Training course materials developed and delivered to the Ministry of Health include:
- Basic ART is comprehensive ART course for physicians, pharmacists, and nurses. This 7-day training provides participants with comprehensive HIV and AIDS clinical management skills. All training materials are in English and are discipline specific. These curricula are updated periodically through a review mechanism by Ethiopian and US partner representatives.
- Additional information, education, and communication (IEC) resources for health care providers and patients have been developed and delivered to the MOH. These materials are in English and/or Amharic (e.g., guidelines on pain management, ART, and opportunistic infections).
- A curriculum on case management has been piloted and will be finalized and presented to the MOH.
- A curriculum on palliative care for use by the MOH and US partners has been finalized by I-TECH.
- A curriculum on national guidelines for pain management has been presented to all I-TECH Ethiopia's partners.
In Ethiopia, I-TECH delivers technical assistance that enhances antiretroviral treatment (ART) service delivery and develops human resources in HIV/AIDS care. I-TECH provides an array of technical, clinical, laboratory, and operational support to 38 health care sites in the three northern regions of Amhara, Afar, and Tigray. These regions account for nearly 50% of the national HIV burden. I-TECH implements, together with the Ministry of Health (MOH), eight different programs, both national and regional, to 31 hospitals and five health centers. More than 241 staff facilitate government-sanctioned activities, such as training, capacity building, clinical mentoring, and technical support. To promote this work, I-TECH Ethiopia acts in close partnership with the Regional Health Bureau (RHB) offices of the MOH.
Field-Based Mentoring Teams.
I-TECH currently has 11 field-based clinical mentoring teams providing technical assistance to its 38 I-TECH-supported sites. The field-based team model allows for expert staff-physician and nurse mentors and ART monitoring and evaluation (M&E) advisors to regularly visit clinical sites to provide intensive site support and clinical mentoring. In addition, I-TECH case managers, lab technicians, and data managers are regionally assigned to work with I-TECH health care facilities and staff at the RHBs. I-TECH provides technical assistance to RHB ART program implementation as well as supports initiatives to build the capacities of Gondar and Mekele universities and teaching hospitals to strengthen local health network systems.
ART Training. I-TECH plays a national leadership role in clinical training and curricula and guideline development. The national ART training curricula guidelines for physicians, nurses, and pharmacists at the hospital level were developed by I-TECH. Further, I-TECH continues to contribute to subsequent ART-related guidelines and protocols, such as those pertaining to sexually transmitted infections (STIs), prevention of mother-to-child transmission of HIV (PMTCT), palliative care, ART standard operating protocol, opportunistic infections, and clinical mentoring.
Case Management. Case management is a job duty within the ART multidisciplinary team that is dedicated to finding solutions for ART patients who are at risk for treatment adherence. The case manager provides a continuum of care that maximizes adherence to treatment and minimizes the number of patients lost to follow-up.
At the request of the Ethiopian Ministry of Health, I-TECH developed a national ART case management model to reduce the load on health care workers by shifting tasks to case managers-individuals, some of whom are persons living with HIV/AIDS, who, though they are not health care professionals, were hired and trained to:
- Monitor ART adherence.
- Link patients to community resources that ensure a continuum of care; where community resources are constrained, case managers mobilize the community to help meet the patients' needs, including clothing, rent, and food.
- Trace lost to follow-up clients on pre-ART and ART services and reduce the number of patients lost to follow-up.
- Provide health education and adherence counseling at hospitals and within the community.
Strengthening the Tiered Laboratory System. Effective laboratory services are essential for the prevention, diagnosis, and treatment monitoring of HIV/AIDS programs. Ethiopian laboratories can be a constraining factor for ART scale-up due to a lack of infrastructure and human resources.
I-TECH, partnering with the Ethiopian Health and Nutrition Research Institute (EHNRI) and RHBs, provides technical assistance to regional labs, 38 hospitals, and four health centers' HIV laboratories in the regions of Amhara, Tigray, and Afar. Twenty-five million people live in these three regions where there are approximately 404,000 people infected with HIV/AIDS and approximately 108,000 who need ART.
I-TECH's field-based laboratory support program provides mentoring and laboratory-associated trainings to laboratory and health care professionals. It also helps to upgrade or renovate laboratory set-ups by providing lab essentials, engaging in laboratory-related troubleshooting, offering technical assistance to ART referral linkages, and to the national ART scale-up program.
I-TECH also provides technical assistance to regional rollout programs, such as the external quality assessment and the national early infant diagnosis programs. Moreover, I-TECH, together with EHNRI, the Centers for Disease Control and Prevention (CDC), and Columbia University's International Center for AIDS Care and Treatment Programs (ICAP), assisted in the establishment of modern laboratories in Amhara and Tigray regions. These labs provide DNA-PCR testing for early detection of HIV infection in infants born to HIV-infected mothers, thus allowing significant pediatric health care benefits.
The training on HIV diagnosis contributed to improved access to HIV testing, which significantly increased the number of HIV-tested individuals and also contributed to an increased number of HIV-infected individuals who were able to be enrolled in HIV prevention and care and treatment in the three regions. For example, during June to December 2007—since the I-TECH field-based laboratory support program launched—13,871 HIV patients were enrolled in HIV programs and 10,893 started ART.
For the Future
Prevention with Positives (PWP). The PWP approach refers to interventions that help individuals infected with HIV to develop safer behaviors so that they can protect their partners and/or future children from getting HIV/AIDS and themselves from getting sicker.
Until recently, HIV prevention efforts have primarily focused on individuals not infected with HIV. A recent paradigm shift in prevention has led to more focused attention on prevention among HIV-infected individuals. It has been found that modifications to the risk behaviors of HIV-infected individuals are likely to have larger effects on slowing the spread of HIV than comparable changes in the risk behaviors of individuals not infected with HIV (King-Spooner S. 1999). "Positive prevention" efforts aim to prevent the spread of HIV to sex partners and infants born to HIV-infected mothers, as well as to protect the health of infected individuals. Helping people living with HIV to adopt safer behaviors is an important part of a comprehensive prevention approach.
I-TECH Ethiopia—together with Federal HAPCO and the CDC—is currently developing a PWP training curriculum for clinicians for the CDC Office of the US Global AIDS Coordinator (OGAC). It is envisioned that this curriculum will integrate HIV prevention to clinical care settings, standardize PWP approaches and materials, and thus enable health care providers to give focused prevention messages for people living with HIV/AIDS.
In close collaboration with I-TECH, Federal HAPCO is working on an overall PWP National Strategic Framework through a participatory process that includes community-based organizations of people living with HIV/AIDS (PLWHA), a national PWP program implementation plan is being developed for different contexts, such as health centers, hospitals, PLWHA organizations, and the community.
Next steps include:
- Finalizing the training materials and sharing them with partners.
- Organizing a pilot PWP training for health care providers.
- Organizing a national-level training of trainers (TOT) so that partners can roll out the training.
The material will be adapted and translated for case managers, outreach workers, PLWHA, and community-based organizations.