In collaboration with the Malawi Ministry of Health (MOH) and Centers for the Disease Control and Prevention (CDC), I-TECH has supported the national COVID-19 response in Malawi since March 2020. Technical assistance has focused on laboratory capacity, supporting quality COVID-19 surveillance and data management, and implementing a COVID-19 population-based survey with oversight from the Public Health Institute of Malawi (PHIM), under MOH.
In June 2020, I-TECH seconded a Technical Advisor (TA) to PHIM to support COVID-19 activities. The I-TECH TA acts as secretariat for the national Public Health Emergency Operations Center (PHEOC), supporting the coordination of the multi-sectoral COVID-19 response, developing and revising strategies and procedures, facilitating communication, and ensuring access to and sharing of COVID-19 data and information between partners.
I-TECH has also assisted with data management and reporting at the district level, as well as with contact tracing and adherence to infection prevention and control measures.
I-TECH has been able to leverage use of its platform for HIV laboratory activities to provide critical lab support for COVID-19 activities and provide key support to the National Health Reference Laboratory, focusing on building or increasing laboratory capacity including with genomic sequencing, maintaining quality assurance, and improving communication and coordination among laboratory stakeholders.
The I-TECH Team also coordinated a population-based survey to evaluate the extent of spread of COVID-19 in five high-burden districts in Malawi.
The International AIDS Society (IAS) virtually hosted the 11th Conference on HIV Science on 18-21 July 2021. The conference also included a “local partner hub” in Berlin, the original host city, for local experts to gather in person. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.
Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters:
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.
The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection by integrating point-of-care testing for recent infection into routine HIV testing services (HTS). A rapid test for recent infection is given to consenting clients 13-years-and-older who screen HIV positive within routine HTS across participating health facilities. Between April 2019-2020, I-TECH and MOH activated 485 testing points at 155 facilities in Malawi. All 155 facilities implemented recent HIV infection surveillance and reported data. The project has reached 11 of 28 districts to date.
These data allow the detection and characterization of recent HIV infection among newly diagnosed individuals and identify geographic areas associated with recent HIV-1 infection to inform geographic prioritization of HIV prevention and treatment strategies. The project has demonstrated high uptake and allowed characterization of recent infections according to socio-demographic and geographic factors. PEPFAR implementers in Malawi will collaborate with MOH to further investigate the reasons for high recent infection prevalence in identified clusters. Based on the findings of these responses, Malawi may focus on interventions such as youth-focused programs that aim to limit HIV acquisition and transmission among young people.
The global health community recognizes March 24 as World Tuberculosis (TB) Day to raise awareness of this deadly, yet preventable and curable, disease. The 2021 theme, “The Clock Is Ticking,” underlines the importance of acting now to end the global TB epidemic. According to World Health Organization, the probability of developing active TB disease is 18 times higher in people living with HIV (PLHIV), and in 2019 TB killed 1.4 million people worldwide, which includes 208,000 people who were HIV-positive.
According to the U.S. Centers for Disease Control and Prevention, TB is one of the leading causes of death worldwide for PLHIV. To help treat and combat the spread of TB, particularly among PLHIV, the International Training and Education Center for Health (I-TECH) supports TB prevention, care, treatment, monitoring, and policy activities across the I-TECH global network. Current I-TECH work includes TB interventions in Mozambique, Namibia, and Malawi.
I-TECH supports the National TB Program in Mozambique by using the Warm Line—a telephone consultation line that supports clinicians—to deliver results for suspected drug-resistant TB cases to clinicians located at health facilities throughout the country. This collaboration with the Ministry of Health’s National TB Reference Lab allows for more timely identification and better management of drug-resistant TB cases. During 2019, 9,103 (83%) of results were delivered via the Warm Line. I-TECH’s team also engaged providers and clinicians in 383 interactions via the Warm Line to support mentoring and to monitoring complicated TB cases.
In addition to supporting clinicians with TB care and diagnosis, I-TECH supports TB prevention, diagnosis, and care among clients attending HIV clinics throughout seven regions and across 150 public health facilities in Namibia. The I-TECH team screens for active TB; monitors drug interactions for TB/HIV co-infection; provides TB screening, prevention, and management of TB/HIV co-infection for HIV-positive clients; tests for HIV at TB clinics for clients with unknown HIV status; and assesses eligibility, previous initiation, and completion of TB Preventive Therapy (TPT) to ensure no clients are missed. As of January 2021, approximately 90% of HIV-positive patients on antiretroviral therapy at supported facilities initiated their TPT course and 80% have completed their TPT course. I-TECH also works closely with healthcare workers and facilities to improve recording keeping of TPT course initiation and completion as well as the use of this data to focus day-to-day clinical efforts.
Since 2015, I-TECH has been providing technical assistance support to the Malawi National TB Program to improve the quality of TB services at all health facilities throughout Malawi. I-TECH continues to train program monitors to interpret and act on data collected using the TB Standard of Care Monitoring Tool. The tool, designed by I-TECH, collects data for case detection, treatment outcome monitoring, TB/HIV status ascertainment, and TB infection control and contact investigation. Using the collected data, I-TECH identifies performance gaps and create action plans for health facilities to improve the quality of TB services. Even with a loss of momentum due to the impact of COVID-19 pandemic, by September 2020, 85% of presumptive TB cases—those who were suspected of TB and referred for testing—knew their HIV status.
I-TECH’S WORK IN MOZAMBIQUE 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 International AIDS Society (IAS) virtually hosted their 23rd International AIDS conference (AIDS 2020: Virtual) on 6-10 July 2020. The AIDS 2020: Virtual theme was resilience, to celebrate and acknowledge the strength of the HIV community and the significant advances in treatment, while also addressing gaps in treatment, prevention, and care.
Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters with accompanying audio recordings:
Malango Msukwa, BSc, MPHc, I-TECH Malawi Monitoring, Evaluation, and Data Manager, received a scholarship from IAS to attend AIDS 2020: Virtual and presented a late-breaker e-poster on a study that evaluated the uptake of a new HIV surveillance system and described which populations have continued HIV transmission titled, “Characterizing recent infections among persons with new HIV-1 diagnoses in Malawi.”
In addition to the I-TECH representatives presenting their posters, representatives from the Centers for Disease Control and Prevention (CDC) and Health Alliance International (HAI) also presented data from I-TECH programs in Malawi and Mozambique.
Many of the International Training and Education Center for Health (I-TECH) country offices have received supplemental funding from the U.S. Centers for Disease Control and Prevention (CDC) or pivoted portions of current CDC funding to implement and support activities related to the global COVID-19 response, such as contact tracing efforts, provider education, vaccine preparedness, and infection prevention and control (IPC).
To date, I-TECH has received over $500,000 of new funding for IPC of COVID-19 in Kenya and Malawi, while several other offices have submitted proposals for additional funding.
CDC has also redirected $83,000 of I-TECH Tanzania’s funding to support training on COVID-19 case investigation and contact tracing teams specifically for field epidemiology and training program graduates and community health care workers.
“The funding and support that we have received from CDC will allow us to apply our decades of implementation knowledge and expertise from combating the HIV epidemic to the current global COVID-19 response,” says Ivonne Butler, MPH, Associate Center Director for I-TECH. “We look forward to working with other implementing partners and local ministries of health to provide comprehensive training, technical assistance, and learn from one another to effectively respond to this evolving pandemic.”
In addition to new funding and funding shifts, I-TECH has been invited by local governments and ministries of health to collaborate in their COVID-19 responses. So far, I-TECH has aided in the creation of standard operating procedures, contributed to public pandemic preparedness materials, and supported hospitals with COVID-19 IPC. Leveraging existing processes and programs — such as warm lines and distance learning platforms — has allowed I-TECH to rapidly respond to the emerging needs of health care workers and providers.
The newly established independent local Zimbabwe office, Zim-TTECH (Zimbabwe Technical Assistance, Training, and Education Center for Health), also received $579,000 for vaccine preparedness and disease prevention for the rapid scale-up and implementation of a SARS-CoV-2 vaccine (when available) as well as IPC triaging at 250 sites throughout the country.
Ensuring Continuity of HIV Care
I-TECH’s programs are now faced with the difficult task of ensuring the continuity of HIV care and treatment for people living with HIV (PLHIV) during the pandemic. Due to the COVID-19 pandemic, some countries are facing disruptions in antiretroviral therapy (ART) medication supply, an inability for PLHIV to pick up ART medication at pharmacies or hospitals, and a diverted focus from HIV testing due to lack of personal protective equipment and safety concerns.
“Our programs are committed to continuing to provide quality HIV care and treatment while maintaining a safe environment for those for staff and patients,” says Butler. “Our teams and programs have had to adapt and bring innovative delivery of uninterrupted HIV care and treatment services to people living with HIV. They have done an outstanding job in their rapid responses during this unprecedented time.”
Some examples of the innovative way teams are delivering HIV care during the COVID-19 pandemic is through text messaging as a way to reach PLHIV, coordinating community ART refill groups, educating and training providers via distance learning platforms, and using warm lines and WhatsApp to support providers.
Cervical cancer is the leading cause of cancer death among women in Malawi. In response, the Ministry of Health (MOH) in Malawi developed a five-year National Cervical Cancer Control Strategy for 2016-2020. The strategy outlines comprehensive interventions, including the integration of cervical cancer screening services into HIV care.
In 2019, I-TECH supported the review and update of the National Cervical Cancer Guidelines and the accompanying monitoring and evaluation (M&E) framework in partnership with the Department of Reproductive Health and the Department of HIV/AIDS in Malawi. Training materials were developed in accordance with the updated guidelines and trainings rolled out across the country. As part of their support, the I-TECH team conducted a needs assessment to establish which sites in the Southwest Zone had received equipment for cervical cancer screening and treatment services. At that time, they found only 45 health facilities that offered these services to women. Just two years later (as of June 2021), there are at least 357 health facilities (46.1% of all HIV treatment sites in Malawi) currently providing cervical cancer screening services and 211 providing treatment services. Integration with HIV/AIDS programming has resulted in the screening of 79,171 HIV positive women (52.4% of all women screened), with 4,506 (6%) obtaining a screen positive test result and 1,584 (35% of those with a screen positive result) receiving treatment in 2020.
All women and girls (inclusive of HIV positive women) reached with cervical cancer prevention, screening, and treatment services in 2020 is illustrated in the following graph:
I-TECH also led the development of a cervical cancer Client Diagnosis and Treatment Register that is used in hospitals providing cervical cancer treatment in Malawi. This register helps to provide critical data for programmatic decision making, like confirmed cases, deaths, as well as data on cancer staging and the number of women receiving treatment.
To ensure that the strategy continues to endorse current evidence-based approaches and M&E frameworks, the team convenes regular cervical cancer partner meetings to review standard operating procedures and the M&E framework, revise monitoring tools, and conduct situational analyses. I-TECH is also part of the team providing technical guidance on development of the strategic plan for 2021-2025.
In addition to contributing to national strategy updates, I-TECH is working with MOH to ensure same-day treatment or follow-up for all pre-cancerous lesions found among women screened.
Representatives from the International Training and Education Center for Health (I-TECH) attended the 10th Annual International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City, Mexico on 21-24 July 2019. The IAS Conference on HIV Science is a biennial conference that brings together approximately 6,000 researchers, advocates, policy makers, funders, and community leaders. It showcases advances in HIV care, prevention, and treatment; explores new directions for HIV care, prevention, treatment, and research; and features the latest in HIV research.
The Kuunika Project: Data for Action was a four-year program implemented by a consortium of organizations, including the International Training and Education Center for Health (I-TECH), that began in 2016 to improve healthcare service delivery through the effective use of data. Consortium activities aimed to improve data systems, data use, and data governance in five districts throughout Malawi. I-TECH’s main focus was to build the capacity of healthcare workers (HCWs) to access, manage and use health data in high-burden HIV/AIDS facilities and communities.
I-TECH conducted an HCW training needs assessment with support from the Ministry of Health (MOH) in 2017. Using the assessment data, I-TECH collaborated with MOH, district health teams, local university representatives, and subject matter experts to design and develop a training curriculum that was piloted in 2018.
In January 2019, I-TECH rolled out a national training comprised of seven-day, in-person workshops and complementary eLearning modules with the goal of establishing a culture of data use, a strong base of high-quality data, and improve the availability of high-quality information to decision makers with the ultimate goal of improving health outcomes. The eLearning program, Building Effective Health Information Systems, is comprised of seven modules that introduce frontline healthcare workers and managers to health information systems. The modules include:
Introduction to Health Information Systems
Health Information Systems: Data Management Concepts
Using EMR Data for Decision Making
Improving and Maintaining the Quality of EMR System Data
Logic Models and System Classification
Overview of System Architecture
Introduction to Interoperability at the Facility Level.
An average of 150 HCWs per district were trained for an overall total of more than 800 HCWs trained across the country.
In May 2019, I-TECH launched a mentorship program designed to bridge the gap between training and practice, and to help participants apply their newly gained knowledge on the job. By the end of Phase 1, the I-TECH team had oriented over 100 district mentors to the mentorship program and tools. I-TECH’s role in the consortium concluded in August 2019 when Phase 1 of the Kuunika Project ended.