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HIV Positive Teens in Namibia Gather for Weekend of Fun and Support

HIV-positive teens gathered at B2Gold’s Otijikoto Mine Nature Reserve for a weekend of team-building exercises, support, and discussions about the importance of adherence to treatment.

All teens need consistent opportunities to build self-worth, explore their gifts, and feel the support of peers and adults. For teens who are HIV positive, the everyday pressures and fears of adolescence (rejection, bullying, gossip) can be amplified, making these opportunities especially important. In Namibia, adolescents and young people, especially girls and young women, continue to be disproportionately affected by HIV.

In response to these realities, in late August, a three-day Teen Club Retreat was organized by the Katutura Hospital Paediatrics Communicable Disease Clinic (PCDC) team, in collaboration with B2Gold, Champions for Life, and the International Training and Education Center for Health (I-TECH).

Fully funded by B2Gold and hosted at its Otjikoto Mine Nature Reserve, the retreat included 49 teens from the clinic (31 girls and 18 boys), who were joined by clinic doctors, nurses, and counselors as well as facilitators from Champions for Life, a psychosocial-spiritual program for children, adolescents, and young adults with the challenges of being infected or affected by HIV.

Through team exercises, game drives, inspiring films such as “Hacksaw Ridge” and “The Soul Surfer,” lectures, and small group sessions, the retreat aimed to:

  • strengthen bonds and networks;
  • create enthusiasm about the future;
  • develop self-respect;
  • instill the values of a healthy environment, teamwork, and responsibility; and
  • keep teens engaged in care.

“I enjoyed the movies, as they motivated me. I realized that I am not the only one facing challenges. When I courageously tackle my challenges, I remain strong even if I may not win them all.” – Teen Club member

I-TECH Namibia’s Sharon Mambo, an HIV Pediatric Expert Nurse, served as a chaperone and as one of the key organizers of the retreat. Mambo led a discussion on the importance of treatment adherence and viral load suppression. In addition, she tasked one of the teens with facilitating a discussion on “transitioning,” the process during which adolescents move from paediatric HIV care to more independent adult care. At Katutura hospital, this means accessing health services at an adult ART clinic.

Addressing the teens’ fears of waiting too long for services and meeting unfamiliar faces, Mambo assured the group that a specific health worker has been assigned to work with them and they would be “fast tracked.”

“It’s a matter of changing consultation rooms when you transition to the adult clinic,” said Mambo. “You will still meet the happy, friendly staff on the other side, so lay your worries aside.”

Teen Club members enjoyed a tour of the B2Gold facility, as well as nature and wildlife walks.

Highlights of the retreat also included a tour of the B2Gold mine and a game drive, where the kids were thrilled to see reserve animals including giraffes, springboks, wildebeests, and zebras at close range. “I got to see some of these animals for the first time,” said one teen. “I never knew that some animals could be as clever as human beings.”

The team from Champions for Life also held a full-day seminar titled “NICHE,” focused on self-image, identifying gifts and abilities, and creating one’s vision for the future. This was done through music, dance drama, group presentations, and poetry.

 “I enjoyed the team-building activities because we got to work as a group and had the opportunity to come up with ideas together as a team.” – Teen Club member

“A major success of this trip was the close bond, mutual respect, and trust that developed between the staff and adolescents during the three days,” says Mambo. “The shared experience and willingness of the staff to participate fully in all sessions of the program really lowered some of the barriers and discomfort that normally exist between teens and adults.”

Mambo has also been working with teen leaders from the group to support other facilities in Windhoek to establish their own Teen Clubs.

Caribbean Partnerships

I-TECH works with a wide variety of partners in the Caribbean and the United States. Partners include:

Regional Organizations partnering with I-TECH include:

Health Information Systems in Botswana

I-TECH began working with the Ministry of Health and Wellness (MOHW), Centers for Disease Control and Prevention (CDC), and other implementing partners in 2016 to develop and implement robust national health information systems (HIS) that enable greater efficiency and accountability and strategic use of information.

These HIS included:

  • Real-time Reporting System: Support a real-time SMS-based reporting system that utilizes a toll-free for rapid interpretation and remediation of service delivery challenges related to HIV testing services (HTS), HIV care & treatment, prevention of mother-to-child transmission of HIV (PMTCT), and tuberculosis (TB).
  • TB Health Information System: Develop and maintain the national TB patient level health information management system based on the OpenMRS platform to increase efficiency in identification, care, and treatment of TB patients.
  • HIV National Data Warehouse: Ensure the availability of strategic information to monitor progress toward reaching epidemic control, with particular focus on Treat All, linkages to care, and HIV clinical cascade for 90-90-90 care continuum.
  • DHIS2 for Monitoring and Evaluation (M&E): Provide aggregate data down to the facility level from HIV programs including antiretroviral therapy, PMTCT, and HTS for use by the national program and M&E staff to monitor program success.

I-TECH HIS programming in Botswana ended in 2021. To learn more about the program, please see the I-TECH Botswana Over the Years: Improving the Health of Communities in Botswana through Strong, Compassionate, and Equitable Health Systems brochure.

National-Level Quality Improvement in Botswana

I-TECH Botswana provided national-level technical assistance to improve HIV care and treatment, tuberculosis and HIV, and HIV testing and counselling programs through continuous quality improvement (QI) activities from 2016 to 2022.

I-TECH Botswana collaborated with the Ministry of Health and Wellness (MOHW) to help strengthen health systems to improve quality of HIV service delivery through the secondment of a QI technical advisor and by providing support for the development of continuous quality improvement activities at MOHW. I-TECH Botswana also developed and supported district- and facility-level QI teams in 11 PEPFAR districts, who come together for regular collaborative meetings to share successes and lessons learned and identify issues for support visits.

To learn more about I-TECH’s CQI activities in Botswana, please see the I-TECH Botswana Over the Years: Improving the Health of Communities in Botswana through Strong, Compassionate, and Equitable Health Systems brochure.

Laboratory CQI in Botswana

I-TECH Botswana worked to strengthen external quality assurances for HIV-related testing by conducting regular on-site proficiency testing support visits, conducted competency assessments and carried out continuous quality improvement (CQI) activities at 22 I-TECH-supported labs (45% of the labs in the country) between 2016 and 2021. I-TECH Botswana also provided technical assistance and support to the Botswana National Quality Assurance Lab (BNQAL).

To learn more about the I-TECH laboratory CQI program activities, please see the I-TECH Botswana Over the Years: Improving the Health of Communities in Botswana through Strong, Compassionate, and Equitable Health Systems brochure.

HIV Testing Services in Botswana

I-TECH Botswana conducted facility-based HIV testing at selected PEPFAR supported scale-up sites in seven PEPFAR districts between 2011 and 2020. Testing was carried out by Health Care Assistants and included expanded provider initiated testing, counseling, and partner notification. In addition, I-TECH Botswana conducted regular continuous quality improvement visits at I-TECH-supported facilities and provided support for linkage to care. Continue reading “HIV Testing Services in Botswana”

BID Initiative Partners with I-TECH to Track Vaccinations with Better Data

The following post was written in partnership with PATH‘s Better Immunization Data (BID) Initiative.

Patients at Usa River Health Center Tanzania. Photo courtesy of the BID Initiative.

The digital health landscape is rife with disconnected systems that make it challenging to aggregate information and improve the health of populations. After years of disjointed experiences, multiple organizations and governments have found that multi-platform, standardized, and connected information systems are critical to allow health care providers and decision makers access to timely and accurate information.

In this spirit, the International Training and Education Center for Health (I-TECH) joined forces with PATH’s BID Initiative to prevent disease by developing a platform to better trace vaccinations in low-resource settings. As part of its Global Health Security award, I-TECH is localizing the BID Initiative’s Zambia Electronic Immunisation Registry (ZEIR), an app powered by OpenSRP which is an open source mobile health platform, for use in Siaya County, Kenya.

I-TECH reached out to the BID Initiative last summer to hear more about BID’s lessons learned. The two teams began collaborating in earnest last December, leveraging the BID Initiative’s large scope in Zambia and Tanzania with I-TECH’s expertise in working with the OpenMRS platform.

Parallel projects with common goals

Reuben Mwanza (right) of PATH enters vaccination data into a tablet computer during a vaccination service at the Mahatma Gandhi Clinic in Livingstone, Zambia on October 17, 2016. Photo courtesy of the BID Initiative.

In Kenya, I-TECH has been tasked with building an electronic platform to capture immunizations when they happen. The aim of the project—conducted in partnership with the Kenyan Ministry of Health, the CDC Global Health Protection Division, and the CDC Global Immunization Division—is to improve immunization coverage. This is done by tracking and monitoring who is due for which vaccine, starting with population-level coverage within a single county, thus decreasing the chance of outbreaks of vaccine-preventable diseases.

Similarly, the BID Initiative has been working with the Ministry of Health and nurses in Tanzania and Zambia to develop an electronic immunization registry, among other data use tools, to ensure data becomes more accessible and useful to health workers. This, in turn, can help with decision making to prevent vaccine stockouts and enable follow-up with patients who have not returned for needed vaccines. BID’s learnings provided an opportune starting point for I-TECH’s work.

“ZEIR provides all of the workflows we need,” says Craig Appl, I-TECH Senior Technical Advisor for Health Informatics. “It already considers how users will interact with the application. It collects immunization data in a user-friendly manner, allowing health care workers to more accurately administer and record childhood immunizations and to more easily follow-up with children defaulting on their immunization schedule.”

Improvements through open source collaboration

I-TECH and BID have turned to Ona, a social enterprise based in Nairobi, Kenya, committed to fostering change by building information systems infrastructure. BID began working with Ona in January 2017 to adapt the OpenSRP system to Zambia’s national immunization program. This open source development process has been critical to the success of both teams and represents the collective knowledge of a community of developers known as the THRIVE Consortium.

“We simply couldn’t do this if OpenSRP and ZEIR software development was closed source,” says Appl. “The documentation, source code, and community wiki are all open for collaboration. Our team is able to actively track the improvements across the community, receive value where others have built features, and contribute where our projects align. Through open collaboration, we have many more individuals and teams working to improve health outcomes where we work.”

Laurie Werner, BID’s Global Director, agrees, pointing out that each new tool and iteration of the app is more adaptable and affordable than the last. “I-TECH is able to see solutions and propose solutions,” says Werner, “that’s the beauty of open source software.”

Matt Berg, CEO of Ona, views the OpenSRP app created for both projects as a customizable springboard that could potentially accommodate additional modules for antenatal care, malaria data, and maternal and child health.

“From our prior work with BID, we had this great starting point that another country or group could take and adapt and get up and running quickly,” says Berg.

Adaptability equals cost efficiency

Cost is a major driver for any implementation. Until now, it has been more cost efficient to build specific functionality on top of popular generalized information systems and tools, which decreases adaptability. Initial investments in the BID and I-TECH projects have allowed for both flexibility and specificity.

“We tend to focus too much [in the digital health field] on localization, and not on great design,” says Berg. “I think our success in Zambia and Kenya validates the importance of good design…and shows the potential of replicating in places for a fraction of what was originally invested.”

This collaborative environment and focus on adaptable design increases cost efficiency and allows the BID Initiative to fulfill the intention for its solutions to be used in multiple contexts.

“This is the core of the BID Initiative’s theory,” says Werner. “Effective electronic immunization registries have to be adapted to a country’s context and specific needs. Each time you do that, it becomes less and less of a financial investment for future countries.”

This blog post was supported by the Cooperative Agreement Number, U2GH001721, funded by the U.S. Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.