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Cervical Cancer Screening and Treatment Strategy Support in Malawi

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.

I-TECH Shares Work at IAS 2019

Yusuf Babaye, MBA, MSc, presents his poster at IAS 2019.
Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presenting a poster at IAS 2019.

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.

Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presented a poster titled, “A Cross-Sectional Study on Levels of Knowledge on Provision of Second-Line Antiretroviral Therapy in Malawi in 2016.” The poster focused on the need to build capacity for providing second-line antiretroviral therapy following first-line treatment failure.

I-TECH’s partner notification services work in Mozambique was also highlighted in an article that was included in the Journal of the International AIDS Society (JIAS) supplement published prior to IAS 2019. The supplement, “The Power of Partners: Experiences from implementing and scaling-up HIV partner notification and index testing services,” shares key lessons learned from programs implementing, evaluating, and scaling up partner notification services.

Using Data to Improve Health Service Delivery in Malawi

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:

  1. Introduction to Health Information Systems
  2. Health Information Systems: Data Management Concepts
  3. Using EMR Data for Decision Making
  4. Improving and Maintaining the Quality of EMR System Data
  5. Logic Models and System Classification
  6. Overview of System Architecture
  7. 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.

MetaECHO Conference Examines New Frontiers in TeleHealth

Liz Blanton, M&E advisor at I-TECH, presents her poster at MetaECHO.

On March 13-16, Liz Blanton, Monitoring and Evaluation Advisor at the International Training and Education Center for Health (I-TECH), joined more than a thousand clinicians, funders, academic leaders, government officials, and public health experts for the MetaECHO™ conference in Albuquerque, New Mexico. The University of New Mexico’s Project ECHO® model aims to bring specialized health care and expertise to rural and underserved communities in the U.S. and worldwide.

Blanton presented a poster titled “An Evaluation of Pilot Project ECHO in the Republic of South Sudan and Implications for Implementation in Fragile States.” The evaluation, still in its early stages, will assess the feasibility and acceptability of the model, which is implemented by Columbia University’s ICAP and is the first of its kind in a fragile state.

It will also gauge the impact of the ECHO model – based on telementoring and case presentation from a panel of experts – on providers’ sense of self-efficacy and professional satisfaction, as well as assess outcomes at the facility and systems levels.

“It’s the outcomes piece that really interested people,” said Blanton, pointing out that most of the outcomes studies to date have been fairly small. “It’s something a lot of people at the conference were talking about: how effective is Project ECHO at improving health outcomes?”

In light of this year’s theme of “Infinite Possibilities,” there were also deep discussions about the evolution of the model and how it might be adapted to improve communication between providers and patients, not just among providers. “There were several ‘ECHO Talks’ – TED-style talks – that were really moving,” said Blanton. “Some of the best were by patient advocates,” who highlighted the need for patient-centered care.

A fireside chat with keynote speaker Dr. Don Berwick, President Emeritus and Senior Fellow at the Institute of Healthcare Improvement, underscored the question: how can ECHO teams best deliver what patients need?

Today, Project ECHO operates more than 220 hubs for more than 100 diseases and conditions in 31 countries. The MetaECHO community encompasses all those dedicated to reaching the collective goal of touching 1 billion lives by 2025.

Project ECHO at I-TECH

Several programs at I-TECH utilize the Project ECHO model as a mentoring tool and force multiplier:

  • The first I-TECH-supported ECHO program in the Caribbean was established in January 2018, with the hub site in Jamaica. In that initial year, 41 ECHO sessions were provided, with participation by nearly 300 health care workers. Topics centered on viral load suppression and also included a series on TB prevention, diagnosis, and treatment in people with HIV; tenofovir toxicity; and HIV and lymphoma. During an I-TECH assessment, it was found that the majority of complicated cases presented during ECHO sessions in the Caribbean involved patients with mental health and substance use disorders that negatively impact their ability to adhere to medication and care. Plans are under way to include a psychiatrist/mental health specialist on the ECHO expert panel, and one Wednesday per month will be focused on HIV/mental health co-morbidities. The Jamaica Ministry of Health has also requested that I-TECH include an additional 20 HIV care and treatment sites, as well as a small group of private practitioners, in the current HIV ECHO program community of practice. In service of this request, I-TECH will support the development of a second ECHO program based in Trinidad, which will be launched this month.
  • I-TECH is implementing ECHO to build the capacity of laboratory staff and improve the quality of lab services in Côte d’Ivoire. Sessions include up to 17 laboratories and nearly 30 participants apiece; topics have included management of non-conformities in laboratories. laboratory equipment preventive maintenance, best practices in HIV serology, and external quality assurance.
  • In Malawi, I-TECH supports Project ECHO in partnership with the U.S. Centers for Disease Control and Prevention (CDC), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and Lighthouse Trust. The program has more than 40 participants from five different sites, and case presentation topics have ranged from tuberculosis to HIV encephalitis to Kaposi’s sarcoma. Benefits of the program include not only increased engagement of providers to discuss difficult cases, but also an improved referral system between clinics.
  • ECHO is installed and supported by I-TECH at 41 sites in Namibia, and monthly participation reaches up to 400 subject matter experts and staff. Dozens of topics were discussed during the pilot period (November 2015 to September 2016) alone – the most widely attended were on HIV disclosure to children, PMTCT Option B+, and presentation of tuberculosis. In an evaluation of the Namibia pilot, nearly 80% of participants cited that access to the expertise of HIV specialists and inter-disciplinary consultation was a major area of need for them and their clinics. Ninety-three percent of the participants reported that the presentations during the pilot ECHO sessions provided them with useful, up-to-date knowledge.

 

Technical Support to the National HIV Response in Malawi

I-TECH seconded staff work in collaboration with government officers and program managers, and bring technical expertise to efforts to strengthen health systems. Continue reading “Technical Support to the National HIV Response in Malawi”

Malawi Partnerships

Together, I-TECH Malawi, the Malawi Ministry of Health, and partners work continuously to address the country’s health priorities, including curbing the HIV epidemic towards an AIDS free generation through the efficient scale up of HIV resources and services. Through close collaboration, they endeavor to build a highly capable and organized health care workforce and make quality care available to a greater number of Malawians.

Pamela Kohler

Pamela Kohler, PhD, MPH, BSN

Pamela Kohler, PhD, MPH, BSN, is a Professor and holds joint appointments in the departments of Child, Family, and Population Health Nursing, and the Department of Global Health. At I-TECH, Dr. Kohler led the Tanzania Intermediate Field Epidemiology Training Program (FETP) and currently leads the evaluation and continuous quality improvement activities of the Afya Hatua Project under Tanzania Health Promotion Support. She has led multiple evaluations of programs and policies throughout Eastern and Southern Africa, including HIV differentiated care, cervical cancer screening and treatment, and cryptococcol meningitis services.

Dr. Kohler’s research involves development and testing of health services interventions to improve engagement in HIV care. She led two trials using standardized patient actors to destigmatize HIV prevention and treatment services for adolescents in Kenya and currently leads a stepped care intervention, assigning intensity of services to those with highest need, in Western Kenya. Dr. Kohler completed her nursing training at Johns Hopkins University, and worked clinically in HIV care and Emergency Departments. She holds a PhD in Nursing and an MPH in Health Services from the University of Washington.

Publications

McConnico C, Jed SL, Marumo E, Mazibuko S, Mema GM, DeKadt J, Holmes K, Kohler PK. Systems Mapping of Sexually Transmitted Infection Services at Three Clinical Sentinel Surveillance Sites in South Africa: Opportunities for Integrated Care. J Assoc Nurses AIDS Care. 2017 Jan-Feb. pii: S1055-3290(16)30121-2. doi: 10.1016/j.jana.2016.09.004.

Kohler PK, Marumo E, Jed SL, Mema G, Galagan S, Tapia K, Pillay E, DeKadt J, Naidoo E, Dombrowski JC, Holmes KK. A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa. Sex Transm Infect. 2017 Jan 27. pii: sextrans-2016-052930. doi: 10.1136/sextrans-2016-052930.

Kohler PK, Tippett Barr BA, Kangʼombe A, Hofstee C, Kilembe F, Galagan S, Chilongozi D, Namate D, Machaya M, Kabwere K, Mwale M, Msunguma W, Reed J, Chimbwandira F. Safety, Feasibility, and Acceptability of the PrePex Device for Adult Male Circumcision in Malawi. J Acquir Immune Defic Syndr. 2016 Jun 1;72 Suppl 1:S49-55. doi: 10.1097/QAI.0000000000000774.

Kohler PK, Namate D, Barnhart S, Chimbwandira F, Tippet-Barr BA, Perdue T, Chilongozi DA, Tenthani L, Phiri O, Msungama W, Holmes KK, Krieger JN. Classification and rates of adverse events in a Malawi male circumcision program: impact of quality improvement training. BMC Health Serv Res. 2016 Feb 17;16(1):61. doi: 10.1186/s12913-016-1305-x.

Program Highlights

No posts found.

Field Epidemiology Training Program in Malawi

The Frontline Field Epidemiology Training Program (Frontline FETP) enhances the capacity of HIV and AIDS surveillance and strengthens health systems. The program contributes to a sustainable response to HIV by training health professionals in basic field epidemiology that can support responsiveness to HIV surveillance needs.  Continue reading “Field Epidemiology Training Program in Malawi”

I-TECH Shares Research at CUGH 2015

CUGH 2015

On March 26-28, Boston University will host the Sixth Annual Consortium of Universities for Global Health (CUGH) Conference.

The theme of this year’s conference is “Mobilizing Research for Global Health,” and featured speakers include Olusoji Adeyi, Director, Health, Nutrition and Population, World Bank; Paul Farmer, Co-Founder, Partners in Health; and Stephen Morrison, Vice President, Center for Strategic and International Studies.

Staff members from the International Training and Education Center for Health (I-TECH) will attend to present research on several topics:

Malawi

  • Quality improvement practices decrease adverse event rates in a surgical male circumcision program in Malawi
    Kohler PK, Chilongozi DA, Namate D, Barr BA, Msungama W, Phiri O, Tenthani L, Chalulu K, Perdue T, Barnhart S, Krieger JN
  • Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi
    Holman J, Muyaso M, Msiska G, Namate D, Wasili R

Haiti

  • An assessment of data quality in Haiti’s multi-site electronic medical record system
    Puttkammer N, Baseman JG, Devine EB, Hyppolite N, France G, Honoré JG, Matheson AI, Zeliadt S, Yuhas K, Sherr K, Cadet JR, G. Zamor, Barnhart S

Kenya

  • Evolution of the KenyaEMR training program: Towards efficiency and quality in scale-up
    Atelu C, Antilla J, Muthee V, Puttkammer N

About CUGH

Founded by leading North American university global health programs, CUGH aims to:

  • Define the field and discipline of global health;
  • Standardize required curricula and competencies for global health;
  • Define criteria and conditions for student and faculty field placements in host institutions;
  • Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.

CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.

 

VMMC Community Mobilizers Now More Mobile in Malawi

Adyasi Bamusi (left) receives advice on bicycle care from Lilongwe District Environmental Health Officer Mavuto Thomas.

Community Mobilizer Adyasi Bamusi (left) receives advice on bicycle care from Lilongwe District Environmental Health Officer Mavuto Thomas.

A group of eight Voluntary Medical Male Circumcision (VMMC) Community Mobilizers can breathe a sigh of relief after receiving bicycles to ease mobility in their clusters. The beneficiaries were selected based on the remote areas and long distances they cover.

Desiree Mhango, I-TECH Malawi’s Deputy Country Director, presented the bicycles. During the ceremony, Lilongwe District Environmental Health Officer Mavuto Thomas, thanked I-TECH for the donation of the 10 bicycles, saying they will be a huge help to mobilizers as they disseminate information on the importance of male circumcision.

Mr. Thomas further advised the eight beneficiaries to take good care of the bicycles in order to sustain their usefulness well into the future.

One of the beneficiaries, Adyasi Bamusi, said the bicycles will not only solve mobility problems in rural communities, but also will be used to ferry clients to circumcision centers.

I-TECH’s VMMC program, administered in partnership with the Lilongwe District Health Office, is funded by the Health Resources and Services Administration (HRSA) in collaboration with the U.S. Centers for Disease Control and Prevention’s Division of Global HIV and AIDS (CDC-DGHA), under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

The donation is part of a pilot study examining the impact of bicycles on the effectiveness of community mobilizers in rural areas.