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COVID-19 Sentinel Surveillance in Malawi

Despite establishing  COVID-19 monitoring measures within the existing routine national surveillance system and significant efforts to conduct testing, contact tracing, and case investigations, Government of Malawi institutions at both the national and district levels faced many challenges in mounting an effective response to the COVID-19 pandemic. The existing COVID-19 surveillance system relied on retrospective data and it struggled to establish the magnitude of community transmission or identify emerging variants.

In June 2022, in collaboration with the Public Health Institute of Malawi and support from the US Centers for Disease Control and Prevention, I-TECH began sentinel surveillance monitoring of COVID-19 in seven sites. The COVID-19 sentinel surveillance system in Malawi was able to quickly detect changes in positivity rates and the emergence of variants. Read more about key findings and methods in I-TECH’s Sentinel Surveillance program brief.

Digitizing HIV Case Management to Support Patient-Centered Care in Jamaica

In collaboration with the Caribbean Training and Education Center for Health (C-TECH), Jamaica Ministry of Health and Wellness, JASL, and technical working group members, the Digital Initiatives Group at I-TECH (DIGI) is supporting the development and implementation of a mobile health client engagement tool in Jamaica. 

The tool facilitates communication between clients living with HIV and their healthcare providers in between their care visits, through a digital case management system and two-way text messaging services. The tool gives clients anytime access to a text-message-based health library and the ability to ping their care team for telemedicine services.  This digital health intervention seeks to strengthen the therapeutic alliance and enhance patient medication adherence.

This digital health intervention is made possible through funding and support from the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) via a sub-award granted to the Caribbean Training and Education Center for Health (C-TECH) and DIGI through the International Training and Education Center for Health (I-TECH). 

National HIV Psychosocial Services Expansion in Trinidad and Tobago

In 2019, I-TECH conducted an on-site assessment at Trinidad and Tobago’s largest HIV treatment site. The findings of that assessment led to the establishment of an integrated psychosocial program at this site that has yielded favorable results. This further inspired the need for expansion of this psychosocial approach to other HIV treatment and care sites.

In 2022, I-TECH collaborated with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH) to conduct a similar rapid assessment throughout the national treatment and care sites. The results reflected that there was a need for specialized staff to identify and treat common mental health and psychosocial concerns, as well as a standardized approach. Therefore, I-TECH is supporting the HACU to lead the expansion and strengthening of mental health and psychosocial (MHPS) service delivery for persons living with HIV at HIV treatment and care sites in Trinidad and Tobago. Goals include the standardization of psychosocial assessments to support the early identification of psychological distress, symptoms of co-morbid mental illness and psychosocial issues; as well as the standardization of the procedures for making interventions.

Activities include:

  • Developing a draft MHPS Protocol to include screening and intervention tools and psychosocial standard operating procedures (SOPs)
  • Establishing a standardized referral system
  • Training and supporting psychosocial team members in the use of the SOPs and all screening and assessment tools. Training will address areas of intimate partner violence, gender-based violence, and mental health challenges that are frequently encountered within the client population
  • Training and supporting psychosocial team members in data collection and reporting requirements
  • Training and capacity -building of psychosocial team members of the Psychosocial Coordination Unit being established by the HACU

eLearning Programs for Health Care Workers in Trinidad and Tobago

I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) of the Office of the Prime Minister, and other local organizations to make accessible learning and capacity-building opportunities for all cadres of health care workers.

  • Learning Management System (LMS): I-TECH and the University of Washington Department of Global Health’s eLearning Program (eDGH) collaborated to adapt an LMS for Trinidad and Tobago from the Jamaica LMS. The LMS for Trinidad and Tobago will support ongoing, standardized capacity-building of an increased number of health care providers in a cost-effective way. The LMS will also function as a monitoring and evaluation tool for training and skill building. I-TECH will support, develop, and adapt HIV course material and provide local administration and coordination support.
  • Key Populations Preceptorship Web Modules: I-TECH is currently developing self-paced, eLearning training modules to improve providers’ knowledge, skill, and comfort in providing respectful and gender-affirming care for gay and bisexual men, other men who have sex with men, people of transgender experience, and people engaging in sex work. This module will be an adaptation of the innovative in-person Key Population Preceptorship (KPP) Program for Clinicians and will be made accessible on the I-TECH/eDGH LMS that is being developed. The modules will incorporate video recordings featuring local community members, modeling of best practices, and show interactive exercises.
  • UW eDGH Online Courses: I-TECH, through eDGH and in collaboration with HACU and the NACC Office of the Prime Minister, provides online certification courses to health care providers in Trinidad and Tobago. Courses include: Clinical Management of HIV; Leadership and Management in Health; Fundamentals in Global Health Research; Policy Development and Advocacy for Global Health; Project Management in Global Health; Monitoring and Evaluation in Global Health; Fundamentals of Implementation Science; Wellbeing for Healthcare Professionals; and Global Mental Health.
  • Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported MRFTT, the HIV treatment site with the largest adult population in Trinidad and Tobago, to become an ECHO® hub site. The hub provides virtual clinical consultation support as well as brief didactic sessions for healthcare workers in Trinidad and Tobago on a range of medical/clinical and psychosocial topics, as well as those relevant to HIV care, treatment and support. Healthcare workers (HCWs) who have benefitted from the series not only include those from Trinidad and Tobago, but also HCWs from Haiti, Barbados, Bahamas, St. Vincent, Grenada, and Florida, USA.
  • Management of HIV Infections Diploma Course: In 2014, I-TECH partnered with the University of the West Indies (UWI) – St. Augustine campus in Trinidad and Tobago to develop a blended eLearning course that enables HCWs to provide high-quality clinical management of patients living with HIV. This ten-month 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. In recent years, I-TECH worked with the UWI to integrate extensive care and treatment content specifically focused on comprehensive care for key populations affected by HIV. The course is offered annually to healthcare workers from PEPFAR priority sites in the region. Course graduates include health care workers from Trinidad, Jamaica, Suriname, and Barbados.

Key Populations Preceptorship Program in Trinidad and Tobago

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. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider and a preceptorship trainer (PT), who is a member of a key population group, with the observation of a training facilitator. The PT takes on the role of a mock patient and uses a pre-scripted scenario as a guide to interact with the provider-in-training, giving feedback after each scenario. The KPP builds the provider’s capacity to provide comprehensive and nonjudgmental care to key population groups including gay and bisexual men, other men who have sex with men, persons of trans experience, and sex workers.

The KPP was adapted  based on Jamaica’s KPP for clinicians in 2016 for physicians in Trinidad. In 2017, it was adapted for nurses and was delivered in-person over the course of a two-day period. In response to COVID-19 protocols, the KPP for social workers, which was adapted in 2020, was delivered virtually.

To be both cost efficient and effective, the KPP for Clinicians will be made into web modules and be accessible on a Learning Management System (LMS) that is being developed as a collaborative between I-TECH and the University of Washington Department of Global Health’s eLearning Program (eDGH).

In late October 2021, the KPP lost one of its most vibrant PTs when Trinidad and Tobago activist and community leader, Brandy Rodriquez, passed away.

PLHIV Support in Trinidad and Tobago

I-TECH Trinidad and Tobago collaborates with  local organizations to implement programs focused on supporting the health and wellness of people living with HIV (PLHIV), including:

National HIV Helpline: The COVID-19 pandemic highlighted the need for virtual support and information on HIV testing, care, treatment, and support, and an increased need for guidance and psychosocial support for PLHIV. This prompted the need for a central line for communication and connection to the HIV/AIDS network. For World AIDS Day 2021, the National AIDS Coordinating Committee (NACC), Office of the Prime Minister, in collaboration with the HIV AIDS Coordinating Unit (HACU) of the Ministry of Health and I-TECH, launched the national HIV helpline. I-TECH provides technical assistance, training, and capacity building support to the HIV Helpline Coordinator and Active Listeners and is supporting efforts to raise the social media profile to increase caller volume.

The NACC website has a new dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable to support health and treatment for PLHIV.

 Patient Health and Literacy: In collaboration with the National AIDS Coordinating Committee (NACC), Office of the Prime Minister and a technical working group comprised of PLHIV and non-governmental organization (NGO) representatives, I-TECH developed content across nine topic areas aimed at improving PLHIV health and treatment literacy. The content was integrated into the inaugural NACC website in a dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable. Topic areas were focused on promoting and encouraging U=U with content titled: U and Your Dream Team; A healthy U; All about U and HIV; What U may get wrong; Your journey to U; U and your Partner; U in the future – HIV and Aging; U and your Baby – HIV and Pregnancy; HIV and COIVD-19 . The website is expected to facilitate wider access and reach to the PLHIV community and is the first content of its kind to provide consolidated, standardized and culturally appropriate material on HIV and AIDS treatment, care, and support in Trinidad and Tobago.

 

 

 

HIV Drug Resistance Surveillance in Malawi

The World Health Organization recommends countries routinely implement nationally representative HIV drug resistance (HIVDR) surveys among people infected with HIV to measure the level of drug resistance. The results of HIVDR surveys are a critical component of HIV programs and can guide changes to pediatric and adult antiretroviral therapy (ART) treatment regimens, including first- and second-line regimen decisions. I-TECH has been implementing HIVDR surveys in Malawi since 2016.

HIV DR Surveys Conducted Since 2016:

  • Infant HIVDR Survey: An HIVDR survey was conducted among infants aged 18 months and younger to determine the level of pediatric resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI), and protease inhibitors (PI) ART drugs through exposure during pregnancy and breastfeeding. A total of 232 eligible remnant dried blood spot (DBS) samples from nine early infant diagnosis (EID)-approved laboratories were used for the diagnosis of HIV in infants between June 2016 and December 2017.
  • Antenatal Care (ANC)/Pregnant Women HIVDR Survey: An HIVDR survey was conducted to measure resistance to NNRTI, NRTI and PI drugs among ANC clients who were found to have a recent HIV infection. A total of 45 DBS samples from women with recent HIV infection were collected as part of the 2016 HIV sentinel surveillance survey and were successfully amplified and sequenced.

The next step in HIV surveillance activity is monitoring HIVDR among pregnant women initiating dolutegravir (DTG)-based regimens, as well as the potential emergence of DTG resistance in infants via mother-to-child transmission. A study of DTG resistance is currently underway in Malawi and will determine the level of DTG resistance in adults who are unable to achieve viral load suppression and DTG resistance in children < 15 years old who are unable to achieve viral load suppression.

I-TECH Presents at 2023 IAS Conference on HIV Science

The 2023 IAS Conference on HIV Science logo. Read the full background and inspiration behind the 2023 IAS Logo. Image credit: IAS

The International AIDS Society (IAS) hosted the 12th IAS Conference on HIV Science on 23 – 26 July 2023 in Brisbane, Australia, and virtually. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.

This year, representatives from the International Training and Education Center for Health (I-TECH), I-TECH’s partner network organizations, and the Centers for Disease Control and Prevention (CDC) shared findings from I-TECH-supported programs in India, Malawi, and Zimbabwe. Read the ePoster abstracts below.

India:

Malawi:

Zimbabwe: