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Category: HIV and STI Prevention

E-Learning Increases Accessibility to HIV Diploma Program in the Caribbean

Post categories: Caribbean eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment
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HIV Diploma Program in the Caribbean

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.”


 

 

Haiti’s Electronic Medical Records System iSanté Proves Useful Tool to Improve Patient Outcomes

Post categories: Haiti Health Information Systems Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment
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For nearly a decade, iSanté has allowed providers to share information among care team members and health professionals.

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.
  • “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

UW Physician Delivers Keynote at Groundbreaking Ukrainian Conference

Post categories: Health Systems Strengthening HIV and STI Prevention Ukraine
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Dr. Joseph Merrill speaks at the Ukrainian National Conference.

Dr. Joseph Merrill (left) speaks through an interpreter at the Ukrainian National Conference.

On Sept. 25-26, Ukraine hosted “The Principles for the Management of Drugs, Psychotropic Substances and Its Precursors in General Practice Settings,” the first national conference of its kind. Initiated and organized by the International Renaissance Foundation (IRF) and other international and national stakeholders, including the International Training and Education Center for Health (I-TECH), the event brought together more than 300 experts, including general practitioners and family physicians, state officials, policy makers, infectious disease doctors, narcologists, psychiatrists, and palliative care providers.

The key goal of the conference was to educate primary health care providers on the application of controlled substances in key areas of their practice – such as medication assisted treatment (MAT), often referred to as opioid substitution therapy (OST); palliative care; and mental health – as well as initiate a dialogue about decentralization of these services through primary health centers (PHC) and coordination with specialized facilities and medical specialists.

Joseph Merrill, MD, MPH, an internal medicine physician and associate professor in the University of Washington’s Department of Medicine, delivered a keynote speech on OST in the practice of the family doctor. He also facilitated a day-long section on OST in partnership with local OST expert Vadim Klorfain, MD, from Poltava.

“Dr. Merrill’s contribution was greatly appreciated by the IRF and other conference organizers,” said Anna Shapoval, I-TECH Ukraine Project Director. “His successful participation in the conference seems to indicate a promising start to expanding I-TECH’s activities in this area in the future.”

Topics discussed included the basics of addiction and measuring success in addiction treatment; OST with methadone and buprenorphine; co-occurring medical and psychiatric conditions such as HIV infection, depression, tuberculosis, and viral hepatitis; and the advantages of integrating OST into the practice of family doctors.

Dr. Merrill says the last topic is particularly important to ensure increased access to care. “With the current siloed system, specialties have narrowly defined roles, which often has a negative impact on people with co-existing problems, such as HIV, mental health, and addiction,” says Dr. Merrill. “These individuals currently have to access multiple systems to get reasonable care.”

He also cites efforts to integrate HIV specialists into OST sites as a step in the right direction, as the HIV epidemic in Ukraine is driven in large part by injecting drug users and their sexual partners.

Dr. Merrill had the opportunity to visit an overburdened OST site at the City Clinical Hospital #5, next to the Kyiv City AIDS Center. “There were too many patients for the amount of staff, and there wasn’t any onsite counseling or psychosocial treatment when I was there,” he says. “We continue to have the same issues here in the U.S., where it is easier to implement medication than the treatment around the medication.”

To inform efforts to bring this care into family practice, Ukraine hopes to learn from the experiences we’ve had in the U.S., he says.

Recent health care reform, still under way in Ukraine, brought significant changes in legislation and regulations that now enable access to narcotic, psychotropic, and precursor substances at PHC facilities. The 2013-2020 National Drug Strategy of Ukraine envisions development of a humanistic model of drug policy, moving away from law-enforcement approaches to prevention and treatment, including broadening access to controlled substances – such as OST – to those patients in need.

“Ukraine is in a crisis situation, and that is both an obstacle to change and an opportunity for change,” says Dr. Merrill. “They are making a really strong effort to change their health care systems for the better, and they seem to really rally around each other and try to move forward in spite of the challenges they face.”

I-TECH and DGH Leadership Visit I-TECH Ethiopia, Speak at Outpatient Clinic Launch

Post categories: Ethiopia Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment
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Dancers prepare to perform at the University of Gondar's Diamond Jubilee.

Dancers prepare to perform at the University of Gondar’s Diamond Jubilee.

Earlier this month, a distinguished group from the University of Washington’s International Training and Education Center for Health (I-TECH) and Department of Global Health (DGH) visited Addis Ababa and Gondar, Ethiopia, for several days of discussion, workshops, events, and celebration — including the University of Gondar’s 60th anniversary Diamond Jubilee and the inauguration of the University of Gondar Comprehensive Outpatient Center.

Workshops and discussion at the I-TECH Ethiopia offices

I-TECH has had a presence in Ethiopia since 2003, and in that time, has become a guiding force in antiretroviral therapy service delivery and human resources for health, building the capacity of the Regional Health Bureaus (RHBs), universities, and health facilities; introducing innovative initiatives such as task sharing; activating effective monitoring and evaluation interventions; advocating for and implementing TB prevention programs, including MDR-TB; and building the capacity of health facilities and regional labs. The team acts in close partnership with the RHB offices of the Ministry of Health in Afar, Amhara, and Tigray and will be transitioning most of its programs to the RHBs in September 2014.

In advance of this transition, Dr. King Holmes, Chair of the DGH, and Dr. Ann Downer, I-TECH Executive Director, met with staff in Addis Ababa during a July 4 coffee ceremony. The meeting was an opportunity to say farewell to some incredibly valuable members of the I-TECH Ethiopia team who are leaving as projects are transitioned to the RHBs and discuss highlights of more than a decade of outstanding work in Ethiopia.

Bryan Verity, I-TECH HQ Director of Human Resources, was earlier on hand to facilitate a four-day career transition series with materials adopted from the UW career center. The series was co-facilitated by Tigist Dagne, Human Resources Manager at I-TECH Ethiopia.

“We had a great level of involvement by the staff, especially during the ‘assessing personal strengths’ workshop,” said Verity. During this exercise, a staff member shared experiences, while “listeners” tracked skills/strengths that the speaker employed during the experience.

The series also covered writing curriculum vitae (CV), conducting a job search, and strengthening interview skills. In addition, Verity presented a 60-minute training on personal financial management.

“It’s been a tremendous honor to work with such a dedicated and talented group of people,” said Dr. Downer. “I am so pleased that King and I had the opportunity to express our gratitude in person for the fine work this team has done to combat HIV/AIDS in Ethiopia. Everywhere we went in Ethiopia we heard about the positive reputation and valued contributions of our I-TECH Ethiopia team.”

Much to celebrate at the University of Gondar

Ethiopian Prime Minister Hailemariam Desalegn

Ethiopian Prime Minister Hailemariam Desalegn

Speaking alongside Ethiopian Prime Minister Hailemariam Desalegn and U.S. Ambassador to Ethiopia Patricia Haslach, Dr. Holmes delivered a keynote address at the inauguration of the Gondar Comprehensive Outpatient Center on July 6. The launch was bookended by the university’s graduation ceremony and its 60th anniversary Diamond Jubilee conference.

The center was a collaborative effort of I-TECH, UW, the University of Gondar, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) representatives in Ethiopia: the U.S. Centers for Disease Control and Prevention (CDC) and the Health Resource and Services Administration (HRSA).

The construction of this center was critical to address the significant burden and impact of disease in Ethiopia to comply with the Ethiopian Ministry of Health’s (MOH) mandate to increase the number of health care workers and to support the goal of PEPFAR to improve delivery of acute and preventive services related to HIV, TB, and malaria.

To meet these goals, the building can provide care to approximately 350,000 patients per year and serve as a training center for clinical outpatient care in TB, infectious disease, adult medicine, surgery, pediatrics, and emergency care. It houses a state-of-the-art TB facility.

Dr. Holmes visits his namesake CPD center.

Dr. Holmes visits his namesake CPD center.

I-TECH and the UW, through funding from PEPFAR, were instrumental in the conception and execution of the center, serving as consultants for both facility design and curriculum development. In this work, I-TECH helped to ensure that the facility allows for the integration of clinical care, teaching, and training. Dr. Scott Barnhart, an I-TECH principal investigator and a UW professor of medicine and global health, brought in Christine Kiefer, a Harborview Medical Center architect, to consult on the project.

In the days following the inauguration, Dr. Holmes and Dr. Downer led conference sessions on Innovations in Global Health and Effective Teaching, respectively.

Dr. Holmes also had the opportunity to visit a namesake training hall at the University of Gondar: the King Holmes Continuous Professional Development Center. “What a wonderful and humbling experience,” Dr. Holmes said of the visit. “And what a great way to end the trip.”

I-TECH Presents at AIDS 2014 in Melbourne

Post categories: Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Namibia
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On July 20-25, the biennial International AIDS Conference, AIDS 2014, will be held in Melbourne, Australia. Dr. Gabrielle O’Malley, I-TECH’s Director of Implementation Science, is heading down under to present two posters:

  • Evaluating the Effectiveness of Patient Education and Empowerment to Improve Patient-Provider Interactions at ART Clinics in Namibia, lead authored by Dr. Ellen MacLachlan, I-TECH Senior Research and Publications Advisor
  • “If I Take My Medicine, I Will Be Strong”: Evaluation of an Innovative Pediatric HIV Disclosure Intervention in Namibia, lead authored by Dr. O’Malley

For full versions of these posters, contact Anne Fox, Communications Officer, at foxanne@uw.edu.

As always, the conference is a tremendous opportunity for those working in the field of HIV, policy makers, civil society, and persons living with HIV to share perspectives and knowledge — with a focus on the diversity of response in the Asia Pacific region.

The theme of AIDS 2014 is “Stepping Up the Pace,” and speakers including former President Bill Clinton; new U.S. Global AIDS Coordinator Deborah Birx; and Dr. Tony Fauci, Director of the National Institute of Allergy and Infectious Disease, will examine scientific developments, human rights, and lessons learned in the effort to map our next steps in the fight against the pandemic.

Read more about the conference — as well as the 2012 Melbourne Declaration in support of human rights in the march toward an AIDS-free generation — at www.aids2014.org.

Ukrainian Medical University Delegation Visits I-TECH HQ

Post categories: Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Human Resources for Health Nursing/HCW Cadres Quality Improvement Ukraine
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From L to R: Dr. King Holmes, Dr. Olga Vystoska, and Dr. Ann Downer present the signed MOU.

On June 12 and 13, representatives from Ukraine’s Bogomolets National Medical University (NMU) visited I-TECH HQ offices at Harborview Medical Center and the University of Washington (UW) Department of Family Medicine.

NMU is the leading medical school in Ukraine, with more than 150 years of history. This visit formally launched the partnership between NMU and the UW’s I-TECH, Department of Global Health, School of Nursing, School of Medicine, and Family Medicine Department. Steps toward partnership began this spring, with a Memorandum of Understanding (MOU) signed by all parties.

The visit started off with a two-hour planning meeting, during which Dr. King Holmes, chair of the UW Department of Global Health (DGH), gave an introduction to the department. This was followed by presentations by Olga Vystoska, Director of the Ukrainian Family Medicine Training Center at NMU, and other UW department representatives, who explored possible areas of collaboration.  The meeting wrapped up with the exchange of signed originals of the MOU.

The Ukrainian delegation particularly appreciated the opportunity to meet I-TECH’s Executive Director, Dr. Ann Downer, and staff; learn about I-TECH’s activities; and tour the UW’s Family Medicine Clinic and Harborview Madison Clinic, which provides medical care and social services for persons living with HIV/AIDS. The group was especially impressed by a tour of the UW Institute for Simulation and Interprofessional Studies (ISIS) lab at Harborview, and Dr. Vystoska expressed interest in starting a similar lab at NMU.

The delegation also had a working meeting with Dr. Chris Behrens to discuss next steps in developing an HIV in-service training curriculum for family practitioners that I-TECH plans to pilot in Kyiv in October with Dr. Behrens’s co-facilitation.

The new Project Director of I-TECH Ukraine, Anna Shapoval, was a driving force behind this collaboration and visit.

“The I-TECH Ukraine team is excited to promote the HIV response and health care reform in Ukraine,” said Ms. Shapoval, who added that she was very pleased with how the meetings went. “We look forward to growing I-TECH’s presence in country, focusing on the most urgent issues of streamlining HIV into primary health care, advancing quality assurance and quality improvement models — as continuation of its unique experience with CLASS.”

Other potential areas of collaboration include joint research activities, publications, and library exchanges; the exchange of faculty members and students for study, teaching, and research; and joint hosting of distance education broadcasts and online courses and seminars.

Julie Stein, Technical Officer for Training Development on the I-TECH Ukraine team, expressed enthusiasm as well. “This visit was incredibly fruitful,” said Ms. Stein. “The meetings and tours generated a lot of excitement from everyone about possible future collaboration.”

Launch of HIV Programs in Zimbabwe Hits the Right Note

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

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

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

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

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

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

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

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

Five-Year Cooperative Agreement with CDC to Train and Mentor Zimbabwe Medical Staff

Post categories: eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Zimbabwe
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A new award to I-TECH seeks to fight the spread of HIV in Zimbabwe by rapidly scaling up training and mentoring of the country’s medical staff.