I-TECH has provided technical support and capacity building to Ministries of Health and local organizations in the Caribbean since 2003. Technical assistance has focused on continuous quality improvement, clinical mentoring of physicians and nurses, health systems strengthening, distance learning, and instructional design. I-TECH has worked in many Caribbean countries, including Jamaica, Trinidad and Tobago, Suriname, Guyana, Barbados, the Bahamas, Belize, St. Lucia, St. Vincent and the Grenadines, St. Kitts and Nevis, Dominica, Grenada and Antigua and Barbuda.
I-TECH’s current work in the Caribbean region supports activities to strengthen the HIV continuum of care, improving HIV diagnosis and treatment adherence with the goal of viral suppression among people living with HIV. I-TECH also implements programs that improve access and quality of care for key population groups affected by HIV, such as gay and bisexual men, other men who have sex with men, transgender women and sex workers. As widespread viral suppression is improved, regional HIV incidence will decrease. In 2016-17 the I-TECH Caribbean program will be working in Jamaica, Trinidad and Tobago, Guyana, Suriname and Barbados.
Continuous Quality Improvement:
Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region and continues to provide technical assistance and support. Quality Improvement collaboratives enable multidisciplinary teams based at health facilities to work together toward a common goal of improving care and treatment for patients with HIV and AIDS. Facility-based QI teams meet as a collective for periodic learning sessions where they are taught QI methods, share their results, and learn strategies from the other teams. Between learning sessions, teams receive coaching from local, regional and international experts, participate in webinars, implement Plan-Do-Study-Act cycles, and track data. Data monitoring and utilization underpin all QI activities.
The Caribbean Regional Quality Improvement Collaborative (CaReQIC) was launched in 2014. In 2015-2016, the collaborative brought together healthcare teams from Barbados, Jamaica, Suriname and Trinidad and Tobago to test change concepts aimed at improving four drivers of virologic suppression: returning patients to care, retaining patients in care, adherence to medication, and laboratory monitoring. A critical addition to CaReQIC in 2015 was support for patient engagement in quality improvement. I-TECH has encouraged and facilitated healthcare workers and patients working together to identify solutions to the difficult challenges they face. Initially, I-TECH recruited patients to attend learning sessions and serve as advisors to teams. Over time, these trusted advisors have joined the QI teams at many facilities and others have been recruited directly by their facility. Currently, 13 of the 17 I-TECH supported QI teams include patient members. In 2016-17, CaReQIC will focus on testing differentiated models of care to improve retention in care and adherence to medication and thus increase virologic suppression. I-TECH will continue to expand the integration of patients on QI teams and build local capacity for sustainability of national quality improvement initiatives.
Reducing Stigma and Discrimination and Supporting Key Populations:
Stigma and discrimination continue to fuel the HIV/AIDS epidemic in the Caribbean region. A 2015 study found that HIV prevalence among men who have sex with men in Jamaica was 31.4%, compared to an estimated prevalence of 1.8% in the general adult population. Among transgender people, the HIV prevalence was estimated at 52.9% and among female sex workers, HIV prevalence is estimated at 4.1%. Stigma and discrimination in health care settings exacerbates health disparities among key population groups due to delays in diagnosis, care-seeking, and treatment.
To address this challenge in HIV care and treatment settings, I-TECH designed and launched Improving HIV Care for Key Populations in the Caribbean, a novel preceptorship programme aimed at building clinicians’ capacity to provide nonjudgmental, high-quality comprehensive HIV care to key populations. The training occurs in a simulated clinic setting, using targeted scenarios portrayed by skilled key population patient-trainers in collaboration with an experienced clinical facilitator. Clinicians practice taking a comprehensive sexual history, performing a proper ano-genital examination with appropriate site-specific STD screening, as well as practicing individual risk assessment and risk reduction counselling. The clinician is also afforded the opportunity to have a frank and open discussion with the key population patient-trainer about the obstacles that prevent them from accessing care, the healthcare issues they face, their sexual orientation and gender identity, sexual practices, mental health issues, gender-based violence and substance abuse. Reducing stigma and discrimination towards vulnerable groups in health care settings will positively impact enrollment in care, retention in care and treatment, and viral suppression of HIV in communities most heavily burdened by HIV infection. In 2016, the program trained 20 clinicians from the highest volume HIV care and treatment clinics in Jamaica and Trinidad. In 2017, I-TECH will continue to train clinicians and will also adapt the training for nurses in the region.
Online Diploma Course in the Management of HIV Infection:
I-TECH partnered with the University of the West Indies (UWI) – St. Augustine campus in Trinidad and Tobago to develop a blended e-learning course that enables healthcare workers to provide high-quality clinical management of patients living with HIV. This post-graduate diploma program is delivered through a series of online, self-paced courses taught by UWI faculty and is augmented by synchronous virtual classroom discussions and hands-on clinical practicum experiences. I-TECH has provided technical assistance to UWI faculty and staff, including capacity building activities focused on online teaching skills, e-learning coordination, and e-learning development. In 2015-16 I-TECH worked with UWI to integrate extensive care and treatment content specifically focused on comprehensive care for key populations affected by HIV. The course is offered annually, and I-TECH will continue to offer targeted assistance to ensure ongoing quality and to expand the regional uptake of the programme.
Improving HIV Care and Treatment: In collaboration with local and international partners, I-TECH has supported many activities aimed at improving HIV/AIDS and HIV/TB care and treatment in the Caribbean region. I-TECH has provided on-the-job mentoring to clinicians, developed clinical guidelines, produced training curricula, and created clinical support materials such as job aides to improve care and treatment for HIV/AIDS and TB in the Caribbean region. In 2016-17 I-TECH will provide clinical mentoring to healthcare workers in PEPFAR supported facilities in Jamaica, Trinidad and Barbados as well as targeted onsite or distance training related to the comprehensive care of people living with HIV. Additionally, I-TECH will collaborate with the Jamaica Ministry of Health to develop and roll out standardized national curricula related to HIV Case Management and Adherence Counseling.
1. Figueroa JP, Cooper CJ, Edwards JK, Byfield L, Eastman S, Hobbs MM, et al. (2015) Understanding the High Prevalence of HIV and Other Sexually Transmitted Infections among Socio-Economically Vulnerable Men Who Have Sex with Men in Jamaica. PLoS ONE 10(2): e0117686. doi:10.1371/journal.pone.0117686
2. UNAIDS. 2013. HIV and AIDS Estimates in Jamaica. Retrieved from:http://www.unaids.org/en/regionscountries/countries/jamaica
3. Figueroa, JP, Bailey A. (2015) A framework for sexual decision-making among female sex workers in Jamaica. Archives of Sexual Behavior: 2015 Apr 3. doi:10.1007/s10508-014-0449-1