Spotlight: Clinical Mentoring at HUEH
HUEH is the largest hospital in Haiti and treats over 169,000 patients a year. The complexity of the institution and the disintegration of its infrastructure after years of neglect and underfunding present challenges to launching, scaling-up, and assuring quality of HIV care and treatment programs. In 2005, I-TECH began placing clinical mentors at HUEH to provide training as well as improve systems affecting quality of HIV care and patient access to services. There are currently eight I-TECH clinical mentors embedded at HUEH. The clinical mentors hold weekly staff meetings to examine barriers to quality care. In these meetings, the team identifies indicators, brainstorms solutions to improve care processes, and designs and plans for implementation of Plan-Do-Study-Act (PDSA) cycles. Through the implementation of these simple quality improvement cycles, I-TECH mentors have been a catalyst for positive change. Their most recent success was in March 2008, when the clinical mentors identified the need for systematic evaluation of patients' adherence to ART. They tested an existing adherence evaluation tool and then determined appropriate roles related to the use of the tool. Finally, the mentors trained HUEH staff to use the adherence evaluation tool. Three months later, there was an increase of 36% of HUEH's ART patients who had a documented evaluation of their adherence to ART in their medical records.
Training course materials developed and delivered, in collaboration with the MSPP, include:
- HIV/AIDS Stigma and Discrimination in Caribbean Health Care Settings: Trigger Scenarios (Stigmatisation et discrimination liées au VIH/SIDA dans les dispensaires de soins de santé des Caraïbes: scenarios à méditer). Facilitator guide in French and video scenarios in Haitian Creole.
- Training Trigger Tapes for the Therapeutic Management of PLWHA (Scénarios pour la Formation de la Prise en Charge Thérapeutique des PVVIH). Facilitator guide in French and video scenarios in Haitian Creole.
- National Care and Treatment of People Living with HIV Curriculum (Prise en charge thérapeutique complète des personnes vivant avec le VIH). Facilitator and participant manuals in French.
- The Chance (Chans). Video in Creole (subtitles in English) with accompanying discussion guides for general public and clinicians.
Since 2004, I-TECH has been working in close collaboration with the Ministère de la Santé Publique et de la Population (MSPP) and the Centers for Disease Control and Prevention Global AIDS Program (CDC GAP) in Haiti to strengthen the ability of the country’s health systems to respond to the national HIV and AIDS epidemic. I-TECH’s programs in Haiti are focused on strengthening HIV and AIDS-related services by improving service delivery at medical and laboratory facilities; training and task-shifting to support human resources for health; and developing integrated health information systems.
Curriculum development and training in the HIV/AIDS field. In collaboration with the MSPP, I-TECH developed and iteratively revises and updates a national 16-module in-service training curriculum on comprehensive HIV/AIDS care and treatment. The curriculum was validated in 2007 by MSPP as Haiti's national standardized training on HIV/AIDS. I-TECH works in partnership with the local training organization Institut Haïtien de Santé Communautaire (INHSAC) to develop and implement training for health care workers. INHSAC has trained more than 1,100 physicians, nurses, psychologists, social workers, laboratory technicians, pharmacists, and auxiliary health staff in a variety of areas, including prevention of mother-to-child transmission of HIV (PMTCT), voluntary counseling and testing (VCT) and rapid testing, and comprehensive psychosocial support for people living with HIV/AIDS (PLWHA). I-TECH also developed with the MSPP pre-service training materials for the National Nursing School's (Ecoles Nationales d'Infirmières [ENI]) curriculum for HIV/AIDS. Faculty mentors conduct follow-up visits to support faculty members to incorporate the new teaching methods and HIV content into their courses. I-TECH is currently engaged in a curriculum reform process with the faculty of the national schools of laboratory technology, medicine, and social work to strengthen their respective pre-service training programs.
Development of a Standardized Training Package for Service Providers Working with Orphaned and Vulnerable Children (OVC).
Based on the results of a training needs assessment for community-based workers who provide care and support services for OVC, I-TECH and the François-Xavier Bagnoud Center (FXB) are collaborating with the MSPP, the Ministry of Social Affairs and Labor, and other stakeholders to develop a national reference manual on the provision of services for OVC. The manual serves to equip OVC workers with competency-based skills to provide basic health care, education, and psychosocial support. Furthermore, the manual will enable OVC community-service providers to strengthen linkages between different OVC interventions, and enhance collaboration and partnerships among stakeholders involved in implementing OVC initiatives.
Extension of Antiretroviral Therapy (ART) to Clinics and Hospitals.
I-TECH is providing eight full-time clinical mentors to Hôpital de l'Université d'état d'Haiti (HUEH), Haiti's largest hospital, in support of increasing ART services. In addition, I-TECH has provided operational support, equipment, and supplies to establish the HUEH HIV clinical care and management unit and to launch HIV services within the HUEH pediatric unit. Beyond HUEH, I-TECH supports ART and palliative care services to thousands of pediatric and adult patients through partnerships with Hôpital Nos Petits Frères et Soeurs in Port-au-Prince and the Hôpital Universitaire Justinien Family Practice Center in Cap Haïtien.
Strengthening and Scaling-up iSanté, the National Electronic Medical Record System.
At the request of the MSPP and the Centers for Disease Control and Prevention Global AIDS Program in Haiti (CDC GAP), I-TECH began developing iSanté in 2005. iSanté supports health care workers and clinics to manage and utilize patient data, and facilitates timely and accurate reporting on national HIV service delivery and surveillance. There are 41 sites employing iSanté with a total of more than 24,500 patient records entered. Eighteen iSanté sites have local servers, which eliminates reliance on slow Internet connections and allows automatic replication of patient data to a central patient data repository. I-TECH's iSanté team provides training to data management personnel through workshop-based and onsite training, supports configuration and installation of local servers, makes iterative design improvements to the system based on user feedback and evolving needs, and provides ongoing hardware and software maintenance support to iSanté sites. In partnership with the CDC's Regional Information Officers (RIOs), Tulane University Technical Assistance Program (UTAP) and others, I-TECH reinforces data quality and data completeness through system modifications, training and onsite technical assistance. I-TECH has developed national standardized training modules on data management and the iSanté system.
Developing and Implementing a National Laboratory Information System.
At the request of the MSPP and CDC GAP, I-TECH began development and planning for the implementation of a laboratory information system (LIS) in 2007. Haiti's National Public Health Laboratory (LNSP), in close partnership with I-TECH, established the National LIS Working Group (LISWG), which has made rapid progress in developing, pilot testing, printing, and disseminating nationally standardized, paper-based tools for laboratory information management. Such tools are needed to support best practices and to improve the efficiency of information management at sites, many of which use improvised, hand-written lab order slips, lab results forms, results registers, and logs. Importantly, these paper tools lay the foundation for the development and roll-out of an electronic LIS, both by standardizing data management processes among clinical labs prior to adoption of an electronic system, and by informing the adaptation of OpenELIS to match these laboratory workflows. I-TECH is supporting training on the use of the paper-based data management tools, and simultaneously collaborating with the LISWG to produce a beta version of the Haiti-adapted OpenELIS software.