr. Downer. “This award is a result of all the great work we do at I-TECH collectively. So I would like to share this acknowledgement with each and every one of my dedicated, persistent, and focused colleagues – and express my heartfelt thanks.”
The scope and scale of Dr. Downer’s contributions to continuing education at UW have been tremendous. In addition to founding I-TECH in 2002, she has been an Associate Professor in the UW Department of Global Health (DGH) since 2007 and in the Department of Health Services (DHS) for 15 years before that, where she established the Health Promotion and Health Education track.
Dr. Downer has also established two centers during her tenure at UW. She was the Executive Director of UW’s Center for Health Education and Research in DHS from 1988 to 2006 and incorporated parts of that center into I-TECH. She pioneered the use of e-learning in both departments and currently co-directs eDGH, the department’s e-learning initiative. Her Leadership and Management in Health online course attracted nearly 1,500 students in winter 2015 and is being offered twice this year due to demand.
“Her students and colleagues are in awe of her amazing ability to engage in the classroom and to cross-manage a global I-TECH team across two universities and dozens of global academic and professional educational systems,” said UW Provost and Executive Vice President Gerald J. Baldasty, before presenting Dr. Downer with her award.
At I-TECH, Dr. Downer has contributed to 229 curricula and other training resources in countries ranging from Angola to Zimbabwe. She conceptualized the adaptation and integration of classic educational frameworks into a clinical training and mentoring contexts, including instructional design, evaluation, adult learning theory, interactive teaching methods, leadership and management, and delivery of state-of-the-art content guided by subject matter experts. Her Everyday Leadership website is used throughout the world to integrate multicultural insights into training on leadership and management in a global health setting.
“Under Ann’s leadership,” concluded Dr. Baldasty, “I-TECH has played a central role in developing sustainable and effective health care systems in the poorest countries in the world.”
Participants, experts, developers, and trainers of the pilot training event that took place in October 2014 at the UFMTC at NMU.
The International Training and Education Center for Health (I-TECH) Ukraine, in close partnership with the Ukrainian Family Medicine Training Center (UFMTC) at Bogomolets National Medical University (NMU), and under the auspices of the Ministry of Health (MoH) of Ukraine, has published a new facilitator guide, Modern Technologies for the Organization of Prevention of HIV/AIDS Transmission and Drug Use: The Role of Family Medicine Based Primary Health Care.
“This publication is a product of creative collaboration by a united team of experts in the areas of family medicine and HIV,” said Olga Vysotska, Director of the UFMTC at NMU. “It is a unique gift to the faculty of all departments at medical schools and colleges all over Ukraine that train medical doctors and nurses.”
The MoH of Ukraine recommends the guide as a tutorial for clinical interns and doctors enrolled in in-service or continuous medical education training programs, as well as for faculty of the Ukrainian medical universities and colleges that train medical doctors and nurses as general practitioners and family doctors.
The goal of the course is to provide participants with skills and knowledge in the early diagnosis, care, social adaptation, treatment, and early prophylaxis of HIV, specifically in combination with drug addiction, tuberculosis, and hepatitis, as well as to form the proper attitudes necessary for family physicians in Ukraine to provide effective services to HIV patients, and patients of at-risk groups.
The guide is based on the results of a pilot training event that took place in October 2014 at the UFMTC at NMU. Dr. Chris Behrens from I-TECH facilitated the event, along with nine leading national experts from NMU, the Ukrainian Center of Diseases Control (UCDC), the Ivano-Frankivsk Oblast Clinical Center for Palliative Care, and the Kiev City AIDS Center.
“It is the first of its kind in Ukraine; no such publications existed prior to this one,” said Dr. Vysotska. “In addition to their work on the most up-to-date clinical content, we really valued the methodological support provided by I-TECH during the training process and development of the guide, as well as the application of contemporary tools and approaches to adult education.”
The key areas covered by the course are:
HIV/AIDS epidemiology, both globally and in Ukraine, including the roles of primary health care and family medicine in responding to the HIV/AIDS epidemic
Pathophysiology, pathogenesis, and stages of HIV infection, including key diagnostic methods
Palliative care for HIV/AIDS patients by family doctors.
Antiretroviral therapy (ART)
Diagnosis and management of co-infection (HIV/TB/virus, hepatitis B and C) in family practice
HIV in pregnant women, including prevention of mother-to-child transmission
Management of patients with HIV and drug addiction, including opiate substitution therapy (OST)
Post-contact prophylaxis, including universal precautions (international and Ukrainian standards)
“The process of development of this product by a multicultural, multiprofessional team of experts was vibrant, mutually enriching, and very satisfying,” said Anna Shapoval, Country Representative for I-TECH Ukraine. “We are most grateful to the Ministry of Health of Ukraine, HRSA of the US Department of HHS and CDC in Ukraine for their support and guidance through this project and look forward to new initiatives of this kind together with our national partners.”
This project 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.
I-TECH-supported HIV care and counseling in northern Ethiopia, in 2009. Photo courtesy of Julia Sherburne.
Although HIV patients in Ethiopia have greater access to antiretroviral therapy (ART) than they did a decade ago, ensuring that patients adhere to a full course of ART is still a major challenge. In response, in 2008, the International Training and Education Center for Health (I-TECH) launched a landmark HIV/AIDS Case Management program in several of the country’s regions where HIV prevalence was high.
This project was supported by the U.S. President’s Plan for AIDS Relief (PEPFAR), through the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).
The goals of the project are to help control the HIV epidemic in Ethiopia, minimize transmission of HIV, and help HIV patients lead healthy lives. The project actively targets and engages patients considered to be likely non-adherents by assessing clinical, nutritional, domestic, and economic indicators. Those at risk of non-adherence are transferred to I-TECH-trained case managers located within ART clinics.
“ART taken for life is a challenge, but missing a few pills can cause a rapid decline in the health of a patient suffering from HIV. A discontinued course of ART will create a resistant strain of HIV that is much more difficult to treat,” says Misti McDowell, former Country Director for I-TECH Ethiopia.
Poor adherence can also mean high risk of transmission in the patient’s community. The Case Management program helps mitigate that risk.
A new screening tool
I-TECH quickly realized that many patients attending adherence counseling sessions were suffering from mental health issues, including depression, anxiety, and substance abuse. It was also understood that many health workers did not have the competencies or skills to adequately engage in conversation with patients about their mental and emotional welfare.
I-TECH formulated a mental-health screening tool for all ART patients to better assist patients with ART adherence and mental health issues.
“Many HIV patients in Ethiopia become overwhelmed by depression, and commit suicide. The mental health component to our work has helped to prevent these outcomes, and manage mental health issues related to HIV diagnosis,” says Dr. Manuel Kassaye, I-TECH’s Care and Treatment Programs Director.
Shared experiences can save lives
In Ethiopia, there are currently only 42 working psychiatrists catering to the needs of an estimated population of 93 million. “The country is in need of a strategy to deliver mental health services to people,” says Dr. Manuel. I-TECH-trained adherence case managers, working in partnership with hospital clinicians, have directly helped to address mental health issues related to HIV in Ethiopia.
The majority of case managers selected and trained by I-TECH have themselves been diagnosed with HIV, ensuring empathic relationships with their patients.
“To be a good adherence support worker, I believe it is necessary to have HIV,” says Mulugojam Yilikal, who was trained as a support worker by I-TECH in 2008. “The case worker will have enough experience to empathize with the patient, to help guide them through their mental and emotional issues.”
She adds that patients feel secure and comfortable talking to people who also have HIV. “By opening up and talking freely with us, it benefits their mental health, and their adherence to taking their medication.”
Mulugojam’s brother tragically committed suicide in 2007, after struggling to come to terms with his HIV diagnosis. “I know that if this support and counseling service [had been] available to my brother, he would have been saved from killing himself,” she says. “If a patient confides to a support worker that they want to take their own life, they can be prevented [from doing so] through counseling.”
Genet Behre, 30, is married and has a 5-year-old son. She discovered her HIV status during a pregnancy check-up in 2009. She immediately started taking ART and reluctantly disclosed the news to her husband—who subsequently left her. Once disclosure is made, there usually follows a period of emotional and mental distress that often leads to household dysfunction. “It was a terrible time when I first found out,” says Genet. “I was very distressed, and came into conflict with family and friends.”
After being screened for mental health, Genet was offered counseling and medical treatment for her depression and anxiety. “After six months, I had stopped fighting with my family,” she says. “My life is now stable again, my home life is peaceful, and I have an income selling injera. The counseling and medical support I receive has helped me to live like ordinary people, and not fear for the future.”
After counseling, new hope
A peer support group has been set up by I-TECH, in which patients have a platform to confide in others and speak openly without fear of being judged. Here, people are encouraged to share personal experiences and coping strategies. The group focuses on helping patients cope with the stigma associated with HIV, and overcome any barriers to ART adherence, including social and economic problems.
Zenabe Teklu, 35, silently sits with her I-TECH trained case manager at Gondar Hospital. Although she barely speaks, she is evidently happy to be in the reassuring company of her mentor. Zenabe had two children who both tragically died within six months of being born. After the departure of her husband in 2007, her mental health started to deteriorate. Then, after developing physical sores in 2007, she was tested for HIV, and promptly joined I-TECH’s case support program. However, between 2007 and 2013, she continued to suffer strong symptoms of mental disturbance and suicidal tendencies.
In 2013, I-TECH introduced the mental health screening service at Gondar Hospital. Up to this point, Zenabe was mistakenly told that her depression and suicidal thoughts were symptoms of ART medication. Zenabe started receiving the correct medication and counseling shortly after hospital staff members had completed I-TECH training in mental health screening.
Zenabe, who currently works as a cotton weaver, is happy to have turned a huge corner in her life with the support of I-TECH: “My life is stable compared to how I was before. I no longer feel full of anger and depression. I have experienced a lot of trauma, but the support I get from my case managers helps me to live a normal life”.
The theme of this year’s conference is “Mobilizing Research for Global Health,” and featured speakers include Olusoji Adeyi, Director, Health, Nutrition and Population, World Bank; Paul Farmer, Co-Founder, Partners in Health; and Stephen Morrison, Vice President, Center for Strategic and International Studies.
Staff members from the International Training and Education Center for Health (I-TECH) will attend to present research on several topics:
Malawi
Quality improvement practices decrease adverse event rates in a surgical male circumcision program in Malawi Kohler PK, Chilongozi DA, Namate D, Barr BA, Msungama W, Phiri O, Tenthani L, Chalulu K, Perdue T, Barnhart S, Krieger JN
Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi Holman J, Muyaso M, Msiska G, Namate D, Wasili R
Haiti
An assessment of data quality in Haiti’s multi-site electronic medical record system Puttkammer N, Baseman JG, Devine EB, Hyppolite N, France G, Honoré JG, Matheson AI, Zeliadt S, Yuhas K, Sherr K, Cadet JR, G. Zamor, Barnhart S
Kenya
Evolution of the KenyaEMR training program: Towards efficiency and quality in scale-up Atelu C, Antilla J, Muthee V, Puttkammer N
About CUGH
Founded by leading North American university global health programs, CUGH aims to:
Define the field and discipline of global health;
Standardize required curricula and competencies for global health;
Define criteria and conditions for student and faculty field placements in host institutions;
Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.
CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.
From L to R: Igor Kuzin, Head of the National M&E Center at UCDC; Dr. Natalia Nizova, Director of UCDC; Matt Heffron, I-TECH Informatics Implementation Specialist; Anna Shapoval, I-TECH Ukraine Country Director; and Mykhailo Rabinchuk, PR and Event Manager at UCDC.
This landmark event consolidated cooperation between the International Education and Training Center for Health (I-TECH) — a DGH center — and UCDC. This partnership started in 2013 with the launch of the I-TECH-developed Clinical Assessment for Systems Strengthening (ClASS) tool within a project to build clinical and managerial capacity of HIV/AIDS services in Ukraine.
All parties expressed confidence that this MOU would help foster relationships and the development of possible collaborative projects in capacity building, monitoring and evaluation, and research aimed at quality improvement of health care services in Ukraine.
“I-TECH is very excited about this new development in our collaboration with UCDC,” said Anna Shapoval, Country Director of I-TECH Ukraine. “The MOU will help to formalize, fortify, and, hopefully, expand our partnership with the UCDC in the coming year and beyond — in particular in the area of health systems strengthening through development of human resources for health and supporting strategic information systems.”
Despite a decrease in the estimated annual HIV/AIDS incidence since 2001, HIV/AIDS remains a significant source of morbidity and mortality in Namibia.[1]
In 2008, the International Training and Education Center for Health (I-TECH) at the University of Washington (UW) was invited to conduct a rapid assessment of the University of Namibia (UNAM) master’s degree program in public health, with the goal of identifying ways to strengthen UNAM’s School of Nursing Science and Public Health. Dr. Virginia Gonzales, Senior Lecturer in the UW’s Department of Global Health and Senior Technical Specialist with I-TECH, led that study along with Lee Pyne-Mercier, UW Affiliate Instructor and former I-TECH Country Program Manager.
New award based on study findings
Recommendations included the suggestion that UNAM attract lecturers from outside the university to strengthen teaching in subjects such as research methods, epidemiology, and biostatistics. Based on these and other findings from the assessment, UNAM and UW/I-TECH submitted a joint application to the US Centers for Disease Control and Prevention (CDC) and were awarded a five-year cooperative agreement in 2010, with Dr. Ann Downer, Executive Director of I-TECH, serving as principal investigator.
The goal of the agreement was to improve and enhance the UNAM School of Nursing Science and Public Health. Objectives for this project included:
Plan for sustainability and transfer of resources to UNAM.
Strengthen professional development and faculty support at UNAM.
Strengthen content and delivery of the MPH program at UNAM.
Improve research capacity and output of lecturers and students at UNAM.
Strengthen institutional capacity and infrastructure for teaching public health at UNAM.
With this new award, I-TECH/UW and UNAM embarked upon a series of faculty partnerships. The group also began to explore how to separate the UNAM School of Nursing Science and Public Health into two programs, creating both a School of Nursing and a School of Public Health. The UNAM Senate issued a proclamation in 2014 that this would occur.
“The focus of curriculum [in the new School of Public Health] will be needs-driven,” says Dr. Käthe Hofnie Hoëbes, Associate Dean of the UNAM School of Nursing Science and Public Health, “and it will support new job growth in Namibia, as it promotes the creation of new cadres of public health specialization.”
From partnership comes growth
Retreat with UW and UNAM faculty, 2009
The CDC award has now come to an end; however, through this project, UW and UNAM created 16 strong faculty partnerships, all determined by the priorities of the UNAM faculty through a Public Health Working Group (PHWG).
“The benefit of working with the PHWG was one of the key takeaways from this project,” says Dr. Gonzales. “It ensured that UNAM was in the position to offer continual input, guide project activities, and truly lead the project.”
The faculty partnerships occurred in health policy, bioethics, nutrition, research, environmental health, and epidemiology, linking interested faculty at UW and UNAM. Through these relationships, UW faculty visited the main UNAM campus in Windhoek to facilitate workshops and review curriculum, and the UNAM faculty visited UW to observe classes and work on curriculum revision.
As a result of the trust among faculty at both universities, partnerships evolved in unexpected areas as well, including social work, nursing, medicine, pharmacy, teaching technologies, and with the Namibian Ministry of Health and Social Services’ (MOHSS) Primary Health Care Program.
“Working in partnership was a cross fertilizing, fulfilling and enriching exercise for all of us who were involved,” says Magdaleena Nghatanga, former Director of the Directorate of Primary Health Care, MOHSS. “Across the ocean we shared experiences and professional expertise. Utilizing technology such as Skype, Dropbox, and e-learning helped the team in developing and revising the curriculum, as well as in building and improving teaching at the university level. As a result, the Primary Health Care Program and curriculum were revised and updated, and the students were thrilled with the new lectures.”
Outcomes echo throughout the country
Leaders in Health–Namibia! working group, 2010
The collaboration also focused attention on teaching skills, and evaluations of faculty by students at UNAM improved considerably. In addition, UNAM graduates reported improved skills and knowledge in HIV/AIDS, nutrition, health policy, epidimiology, and research and increased knowledge of and interest in public health. Thesis supervisors at UNAM reported greater skills in supervision and student mentoring, and UNAM lecturers reported increased knowledge, skills, and confidence in teaching course materials.[2]
The workshops offered on learning theory and teaching skills were later scaled to all of UNAM, including remote campuses. Several faculty also participated in the Leaders in Health – Namibia! (LIH) program that was designed by I-TECH/UW in collaboration with the MOHSS in order to strengthen the health care delivery system in Namibia through effective mentoring of health leaders and managers. The UNAM faculty who participated in LIH later improved course content on leadership and management at UNAM by using material and content from LIH.
“This partnership has yielded benefits on many fronts,” says Dean Hofnie Hoëbes. “Lines of collaboration have been initiated with other world-class universities, and technical support was provided for the roadmap for establishing a standalone School of Public Health. This will benefit the nation as a whole by supporting public health care in the country and preparing a larger, professional workforce with specialized skills to address shortages in public health practitioners in Namibia.”
_________________
[1] Namibia Global Health Initiative, 2011-2015/16.
[2] University of Namibia and I-TECH Namibia. Evaluation of the Impact of the UNAM/I-TECH Collaboration upon the Master of Public Health Program, 2009-2012. 2013.
Students in Kilosa, Tanzania, try out the new tablet app.
In November 2014, the Tanzania Ministry of Health and Social Welfare (MOHSW) launched a program that allows practicing Clinical Assistants to upgrade to the level of Clinical Officer — the first MOHSW distance learning program in Tanzania to use tablet computers to deliver medical course material.
The International Training and Education Center for Health (I-TECH) and the University of Washington Department of Global Health’s e-learning group (eDGH) collaborated with the MOHSW on the In-Service Programme for Ordinary Diploma in Clinical Medicine, a blended distance learning program.
Credential upgrades expand the range of health care services that these practitioners can provide, including care and treatment of HIV and AIDS. They are also expected to have a positive impact on retention of healthcare workers. The use of tablet technology makes these upgrades more convenient and accessible.
“Working students need learning that will not take them off their workstations for relatively long periods of time,” says Dr. Fabian Mghanga, Principal of Mtwara Clinical Officers Training Center. “Being appropriate to their situation and context, this tablet e-learning [program] provides answers to their demands.”
Support for this project was provided through the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR) by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA). Programmatic oversight was provided by the U.S. Centers for Disease Control and Prevention (CDC) in Tanzania.
A comprehensive educational experience
Sixty-five students have enrolled in the inaugural cohort.
I-TECH has worked with the MOHSW since 2010 to redesign the Clinical Officer upgrading program to align with current clinical guidelines and competency-based training approaches. Sixty-five students, based at health facilities throughout the country, have enrolled in the inaugural cohort, at three Clinical Officer Training Centers based in Kilosa, Mafinga, and Mtwara. Scale-up to additional training centers is planned for next year.
The new two-year Clinical Officer upgrading program incorporates three modalities: self-paced learning using interactive e-learning materials on tablet computers, face-to-face classroom activities and instruction, and hands-on practical training in clinical settings.
Upon completion of all course requirements, students will earn a Diploma in Clinical Medicine after achieving a passing mark on the National Qualifying Examination.
An app for self-directed learning
Learning materials for the In-Service Programme for Ordinary Diploma in Clinical Medicine.
I-TECH and eDGH instructional designers and e-learning specialists collaborated with the MOHSW to design a digital textbook application for the Android platform. Students will complete e-learning modules using this app during self-study periods.
The app is designed to enhance self-directed learning by embedding interactive quizzes, anatomy tutorials, and other learning exercises into the course text. It also includes full-color photos and videos that are not available in the traditional residential training program.
MOHSW and training center representatives designed the course schedule and clinical rotation plan, provided clinical review, app testing, and assisted in the design of learning exercises.
“This modality of learning is quite amazing,” says Dr. Mghanga. “Our students can learn almost anything, wherever they are, at their own time and pace, yet feel they are no less [informed] than the on-campus students.”
Preparing for sustainability
In preparation for the official launch, I-TECH officially handed over all teaching and learning materials, including a donation of 73 tablet computers, to the Human Resource Development Department of the MOHSW. Tablets were distributed to students and faculty at each participating training institution.
I-TECH and the MOHSW conducted a faculty orientation to prepare principals and instructors at each training institution to successfully facilitate a distance learning program. In turn, training center faculty conducted student orientations at each site during the first face-to-face session.
In the coming weeks, the MOHSW and I-TECH will orient distance education mentors based near students’ homes, who will support students during practical rotations.
I-TECH will evaluate the first year of course implementation, and results will inform future scale-up and transition planning with the MOHSW to help ensure a sustainable program. To further support sustainability, the MOHSW has established a revolving fund to purchase tablets for future student cohorts.
Students of the graduate diploma program in the management of HIV infection have the opportunity to receive instruction from a hand-selected group of experts. Photo courtesy of Ben Depp.
In the Caribbean, an estimated 250,000 people are living with HIV (UNAIDS, 2013). To address this epidemic, health workers must have the latest information to guide the treatment and care of those living with HIV and AIDS. The University of the West Indies (UWI) St. Augustine campus in Trinidad and Tobago offers a one-year graduate diploma program in the management of HIV infection.
In partnership with UWI and the Caribbean HIVAIDS Regional Training Network (CHART), the International Training and Education Center for Health (I-TECH) and University of Washington Department of Global Health’s eLearning Program (eDGH) helped to transition the program to a blended learning platform — one that offers courses online as well as an in-person practicum.
Support for this transition was provided by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Department of Health and Human Services’ Health Resources and Services Administration (HRSA).
The program recently completed its first semester in this new format. With the expanded platform, students have the flexibility to access the course material “anytime and anywhere,” says Professor Zulaika Ali, Program Coordinator, “and it allows students to organize their training around their routine activities, which is important for mature working individuals.”
The conversion of courses online creates a one-of-a-kind program in the Caribbean, increasing access for mid-career health professionals working in the public sector, for non-governmental organizations (NGOs), and for commercial organizations. The program was designed for medical doctors, pharmacists and dentists, as well as nurses with bachelor degrees from any recognized university; registered nurses with a minimum of three years of experience; social workers; management staff from government ministries, private sector and NGOs; and tutors and lecturers in training institutions.
After a week-long online student orientation, students explore the following topics through online instruction and relevant resources, synchronous virtual classroom sessions, and collaborative activities and discussions. At the end of each semester, students complete an in-person exam. After completion of the online courses, students participate in an in-person practicum or dissertation. Courses include:
Research Methods and Design
HIV Epidemiology and Pathogenesis
Laboratory Techniques for Diagnosis of HIV
General Management of HIV/AIDS
HIV Co-Infection and Other Related Issues
HIV Health Systems
Sexual and Reproductive Health
In addition to the flexibility this part-time program offers, students also have the opportunity to receive instruction from a hand-selected group of experts from around the globe, including professors, health care workers from the Ministry of Health and NGOs, and professionals practicing in the region.
Transition from in-person to blended learning
In late 2013, I-TECH and eDGH were approached by UWI to convert the in-person diploma program into its second, blended rendition. The team started by piloting two courses online in the Moodle learning management system (LMS). From there, they obtained critical feedback for the remainder of the conversion.
Their research showed that students felt the course content was clear, appropriate, interesting, and applicable to their work and reported a preference for recorded lectures and relevant videos, anytime/anywhere access, and interactions with instructors and peers. Likewise, faculty enjoyed building new skills through online instruction.
“We conducted two in person, on-site faculty workshops, countless Skype calls, online trainings, and emails to build the capacity of faculty to develop and teach online,” says Elizabeth Scott, Senior E-Learning Developer with eDGH. “Working with faculty was a highly rewarding experience. They were motivated and dedicated, and they worked tirelessly side-by-side with us to create the best possible experience for students.”
As part of the project, the I-TECH/eDGH team also developed a commercial for the program (see below), as well as a number of introductory materials that can be used for a variety of online and blended learning programs. Among them are a general student orientation to help learners identify skills and characteristics necessary for success in online courses and an e-learning basics module for instructors.
“The informational materials developed for the program will help to improve the delivery of health care more generally,” says Dr. Ali.
A robust transition guidebook was also assembled, containing roles and expectations, best practices, online orientation materials, processes, budgeting templates, evaluation tools, job aids, and tasks and timelines for faculty and staff for ease of handover from year to year.
“The delivery of this program in the blended format will have a tremendous impact on the quality of care delivered to people infected with and affected by HIV,” says Dr. Ali. “The Faculty of Medical Sciences looks forward to welcoming regional and international students into the program. This new platform will surely enrich the learning experience of all involved.”
For nearly a decade, iSanté has allowed providers to share information among care team members and health professionals.
Over the past several years, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has invested heavily in health systems and clinical data analyses in low-income countries around the world, in its efforts to support the care and treatment of those affected by HIV and AIDS.
With the support of PEPFAR, through the Health Resources and Services Administration (HRSA), in 2005, the International Training and Education Center for Health (I-TECH), together with Haiti’s Ministère de la Santé Publique et de la Population (MSPP) and the U.S. Centers for Disease Control and Prevention (CDC), developed and implemented iSanté — an electronic medical record system to capture and report information on patients living with HIV and AIDS.
For nearly a decade, this system has allowed providers to document HIV patient care, look up patient care histories, and share information between care team members and health professionals.
The MSPP has been particularly concerned with patient adherence to antiretroviral therapy (ART) and treatment failure due to a number of factors, including the 2010 Haiti earthquake. While iSanté has gotten kudos in Haiti for storing and linking patient data, three recent papers, lead-authored by I-TECH Research and Evaluation Advisor Nancy Puttkammer, have illustrated the potential of using this data source to identify and help solve the challenges of adherence and patient attrition.
“Before and After the Earthquake: A Case Study of Attrition from the HIV Antiretroviral Therapy Program in Haiti,” published in Global Health Action in August 2014, compared attrition from the national HIV ART program at two large public-sector hospitals where I-TECH works. One site was less than 30 km from the epicenter of the devastating earthquake of January 2010, while the other site was outside of the area strongly affected by the earthquake. Surprisingly, the paper showed that attrition improved after the earthquake in the site closest to the epicenter. This finding underscores the resilience of patients and providers, and contributes evidence that it is possible to maintain continuity of HIV services even in the context of a complex humanitarian emergency.
“Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting,” published in PLOSOne in November 2014, shows that ART-dispensing data and other data contained in iSanté can be used to estimate patients’ adherence to their medications and predict the patients most likely to experience ART treatment failure in the future. Having an alert to signal patients with high risk of future treatment failure could help providers better target counseling and other adherence support.
“Patient Attrition from the HIV Antiretroviral Therapy Program at Two Hospitals in Haiti,” currently in press at the Pan American Journal of Public Health, examines ART attrition at the same two hospitals, during the period 2005-2011. The study found higher risk of attrition among patients who lived farther away from the hospital, who started on non-standard ART regimens, who did not receive ART adherence counseling before initiating ART, and who rapidly started ART following their enrollment in HIV care and treatment. The findings suggest opportunities for several quality improvement interventions at the two hospitals.
“This research has provided a valuable contribution in documenting health outcomes and encouraging improvement in the ART program in Haiti,” says Dr. Scott Barnhart, Professor of General Internal Medicine and Global Health at the University of Washington. “We are at the dawn of translating large investments in EMRs into useful data for improving the care of patients, as well as supporting important pub
The Training System Monitoring and Reporting Tool (TrainSMART), a web-based training data collection system designed by the International Training and Education Center for Health (I-TECH), was recently tapped by the U.S. Centers for Disease Control and Prevention (CDC) Ebola Emergency Operations Center. I-TECH is a center within the University of Washington’s Department of Global Health.
The CDC approached the TrainSMART team to create databases to track safe handling procedures and training of health care staff at non-Ebola health care facilities – that is, facilities not solely focused on Ebola but likely to receive infected patients when they first seek care. Databases were configured for Liberia and Sierra Leone in a matter of days using existing TrainSMART functions, which allow the system to be customized for local needs.
Trainings tracked by the CDC will include basic infection control, sprayer training, community-level (non-health care worker) training, and training of trainers, among others.
TrainSMART is an open-source, web-based software built on technologies appropriate to contexts with limited resources, expertise, and connectivity. The system allows users to accurately track data about health training programs, trainers, and trainees, to better evaluate training programs, plan new programs, and report activities to stakeholders.
The initial development of TrainSMART was funded by a grant administered by the U.S. Health Resources and Services Administration (HRSA) through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
