Dr. Linda Eckert–University of Washington (UW) Professor of Obstetrics & Gynecology, Adjunct Professor of Global Health, and technical advisor to I-TECH’s cervical cancer programs in Namibia, Malawi, and Botswana–served as one of the lead consultants coordinating the WHO guidelines.
“It has been a true privilege to join with WHO colleagues to collect and synthesize data and work with cost effectiveness modelers and our 60-member multinational Guideline Development Group, who shared their immense experience and knowledge to create these evidence-based guidelines,” said Dr. Eckert. “It is so hopeful for women around the globe, and I feel inspired thinking about how many women can be spared the suffering of cervical cancer through implementation of these guidelines.”
Dr. Laura Muzingwani, the lead physician for I-TECH’s Cervical Cancer Prevention Program in Namibia, was also an active member of the Guideline Development Group. Her experience and expertise in cervical cancer screening and treatment in Namibia enabled her to offer valuable guidance in the crafting of these recommendations.
In addition to the UW, contributing partners in the project included McMaster University, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and Unitaid, among others.
In March, the Botswana Ministry of Health and Wellness (MoHW), launched an online self-registration platform to allow eligible citizens to register for COVID-19 vaccination. The registration portal was developed by the International Training and Education Center for Health (I-TECH), in conjunction with the MoHW and the National COVID-19 Task Force. Since the launch, more than 60,000 people have registered for vaccination through the platform, and more than 45,000 people have received their first dose of the COVID-19 vaccine.
I-TECH assisted the MoHW to develop the following modules for the platform:
A DHIS2 tracker module tracks vaccinated clients for a follow-up dose. I-TECH trained MoHW health informatics and M&E officers to provide remote and on-site support to frontline health care workers across the country on application use. An interactive and intuitive dashboard shows vaccination trends across age and gender bands, geographical area and clinics/health facilities. The tracker module sends automated SMS reminders to clients regarding vaccination date, location, and time. Clients also receive a post-vaccination acknowledgment message.
An adverse events tracking module records any adverse events (AEs) due to COVID-19 vaccines. The module also automates reports on AEs and the correlation between AEs and any underlying conditions as disclosed by the clients.
A stock management module tracks the vaccine stock at facility, district, and national levels. This module is particularly helpful in projecting the vaccine demands at the clinics and vaccine availability against the vaccination bookings. The MoHW team closely monitors daily opening and closing stocks, to ensure optimal supply. Automated data checks and validations are built in to alert the facility management of any misappropriations in the vaccine stocks.
Currently, I-TECH is working on a scheduling application that will be integrated into the portal for online booking of vaccination appointments. This will considerably reduce the number of “walk-in clients,” increase efficiency, and assist frontline workers in managing the workload at vaccination sites.
I-TECH will continue supporting this initiative until the end of the current funding cycle, while simultaneously capacitating the MoHW to take over the day-to-day management and maintenance of the portal.
This online, DHIS2-based platform is available here.
I-TECH’s work in Botswana 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 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.
In Namibia, I-TECH currently supports screening and treatment at 31 health facilities and 11 outreach sites in seven regions. As of August 2020, the program had performed more than 14,000 screenings and 1,700 treatment procedures for HIV-positive women.
The Namibia team has also launched a campaign to raise awareness of the importance of screening for and treatment of cervical pre-cancer in women aged 20–49. The campaign has been crucial during the COVID-19 pandemic, as patients may be less likely to visit their health care provider for preventive care, including cervical cancer screening and treatment.
I-TECH’s network partner in Botswana, the Botswana Training and Education Center for Health (B-TECH), will soon begin work on a national cervical cancer and treatment program, focused on women living with HIV. Activities will include providing quality routine cervical cancer screening and treatment for all eligible women living with HIV at high-volume ART sites in 12 districts, as well as raising awareness among this population.
B-TECH — in conjunction with I-TECH, University of Botswana, and the National Cervical Cancer Prevention Program (NCCPP) — will align national screening and treatment guidelines with WHO standards to ensure sustainability. B-TECH will also work closely with National Laboratories to increase capacity for quality cervical cancer screening services.
Dr. Linda Eckert, UW Professor of Obstetrics & Gynecology as well as Global Health, is lead coordinator for updating WHO recommendations on cervical cancer screening and treatment and serves as technical advisor to I-TECH in this work in Namibia and Botswana. She notes that the time has come for the WHO strategy.
“The WHO’s Cervical Cancer Elimination Strategy will literally save millions of women’s lives around the globe,” says Dr. Eckert. “Each year, over 300,000 women die of cervical cancer, and the number of deaths is projected to increase by over 20% in the next decade.
“Almost all cervical cancer can be prevented—making these deaths even more tragic,” she continues. “This is the first time WHO has launched a cancer elimination strategy, calling on the global community who care for women to say ‘enough’ to cervical cancer, ‘enough’ to these preventable deaths.”
On October 1, the International Training and Education Center for Health (I-TECH) celebrated the launch of the local and independent Botswana Training and Education Center for Health (B-TECH) and Caribbean Training and Education Center for Health (C-TECH).
For more than 17 years, these teams have worked within the regional Botswana and Caribbean offices of I-TECH to respond to the health needs of individuals and communities infected and affected by HIV. B-TECH and C-TECH, as locally registered non-governmental organizations, will continue to build on those years of experience implementing innovative, locally driven HIV prevention, care, and treatment programs, as well as expand their work to tackle other pressing health issues within the Batswana and Caribbean communities.
As part of the I-TECH network, B-TECH and C-TECH are able to access the academic depth and regulatory structures of UW and, together with local and regional clinical and programmatic expertise, scale up best practices and strengthen health systems. As local entities, B-TECH and C-TECH will also be able to take advantage of expanded partnership opportunities.
Both teams have supported pioneering work in their regions to provide comprehensive, patient-centered care for the most vulnerable populations. The C-TECH team has implemented a groundbreaking preceptorship program to improve provider communication with key populations affected by HIV in Jamaica and Trinidad and Tobago. It has also implemented a successful telementoring program through a Project ECHO®-based platform and model, reaching 465 providers. The program connects groups of providers to form communities of practice throughout the region to facilitate clinical updates, case consultations, and strengthened practice in HIV treatment and care and, recently, COVID-19.
“We look forward to remaining within the I-TECH family,” said Natalie Irving-Mattocks, Executive Director of C-TECH. “But our team is equipped and ready to move into this next chapter, deepening our local relationships, expanding our reach throughout the Caribbean, and building on our commitment to support access to high quality health care for the region’s most vulnerable.”
For its part, the B-TECH team has made an enormous impact on the health systems of Botswana, enabling the policy environment for HIV clinical case management; developing and implementing an interoperable, standards-based health information system; and enhancing the capacity of the health workforce at all levels. The team has also implemented innovative, high-yield testing approaches to increase HIV case identification. Targeted HIV testing strategies include partner testing services; HIV self-testing; testing among presumptive tuberculosis cases; and the expansion of afterhours and weekend testing to target men.
“We are excited to begin this new endeavor to promote innovative, locally driven, and effective programs to respond to the HIV epidemic in Botswana,” said Dr. Odirile Bakae, Executive Director of B-TECH. “With a high level of technical assistance from I-TECH, combined with B-TECH’s boots-on-the-ground approach, we are a winning team. We look forward to a fruitful partnership with both I-TECH/UW and the Government of Botswana.”
I-TECH has worked closely with UW Global Operations Support over the past decade to inform the internal procedures and structures necessary for international office registrations. This work has promoted operational effectiveness by enabling a safe, compliant, and legal environment for conducting international work. I-TECH’s close work with Global Operations Support has also helped to create the administrative and policy structures necessary to enable the successful launch of B-TECH and C-TECH.
Over the past two years, three other I-TECH offices – in Haiti, India, and Zimbabwe – have launched local organizations, signaling I-TECH’s bedrock commitment to transition, sustainability, and country ownership.
“These new organizations reflect our shared goals of serving communities, building capacity, and supporting expert leadership across the I-TECH network,” said Dr. Pamela Collins, I-TECH Executive Director. “We look forward to continued strong collaboration that saves lives.”
Read more about the B-TECH and C-TECH leadership teams below.
Dr. Odirile Bakae, Executive Director, B-TECH
Dr. Bakae is a physician with over 15 years of clinical experience in providing services to people living with HIV, as well as a deep understanding of structuring health programs to optimize client outcomes. He has several years of experience practicing medicine in public health settings in Botswana, including the management of the Infectious Disease Control Centers (IDCC), specializing in ART failure clients, complicated TB and HIV cases, and cervical cancer patients.
In addition to his role as B-TECH Executive Director, Dr. Bakae is the Principal Investigator for the CDC funded Cervical Cancer (GH20-2009) and Strategic Information Services (GH20-2007) awards.
He joined I-TECH Botswana in 2015 and led one of the most successful HIV testing programs in the country, focusing on a client-centered approach. Under his leadership, the country program performed exceptionally well, in terms of quality of service delivery and in meeting donor targets and expectations.
Ms. Kauta is a seasoned operations management professional with over 20 years of experience across a wide range of industries. She joined I-TECH Botswana in April 2009 and, as the Deputy Executive Director for B-TECH, she oversees operations, finance, and human resources, and is responsible for design and implementation of internal controls and compliance oversight at all levels of the organization.
In her management role, Ms. Kauta provides planning and coordination of efficient and effective support services to enable delivery of quality work to B-TECH clients and stakeholders. A key function of her role is to identify solutions to address operational challenges within B-TECH as well as ensure the implementation and adherence to the organization’s operational systems, policies and procedures.
Ms. Irving-Mattocks is a public health program director with extensive experience in managing projects focusing on health systems strengthening. She is also a business development practitioner with 13 years of experience in the field of social development. Her expertise includes financial management, budget management, project proposal writing, program design/development, planning, implementation and monitoring, strategic planning, and institutional development.
To her role as C-TECH Executive Director, Ms. Irving-Mattocks also brings deep experience and a proven track record in mobilizing and managing grants from international funding agencies such as United States Department of Human Services Health Resources and Services Administration (HRSA), PANCAP Global Fund, United States Agency for International Development (USAID), Clinton Foundation and National Institutes of Health (NIH).
Dr. Clive Anderson, Board Chair and Technical Advisor, C-TECH
Dr. Anderson has 30 years of experience as a primary care physician, specializing in HIV and STI care and prevention, as well as dermatology. He comes to his role as Board Chair and Technical Advisor after serving as Country Director of I-TECH Jamaica for the past three years.
He remains Technical Advisor to I-TECH Jamaica, where his experience also includes extensive experience as Technical Lead of the Caribbean Quality Improvement Collaborative (CareQIC), Lead HIV Project ECHO® Facilitator and Mentor, and clinical mentor at HIV treatment sites throughout Jamaica.
Dr. Anderson is currently a Clinical Assistant Professor in the Department of Global Health, University of Washington.
I-TECH has worked with the Ministry of Health and Wellness, Centers for Disease Control and Prevention, and other implementing partners in Botswana to develop and implement robust national health information system that enable greater efficiency and accountability and strategic use of information. I-TECH’s work on the National Data Warehouse ensures 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.
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 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.
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).
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”