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, operational systems strengthening, and instructional design. I-TECH has worked in 12 Caribbean countries, including Jamaica, Trinidad and Tobago, Suriname, 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 and AIDS. As widespread viral suppression is improved, regional HIV incidence will decrease. Focus countries in 2015-16 are Jamaica, Suriname, and Trinidad and Tobago.
Continuous Quality Improvement:
I-TECH led the launch of two quality improvement (QI) collaboratives in the Caribbean region and continues to provide technical assistance and support. QI 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.
I-TECH provided leadership and technical assistance to launch the Jamaica Quality Improvement Collaborative (JaQIC) in 2013. JaQIC included 10 treatment sites across Jamaica and focused on increasing viral load and CD4 testing rates. All 10 initial JaQIC sites significantly increased lab monitoring for effective HIV care. CD4 testing increased from 35% to 58% in 9 months and viral load testing increased from 40% to 60% over the same period. In 2015, I-TECH will work with healthcare teams to utilize facility-level data on enrollment and retention in HIV care, and to implement strategies to improve rates of viral suppression among HIV-positive clients.
The Caribbean Regional Quality Improvement Collaborative (CaReQIC) was launched in 2014. This collaborative brought together healthcare teams from the Bahamas, Barbados, Jamaica, and Trinidad and Tobago. From August-December 2014, QI teams tested strategies to improve care, such as: reducing loss to follow-up, improving retention in care, and improving on-time pick-up of medication. In just five months, CaReQIC teams increased on-time pickup of antiretroviral medication and improved working relationships among clinics, pharmacies, and laboratories.
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 medical providers to provide high-quality clinical management of patients living with HIV. This professional certificate 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. The course targets mid-career professionals from the Caribbean region. 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. The course will be offered annually, and I-TECH will continue to offer targeted assistance to ensure quality and expand the regional uptake of the programme.
Reducing Stigma and Discrimination and Supporting Key Populations:
Stigma and discrimination continue to fuel the HIV/AIDS epidemic in the Caribbean region. In 2006, I-TECH collaborated with local partners to produce a series of discussion guides and short films with “trigger” scenarios aimed at sparking dialogue about stigma and discrimination in health care settings.
I-TECH’s ongoing work focuses on improving the quality of care for groups disproportionately affected by HIV infection, stigma, and discrimination, including men who have sex with men, transgender people, and sex workers. 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. I-TECH will provide mentoring and preceptorship opportunities for health care providers to improve skills and sensitivity in providing HIV diagnosis, care, and treatment services to key populations affected by HIV. 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.
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 to improve care and treatment for HIV/AIDS and TB in the Caribbean region. Most recently, I-TECH helped to finalize the HIV/STI Clinical Care and Treatment Guidelines for the Organization of Eastern Caribbean States (accessible from mobile devices) and supported the MOH Barbados to update their HIV care and treatment guidelines. In 2015 I-TECH will work with the Jamaica Ministry of Health to improve training for national adherence counsellors and to ensure that national HIV care and treatment guidelines effectively address the needs of key population groups disproportionately affected by HIV.
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