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I-TECH

Category: Key Populations

Expanding HIV Care and Treatment in Zimbabwe

Post categories: Cervical Cancer Differentiated Care Gender/Women & Girls Health Systems Strengthening HIV Care and Treatment Index Testing/Partner Notification Key Populations PrEP Stefan Wiktor Zimbabwe
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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.

Strengthening Health Service Delivery in India

Post categories: Ann Downer Best Practices Clinical Mentoring Differentiated Care HIV Care and Treatment India Key Populations Quality Improvement
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  • I-TECH India PL has successfully designed and implemented four differentiated ART service delivery models, including models for key population clients, in collaboration with other stakeholders in states of Maharashtra, Nagaland, Manipur and Mizoram to develop a proof of concept for the national level scale up;
  • Improved delivery of health services through onsite technical mentoring and supervison of health care staff in 9% of the ART centers of the country in the last three years;
  • Technically assisted successful implementation of newer initiatives such as treatment of TB through the ART centers, the “Treat All” initiative, and routine viral load monitoring at 48 ART centers; and
  • Conducted/participated in health service delivery assessments of facilities such as the national HIV/AIDS Centers of Excellence, ART Centers, Link ART Centers, and other care and support centers for the NACO.

HIV Positive Teens in Namibia Gather for Weekend of Fun and Support

Post categories: Gender/Women & Girls HIV Care and Treatment Key Populations Namibia Uncategorized
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HIV-positive teens gathered at B2Gold’s Otijikoto Mine Nature Reserve for a weekend of team-building exercises, support, and discussions about the importance of adherence to treatment.

All teens need consistent opportunities to build self-worth, explore their gifts, and feel the support of peers and adults. For teens who are HIV positive, the everyday pressures and fears of adolescence (rejection, bullying, gossip) can be amplified, making these opportunities especially important. In Namibia, adolescents and young people, especially girls and young women, continue to be disproportionately affected by HIV.

In response to these realities, in late August, a three-day Teen Club Retreat was organized by the Katutura Hospital Paediatrics Communicable Disease Clinic (PCDC) team, in collaboration with B2Gold, Champions for Life, and the International Training and Education Center for Health (I-TECH).

Fully funded by B2Gold and hosted at its Otjikoto Mine Nature Reserve, the retreat included 49 teens from the clinic (31 girls and 18 boys), who were joined by clinic doctors, nurses, and counselors as well as facilitators from Champions for Life, a psychosocial-spiritual program for children, adolescents, and young adults with the challenges of being infected or affected by HIV.

Through team exercises, game drives, inspiring films such as “Hacksaw Ridge” and “The Soul Surfer,” lectures, and small group sessions, the retreat aimed to:

  • strengthen bonds and networks;
  • create enthusiasm about the future;
  • develop self-respect;
  • instill the values of a healthy environment, teamwork, and responsibility; and
  • keep teens engaged in care.

“I enjoyed the movies, as they motivated me. I realized that I am not the only one facing challenges. When I courageously tackle my challenges, I remain strong even if I may not win them all.” – Teen Club member

I-TECH Namibia’s Sharon Mambo, an HIV Pediatric Expert Nurse, served as a chaperone and as one of the key organizers of the retreat. Mambo led a discussion on the importance of treatment adherence and viral load suppression. In addition, she tasked one of the teens with facilitating a discussion on “transitioning,” the process during which adolescents move from paediatric HIV care to more independent adult care. At Katutura hospital, this means accessing health services at an adult ART clinic.

Addressing the teens’ fears of waiting too long for services and meeting unfamiliar faces, Mambo assured the group that a specific health worker has been assigned to work with them and they would be “fast tracked.”

“It’s a matter of changing consultation rooms when you transition to the adult clinic,” said Mambo. “You will still meet the happy, friendly staff on the other side, so lay your worries aside.”

Teen Club members enjoyed a tour of the B2Gold facility, as well as nature and wildlife walks.

Highlights of the retreat also included a tour of the B2Gold mine and a game drive, where the kids were thrilled to see reserve animals including giraffes, springboks, wildebeests, and zebras at close range. “I got to see some of these animals for the first time,” said one teen. “I never knew that some animals could be as clever as human beings.”

The team from Champions for Life also held a full-day seminar titled “NICHE,” focused on self-image, identifying gifts and abilities, and creating one’s vision for the future. This was done through music, dance drama, group presentations, and poetry.

 “I enjoyed the team-building activities because we got to work as a group and had the opportunity to come up with ideas together as a team.” – Teen Club member

“A major success of this trip was the close bond, mutual respect, and trust that developed between the staff and adolescents during the three days,” says Mambo. “The shared experience and willingness of the staff to participate fully in all sessions of the program really lowered some of the barriers and discomfort that normally exist between teens and adults.”

Mambo has also been working with teen leaders from the group to support other facilities in Windhoek to establish their own Teen Clubs.

Differentiated HIV Service Delivery Models in Tanzania

Post categories: Ann Downer Differentiated Care Health Policy HIV Care and Treatment HIV Counseling and Testing Key Populations Quality Improvement Tanzania
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In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania.

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Improving HIV Care and Treatment across the Caribbean

Post categories: Best Practices Caribbean Clinical Mentoring Differentiated Care eLearning/Distance Learning HIV Care and Treatment Key Populations Quality Improvement
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I-TECH supports a variety of activities aimed at improving HIV care and treatment in the Caribbean region, such as on-site clinical mentoring, development of training curricula, and providing clinical support materials to improve care and treatment for HIV/AIDS in the Caribbean region.
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Improving HIV Care for Key Populations in the Caribbean

Post categories: Caribbean Differentiated Care Gender/Women & Girls HIV Care and Treatment Human Resources for Health Key Populations
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Key, at-risk populations in the region include men who have sex with men (MSM), bisexual men, transgender women, and sex workers. In Jamaica, HIV prevalence among MSM was estimated at 32.8%,1 as compared to an estimated prevalence of 1.8% in the general adult population in 2017.1 Among transgender women, the HIV prevalence was estimated between 25.2%2 – 52.9%3 and among female sex workers, HIV prevalence is estimated at 2%.1 Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV in communities most heavily burdened by HIV infection.

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Continuous Quality Improvement Collaborative in the Caribbean

Post categories: Best Practices Caribbean Clinical Mentoring Differentiated Care eLearning/Distance Learning HIV Care and Treatment Key Populations Lydia Chwastiak Quality Improvement Transition & Sustainability
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Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region, enabling multidisciplinary teams at health facilities to work toward a common goal of improving care and treatment for HIV-positive patients.
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Support for Pediatric HIV Care and Treatment in Namibia

Post categories: Gabrielle O'Malley HIV Care and Treatment Human Resources for Health Integrating Research and Practice Key Populations Namibia
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I-TECH works to strengthen the quality of pediatric HIV care and treatment in Namibia through the development of a “model” pediatric HIV clinic and supporting decentralization of quality pediatric care to other facilities. In collaboration with the Ministry of Health and Social Services, I-TECH developed an innovative, structured, culturally-relevant intervention to help guide health care workers and caregivers of HIV-positive children through the process of disclosing a child’s HIV-positive status to the child.

An evaluation of the disclosure program showed that it increased health care worker and caregiver confidence and communication in pediatric disclosure, as well as demonstrating improved viral suppression, adherence, and HIV knowledge among pediatric patients. I-TECH clinicians have also worked at the site level to support the development, implementation, and monitoring of strategies to improve adolescent HIV services and transition of adolescents from pediatric to adult care.