Workshop participants were particularly interested in team problem solving.
This month, the International Training and Education Center for Health (I-TECH), working with the Ministry of Health (MOH) in Ukraine, sensitized heads and other managers of HIV/AIDS clinics and centers on how to implement continuous quality improvement (CQI) by applying an approach known as the Clinical Assessment for Systems Strengthening, or ClASS, model.
The MOH’s Center of Public Health and I-TECH Ukraine held a two-day ClASS sensitization workshop for HIV clinicians from seven regions of Ukraine that are new to ClASS. The ClASS approach addresses CQI and identifies areas for improvement and assessment as well as detailed follow-up actions.
Presentation of the model was supplemented by reports and success stories shared by teams from Cherkasy, Kyiv, Chernivtsi Oblast, and Kryviy Rig City AIDS Centers, along with other sites that participated in ClASS between 2014 and 2016. The exchange of this experience proved effective in ensuring buy-in from new regions and raised their interest in and excitement about the model and its potential impact.
I-TECH’s Iryna Yuryeva presents the ClASS model to the workshop.
I-TECH Ukraine Program Director Iryna Yuryeva, who presented the ClASS model, said she was encouraged by the response to the workshop. Perceptions among the new audience shifted “amazingly quickly” she said, “from extreme concern, anxiety, and belief that almost nothing can and should be improved at their health care facilities to sincere and passionate interest and impatient anticipation of ClASS visits in the coming months.”
Participants expressed keen interest in the ClASS approach, which emphasizes team problem-solving and joint identification of ways to improve assessment, develop operational and strategic plans, and seek technical assistance when needed to address gaps. In addition, ClASS could also be helpful for health care facilities preparing for formal accreditation by addressing assessment-based practical recommendations.
The “real-life cases and improvements” reported by the participating clinicians, and their ability to exchange experiences and proactively tackle main areas for improvement, were highlights of the training. This is all part of the ClASS methodology, a process that I-TECH’s Yurveya says demonstrates a “natural and evolutionary continuous quality improvement.”
I-TECH Ukraine will continue to support the MOH by promoting the ClASS approach as part of the CQI process in Ukraine, in particular by conducting additional ClASS trainings in seven new regions in 2017.
THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.
Mentor Dailes Nsofwa from CDC Zambia presents a certificate of completion to Kenneth Ngoma from Kasama General Hospital Laboratory.
At a December ceremony in Lusaka, Zambia, a group of health laboratory supervisors completed the Certificate Program in Laboratory Leadership and Management, a blended-learning course developed and conducted by faculty and staff the International Training and Education Center for Health (I-TECH) at the University of Washington. The program was implemented in partnership with the American International Health Alliance (AIHA), the U.S. Centers for Disease Control and Prevention, and the Zambian Ministry of Health (MOH).
Effective leadership and management in laboratory settings are critical to providing timely detection, surveillance, and response to infectious diseases. Strengthening these skills has a direct, positive effect on quality of care and the capacity of low-resource countries to reach epidemic control.
The 16 managers, recruited from MOH public health laboratories, participated in nine months of online learning, face-to-face meetings, and mentorship. Courses covered leadership and management skills, and also topics related to implementing diagnostic technology, managing and communicating laboratory information. Participants also designed and implemented a capstone project designed to improve their laboratories’ operations. Online modules were developed with support from the UW Department of Global Health’s E-Learning Program (eDGH).
This certificate program is intended for middle- to senior-level clinical and public health laboratory leaders such as managers and directors, medical technologists, health scientists, and physician scientists interested in improving medical laboratory operations and evidence-based health policymaking. The blended-learning format allows participants to remain employed during their studies.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
A patient-trainer (left) performs a scenario with a clinician in Trinidad.
For many communities in the Caribbean Region, barriers to high-quality HIV treatment and care often arise before a client crosses the clinician’s threshold.
“When [key populations] access health care – and when we say key populations, we mean MSM [men who have sex with men], sex workers, transgender people – they are immediately discriminated against,” says Kenyatta Barnaby, a Key Populations (KP) Advisor working with the International Training and Education Center for Health (I-TECH) in Jamaica.
“They can’t relate to the clinician or anyone in their surroundings,” continues Barnaby, “and before they even get to [see] the clinician, there is discrimination in the waiting area.”
If a patient makes it far enough to see a clinician, the stakes become higher – misunderstandings and miscommunication can have grave consequences. Barnaby notes that, often, clients from key populations are afraid to contradict a clinician’s assumptions and may not share information that’s vital to receiving proper care.
When clients do disclose that they are gay, transgender, or doing sex work, “[a clinician] might express disgust or alarm,” explains Conrad Mitchell, I-TECH’s Key Populations Advisor in Trinidad & Tobago. “What happens directly as a result of that is that someone feels alienated, and therefore does not come back and does not get the care that they need.”
When these experiences are shared within community networks, it can result in fewer people from key population groups accessing care at facilities where others have had negative experiences.
A clinician (center) practices a simulated ano-genital examination under the guidance of a clinical mentor (left).
A novel approach using real-world experiences
To address these challenges in HIV care and treatment settings, I-TECH designed and launched Improving HIV Care for Key Populations in the Caribbean, a novel preceptorship program aimed at building clinicians’ capacity to provide nonjudgmental, high-quality, comprehensive HIV care to most-at-risk communities.
The two-day intensive training occurs in a simulated clinic setting, using targeted role-play scenarios based on real-world experiences. “Patients” are portrayed by skilled KP patient-trainers under the supervision of an experienced clinical facilitator. Clinician trainees participate in 8 to 12 different clinical scenarios featuring patients who are transgender, MSM, or doing sex work.
During these trainings, clinicians practice taking a comprehensive sexual history, performing a proper (simulated) ano-genital examination with appropriate site-specific STD screening, conducting rapid mental health screenings, and undertaking individual risk assessment and risk reduction counseling.
The program was developed and implemented by I-TECH in close collaboration with key population groups in in the region. I-TECH developed standardized case scenarios collaboratively with community members, and recruited and trained representatives from the sex worker, MSM, and transgender communities in each country to portray these scenarios as the patient-trainer and to give targeted feedback to clinicians.
Frank, face-to-face discussions
Once the trainer exits the role of “patient,” the clinician is also afforded the opportunity to have a frank and open discussion with the trainer. These conversations are wide-ranging – from the obstacles that prevent key populations from accessing care; to the health care issues they face; to psychosocial issues such as mental health, gender affirmation, gender-based violence, and substance abuse.
“One of the great things that can come out of something like this,” says Mitchell, “is although the person has come in with a physical problem, we are sensitizing the clinician to see past that.”
The patient-trainers share powerful personal stories with the clinicians, noting how small actions or expressions – such as a slight grimace or donning gloves to take blood pressure – can be interpreted as stigma. They offer insight into what runs through a patient’s mind at a health facility: fear of harassment by vendors, security staff, and other patients; anxiety around disclosing they have same-sex partners, the number of partners, or sexual practices; and reluctance to seek care for ano-genital conditions.
The patient-trainers also teach providers about the importance of using preferred names and pronouns, about avoiding the assumption of heterosexuality, and of showing a non-judgmental attitude. “A lot of it is about language,” says Barnaby. “We are equipping them with the knowledge of how to speak to a KP person without discriminating.”
A clinician (right) responds to a patient-trainer’s “upset” reaction during a role playing exercise.
A two-way street
For some clinicians, this training is the first time meeting a transgender person, or the first time receiving constructive feedback about service delivery from the perspective of the patient. Clinicians have noted that they appreciate opportunities to interact with real people from the key population groups and to get feedback on their clinical practice and interpersonal skills directly from a patient’s perspective.
Mitchell, who portrays several patients throughout the training program in Trinidad, also notes that “there is always that ‘wow’ moment with the clinicians: ‘Wow, I didn’t know this was happening.’” Mitchell says that he had a clinician admit to him that the many years of schooling that doctors go through can leave them naïve of social issues.
Perhaps most valuably, the understanding is not one-sided. At the end of the two days, says Mitchell, not only is there a marked improvement in the clinicians, but the patient-trainers come away enlightened, as well.
“Often we forget that doctors are people themselves,” he says. “I think that’s one of the things that the team in Trinidad collectively learned. Because there were a number of doctors that came to the training, and we had sort of a negative view of them…. Often what comes across as negative is this person having a rough day, a bad day, or not being able to give the kind of help they want to give.”
Barnaby echoes that sentiment, noting that a doctor can quickly get a bad reputation within the tight-knit KP communities in Jamaica, and these trainings have helped bridge the gap from both sides. “If the preceptorship trainers can see the doctor’s potential to be good,” says Barnaby, “he gets a good rep in the community, as well.”
So far the program has trained 20 clinicians from the highest volume HIV care and treatment clinics in Jamaica and Trinidad. In the coming year, I-TECH will continue to train clinicians and will also adapt the training for nurses in the region.
THIS PROJECT IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.
Study tour participants visit HRSA offices in Washington, D.C., to hear more about HRSA’s mission and activities.
Ukraine has the second largest HIV epidemic in eastern and central Europe; an estimated 220,000 citizens were living with the disease as of January 2016. As part of national efforts to help curb the impact and spread of HIV, the Ukrainian government is expanding and scaling up HIV services – training is an integral part of this scale-up.
To this end, the International Training and Education Center for Health (I-TECH) is working with national partners in Ukraine to build local capacity to provide high-quality continuing medical education (CME) on HIV and related topics.
Most recently, I-TECH arranged for representatives from the Ukrainian Center for Socially Dangerous Disease Control (UCDC) of the Ministry of Health and the Ukrainian Family Medicine Training Center, based at Bogomolets National Medical University, to participate in a weeklong study tour in Washington, D.C.
“Participants found the study tour to be extremely informative and timely given reforms to health workforce development currently under way in Ukraine,” said Anna Shapoval, I-TECH Ukraine Country Representative. “The information obtained and contacts established through the study tour will help to inform development of an HIV-focused professional medical association in Ukraine.”
The aim of the association will be to advocate on behalf of medical providers, educate health professionals on new developments in clinical practice and relevant legislation and other issues affecting HIV medicine and patients, and potentially provide crucial CME opportunities.
Tour participants met with representatives from CME training networks, HIV-focused professional medical associations, and organizations involved with CME accreditation and physician licensure in the U.S. Highlights from the tour include:
Meeting with the U.S. Human Resources and Services Administration (HRSA) on HRSA’s mission and activities, including the AIDS Education Training Center Program and other initiatives to improve HIV services in the U.S.
Informative sessions with the Maryland State Board of Physicians and Federation of State Medical Boards on the role of state medical boards in physician licensure
An overview and discussion on CME accreditation requirements and standards for commercial support
Meetings with various HIV-focused professional medical associations to discuss their establishment, funding models, advocacy work, CME and certification offerings, and lessons learned
The study tour participants identified several aspects of the U.S. CME and licensure systems to explore further and potentially apply in Ukraine, including decentralized licensure, nongovernmental CME accreditation, and diverse CME providers such as universities and professional associations.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
The Dogg performs to a crowd in Katima Mulilo, Namibia. The Dogg plans to set an example by getting circumcised next month.
Namibian newspaper New Erareported today that hip hop artist The Dogg (real name Martin Morocky) has agreed to be circumcised next month by Dr. Bernard Haufiku, Namibia’s Minister of Health and Social Services, as part of the country’s voluntary medical male circumcision (VMMC) program. The procedure is to take place on Minister Haufiku’s birthday, Sept. 19.
The International Training and Education Center for Health (I-TECH), with PEPFAR funding, has supported the VMMC efforts of the Ministry of Health and Social Services (MOHSS) in the Oshana and Zambezi regions on many fronts. Between 2010 and 2014, I-TECH supported health care worker training in the provision of VMMC nationwide and has supported the delivery of VMMC procedures since November 2014. Since the start of this year, I-TECH has also been engaged in critical efforts to create demand for the procedure.
Marocky, who lost both of his parents to HIV/AIDS, was previously involved in the MOHSS’s “Break the Chain” campaign to reduce concurrent sexual partnerships in Namibia. He’s been a VMMC ambassador since May 2016, serving as the face behind a nationwide concert and social media campaign urging 15- to 49-year-old men to “get the smart cut.”
The Dogg shares the message of HIV prevention with a school in Katima Mulilo.
So far, Marocky has held nine concerts in the Erongo, Oshana, and Zambezi regions, as well as delivered encouragement to young men through radio talk shows and TV advertisements. He has also spoken one-on-one to young men about the preventive benefits of VMMC — namely, that the procedure can reduce the risk of HIV infection by more than 60%.
“I’ve encouraged ‘the smart cut’ through my music and appearances,” said Marocky. “But I’m now looking forward to protecting myself and setting a personal example for young Namibian men.”
The musician will join the more than 11,200 men in Oshana who have undergone a VMMC since 2009. More than 80% of the 12,250-plus procedures performed with I-TECH support since January 2015 are in the high-priority 15- to 29-year-old age group.
Currently, only about a quarter of Namibian men are circumcised. Overcoming cultural hurdles and mobilizing men to get the procedure has become a high priority for the MOHSS.
“Training clinicians in the procedure is only half the battle,” said I-TECH Namibia Country Director Norbert Forster. “Getting the word out to young men about the benefits of VMMC is crucial to ensuring the success of this intervention. The Dogg’s campaign has gone a long way toward changing minds and attitudes.”
The MOHSS and I-TECH are jointly engaging in a number of additional demand generation activities, which mainly focus on school-aged boys and young working men. One such activity, a bicycle lottery, is highlighted below.
Community Members Win Bicycle Lottery After Volunteering for VMMC
The MOHSS, with the support of I-TECH, has awarded the first two winners of new bicycles in a lottery held at Katima Mulilo State Hospital in the Zambezi Region.
The lottery was implemented to encourage more men to come in for VMMC; Zambezi remains the region most affected by HIV/AIDS in Namibia.
The first winner is an NDF soldier. His winning ticket was drawn out of the first group of men who were circumcised between March 1 and April 30, 2016, in the Zambezi region. The second winner, drawn from the May to July cohort, was a 16-year-old attending Mavuluma Senior Secondary School, a remote school in eastern Zambezi region.
During June of this year, the MOHSS Zambezi region team managed to mobilize and circumcise a total of 773 men as part of its I-TECH-supported VMMC program. The vast majority of recipients were between 15 and 29 years of age.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
President Pedro Pablo Kuczynski and Patricia García. Photo courtesy of the Ministry of Health of Peru Twitter feed.
On July 28, Peruvian President Pedro Pablo Kuczynski swore in the country’s new Minister of Health: Dr. Patricia García, alumna of the University of Washington School of Public Health (MPH 1998, Epidemiology). Dr. García is an Affiliate Professor at UW’s Department of Global Health and was Vice Dean of research at the School of Public Health at Cayetano Heredia University, where she received her doctorate and PhD in medicine.
Among her list of credits, she also served as a member of the External Advisory Board of the UW’s Department of Global Health and was the first woman to chair the Peruvian National Institute of Health.
Dr. Chris Behrens (center) and participants at a pilot training event in Uzhgorod.
In June 2016, the academic and professional communities involved in training family physicians and general practitioners in Ukraine received another valuable guide to a highly sensitive topic.
The International Training and Education Center for Health (I-TECH) in Ukraine, the Ukrainian Family Medicine Training Center (UFMTC) at the Bogomolets National Medical University (NMU), and the International Renaissance Foundation, all under the auspices of the Ministry of Health (MoH) of Ukraine, published “Use of Narcotic, Psychotropic Substances and their Precursors in the Practice of Family Medicine.” This facilitator’s guide (published in Ukrainian) was developed by Ukrainian and international experts in the fields of palliative care, controlled drug use, and pain management.
“The uniqueness of this publication is its extremely topical and, until recently, understated issue in Ukraine: provision of medical care with the use of controlled drugs, including opioid analgetics,” said Kateryna Amosova, Rector of the Bogomolets NMU.
The guide incorporates recent, groundbreaking updates in Ukrainian legislation. Resolution #333 of the Cabinet of Ministers of Ukraine and Order #494 of the MoH legitimize primary health care providers to prescribe and manage opioids for pain management in palliative care and opioid substitution therapy (OST).
“I-TECH Ukraine was honored to be able contribute to the development of the in-service training course that promotes most progressive principles of palliative care and OST provision for patients, including those with HIV, tuberculosis, and other HIV-associated diseases,” said Anna Shapoval, Country Representative for I-TECH Ukraine. “As always, we express our profound gratitude to the Ministry of Health of Ukraine, HRSA of the U.S. Department of Health and Human Services, CDC in Ukraine, and the International Renaissance Foundation for supporting this project.”
The goal of this training curriculum is to provide participants with the skills and knowledge required to form competencies in applying narcotic, psychotropic substances, and their precursors in the practice of family medicine, specifically in combination with treatment of drug addiction, tuberculosis, and hepatitis.
Participants work at the pilot training in Uzhgorod.
The guide is based on the results of three pilot training events that took place in October through December 2015 in Uzhgorod and Kyiv. Dr. Chris Behrens, Clinical Associate Professor in the University of Washington’s Department of Global Health, co-facilitated the first event in Uzhgorod. Dr. Behrens also co-authored the guide, along with leading experts from the Bogomolets NMU, the Ministry of Internal Affairs of Ukraine, the National Police of Ukraine, the State Service of Ukraine for the Drug Use Control, the Ivano-Frankivsk Oblast Clinical Center for Palliative Care, the Kyiv and Kryvyi Rih City AIDS Centers, and the International Renaissance Foundation.
The course covers such essential themes as:
The role of family physicians and primary health care facilities in using narcotic and psychotropic drugs and their precursors;
Legal and organizational principles of applying narcotic and psychotropic drugs and their precursors in primary health care practice in Ukraine;
Mental health; pre-conditions and types of opioid addiction; HIV/AIDS and other infectious diseases in IDUs; palliative and hospice care;
Principles and use of opioid maintenance therapy in primary health care, including the patients living with HIV/AIDS; and
Principles and use of narcotic and psychotropic drugs and their precursors in provision of palliative and hospice care, including patients living with HIV/AIDS.
The MoH of Ukraine recommends this guide as a tutorial for clinical interns and doctors enrolled in in-service or continuous medical education training programs, as well as for faculty of the Ukrainian medical universities and colleges that train doctors and nurses as general practitioners and family doctors. The guide has been already disseminated to about 60 medical universities and the largest medical colleges in Ukraine.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
On June 17, Dr. Robert Martin, University of Washington professor and Director of Laboratory Systems Strengthening at UW’s International Training and Education Center for Health (I-TECH), will receive the American Society for Microbiology’s 2016 Hologic Joseph Public Health Award at the ASM Microbe 2016 conference in Boston.
The award takes its name from J. Mehsen Joseph, who directed the Maryland State Laboratory for decades and was instrumental in working with the U.S. Centers for Disease Control and Prevention (CDC) to expand the role of public health laboratories.
“When someone receives an honor like this, it reflects not only on the individual but on the institution and its leadership, which have provided an environment for accomplishments,” said Dr. Martin. “That has certainly been true of UW and I-TECH.
“This award means a lot to me,” Dr. Martin continued, “because as director of the Michigan Public Health Laboratories, I knew and worked closely with Dr. Joseph on a number of national projects through the Association of Public Health Laboratories. He was a great individual and a great leader for public health laboratory science.”
Prior to his post at UW, Dr. Martin served as director of the Division of Laboratory Systems at the CDC, launching the National Laboratory System to link private and public sector laboratories. His engagement of participating private sector laboratories established working relationships between public and private sector laboratories that extend to the present. He also contributed to integrating the laboratory role into CDC’s Field Epidemiology and Training Program and the inclusion of laboratory systems as part of CDC’s international activities, notably in China, Bangladesh, Cambodia, and Thailand.
Previously Dr. Martin served with the Michigan Department of Community Health, becoming state laboratory director in 1991. There he participated in the development of the first national guidelines for laboratory diagnosis of Lyme disease and established a state-of-the-art molecular testing service.
Dr. Martin will deliver a lecture at ASM Microbe on June 17 titled “Strengthening Laboratory Systems Globally – Thinking Beyond the Bench,” in which he’ll talk about I-TECH’s efforts in laboratory systems strengthening in resource-limited countries.
ASM Microbe 2016 gathers the world’s leading scientists, physicians, and researchers to exchange ideas and keep abreast of the latest developments and cutting-edge research. The Opening Keynote Session, titled “A Conversation with Bill Gates: Bringing the Frontiers of Science to the Front Lines of Development,” will feature Bill Gates in an interview with Dr. Richard Besser, Chief Health and Medical Editor at ABC News.
A PMTCT Client Retention training includes tablet-based self-study modules.
In Zimbabwe, health care workers often need to build confidence and skills in caring for HIV-positive infants and children. The International Training and Education Center for Health (I-TECH) has employed an innovative approach to support these front-line staff – a case-based, self-study PMTCT Client Retention training.
During the introductory session, participants are oriented to the course, given self-study tips, loaned tablets and instructed on their use, and given a pre-course assessment. Participants also attend a half-day classroom session at the beginning and end of the five-week course.
A WhatsApp discussion group is also set up to send messages of motivation and reminders and for participants to share issues during the course. WhatsApp is widely used in Zimbabwe as an inexpensive mobile phone platform to message individuals and groups.
WhatsApp for collaborative problem solving
Elizabeth is a primary care nurse who was among a cohort of 30 participants in one of these trainings, conducted in Mashonaland Central Province. About one week into the course, Elizabeth faced a situation at work where she was confused about how to apply national guidelines to one of her pediatric patient cases. Elizabeth chose to bring the issue to her training cohort. Below is a sample of the discussion that ensued among several members of the group, showing that a number of the cohort were similarly perplexed:
Elizabeth: A woman came to our clinic. She was ill. She wanted to get tested because she was ill for a long time on and off. The woman tested positive. Because she is breastfeeding an 11-month-old baby l commenced her on Option B+. l tested the baby with antibody RDT [rapid diagnostic test] and tested negative. l commenced the baby on cotrimoxazole prophylaxis. The question is: Was it necessary for the baby to be given NVP [nevirapine] prophylaxis since the baby tested negative and is now 11 months OR should l give the baby NVP prophylaxis for 6wks from now????
Elizabeth received a range of responses from her cohort:
NVP is only given from birth up to six weeks. Commence mother on Option B+, baby on cotr prophylaxis collect confirmatory DBS [dried blood spots] for the child.
I agree with ~nr
Cotr prophylaxis and confirmatory DBS only for the baby. Thanks guys.
Baby should still get NVP for six wks since still breastfeeding — meaning baby is still exposed.
As per NVP shld be given — the first dose at birth, the second dose 48hrs after first dose, then third dose 96hrs after second dose. Prophylaxis shld be given as soon after delivery as possible. When prophylaxis is delayed the less likely that the infection will be prevented.
By age of 14 days, infection already would be established in most infants. So l think it’s not necessary to give NVP as prophylaxis.
One member of the cohort was a district nursing officer (DNO). He shared that he had deliberately delayed responding until others had weighed in. He not only gave advice but also encouraged the group to refresh themselves on the resources available on their tablets:
Sorry for a late response. Remember key things in your scenario: mother is positive, baby is breastfeeding and is 11 months. … Infant is still at risk, therefore cotri prophy, infant feeding counselling and a continuation of routine FCH [family and child health] care will help. Then 6wks after stopping breastfeeding conduct rapid HIV test again. If negative stop cotri prophy and continue routine care. If positive CT cotri prophy, initiate ART.
He then referred Elizabeth to an algorithm in the national ART guidelines, which were included for easy reference in an application on the participants’ tablets.
This exchange showed the potential use of WhatsApp for support in clinical decision making, in the absence of a warmline for consultation. Upon returning to the classroom, participants engaged in discussion around the WhatsApp conversations, with particular attention paid to the case that Elizabeth had brought to the group. Other members of the cohort reported that they had watched the exchange with interest though they did not contribute.
The cohort members reported that the case was educational for them, and many of them indicated that they would like to continue their group for ongoing support.
As for Elizabeth’s young client, a rapid test was collected and returned negative. Results of the DNA test are still being awaited by the group with much interest. As one member wrote: “We cannot afford to lose that child, wherever she is. … She is still our child.”
The International Training and Education Center for Health (I-TECH) is presenting three posters at the 7th Annual Consortium of Universities for Global Health (CUGH) conference in San Francisco on April 9-11. The theme of this year’s conference is “Bridging to a Sustainable Future in Global Health.”
A critical component in sustainability is the ability to collect accurate and meaningful data through electronic medical records (EMRs) – the subject of two abstracts from the I-TECH Kenya team.
In addition, online learning and electronic learning (e-learning) provides opportunities for health care workers in resource-limited settings to gain critical knowledge and skills while minimizing their need to leave the workplace.
In close partnership with the University of Washington Department of Global Health’s eLearning Initiative (eDGH), I-TECH piloted e-learning modules for KenyaEMR and transitioned the HIV management diploma program at the University of the West Indies into a blended learning program that incorporates online courses.
The transcript tab allows learners to read along with the narration.
Since 2012, the Kenyan Ministry of Health, PEPFAR, and partners have supported implementation of electronic medical record systems (EMRs) at more than 600 public-sector health facilities. The International Training and Education Center for Health (I-TECH) has supported scale-up at more than 300 of these sites.
However, implementation is just part of the story. Successful, sustained use of EMR data depends upon the knowledge and skills of front-line health care workers. To address this need, I-TECH and eDGH developed and piloted two interactive e-learning modules on EMR data quality and EMR data for decision-making.
I-TECH and eDGH found that facility staff were motivated to use EMR e-learning modules and apply what they had learned. Participants found the content relevant to their jobs and cited an interest in additional scenarios and modules. Self-paced e-learning modules were determined to be a viable solution for standardizing sustainable training on EMR systems.
To support progressive EMR data quality improvement, I-TECH developed a Routine Data Quality Assessment (RDQA) standard operating procedure and analysis tool. The RDQA procedure was defined in collaboration with the Kenyan Ministry of Health and integrated within existing policies and procedures.
From 2014 to 2015, 180 baseline and repeat assessments were conducted. I-TECH supported facility personnel to share results during county-level EMR review meetings; these presentations motivated other sites to plan for RDQAs and fostered a culture of ongoing data quality improvement. The RDQA procedure for EMR data has now been institutionalized as a method for progressively improving EMR data quality in Kenya.
In partnership with the University of the West Indies (UWI), eDGH and I-TECH transitioned a one-year diploma program in the Management of HIV Infection to a blended learning platform that combines online courses with either a clinical practicum or a research project.
The shift in pedagogy, methodologies, and technologies was achieved through a three-phased approach designed to not only train UWI faculty and staff, but also transfer online facilitation skills to them and sustain those skills.
In its second year as a blended learning online program, the diploma program has scaled up to include health care workers from Cayman Islands, Jamaica, and Suriname.
These projects are supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA0680, International AIDS Education and Training Center. The content and conclusions of this post are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.
On June 17, Dr. Robert Martin, University of Washington professor and Director of Laboratory Systems Strengthening at UW’s International Training and Education Center for Health (I-TECH), will receive the American Society for Microbiology’s 2016 Hologic Joseph Public Health Award at the 
