Category Archives: Mozambique

I-TECH Presents at CROI 2022

The International Training and Education Center for Health (I-TECH) presented findings from two I-TECH-supported programs during the 2022 Conference on Retroviruses and Opportunistic Infections (CROI). The annual conference took place virtually this year, from 12-16 February 2022, and brought together researchers, academics, and experts to discuss and present on scientific achievements and new research.

During the “Shifting Paradigms in HIV Testing” oral abstract session that was held on 16 February 2022, representatives from I-TECH presented two abstracts (full text linked below) that focused on findings from two HIV partner notification programs in Mozambique and Namibia:

To learn more about CROI, download conference resources, or to peruse the 2022 CROI program, please visit the CROI 2022 website.

Note: Bold name indicates presenting author.

Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination

The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.

However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.

Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.

Record-breaking cervical cancer screening in Namibia

The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia’s national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.

In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.

From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).

“As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Lead Physician in Namibia. “Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening.”

Mentoring and training continues in Mozambique via videoconferencing technology

In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® “superhub” for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.

“Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies,” says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. “The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them.”

In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.

While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.

Access to services increase through health communication in Malawi

Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.

To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.

I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.

In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.

Zimbabwe consortium takes measures to blunt the impact of COVID-19

I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.

By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:

  • Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
  • Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
  • Procurement and distribution adequate PPE for use by health care workers at facilities.

I-TECH Supports Critical TB Prevention, Screening, and Treatment for PLHIV

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.

Photo Credit: I-TECH

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.

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.

Mozambique Partnerships

In Mozambique, I-TECH works closely with the US Centers for Disease Control and Prevention (CDC GAP) and the Mozambican Ministry of Health (MISAU) as well as Centro de Colaboração em Saúde (CCS).  I-TECH has also worked with a number of partner organizations in Mozambique, including: Jhpiego, an affiliate of Johns Hopkins University, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and its affiliate, the Fundação Ariel Glaser, Health Alliance International (HAI), Columbia University (ICAP), FHI 360), HIVQUAL/HEALTHQUAL, and Population Services International (PSI).

Tuberculosis Control in Mozambique

I-TECH recently began to support MISAU’s National TB Program to update its national guidelines for TB, as well as the development of standard operating procedures so that clinical sites can integrate TB diagnosis, care and treatment (including of drug-resistant TB) into HIV services.

Human Resources for Health in Mozambique

I-TECH’s long engagement with clinician education in Mozambique includes support for improvements to the national undergraduate (“pre-service”) curriculum for laboratory technicians (Técnicos Medio de Laboratório) to make the content more current and reflect the health care priorities of the country, including advances in HIV diagnostics and treatment monitoring. The curriculum is now standardized so that students at all health training institutes (HTIs) are taught using the same material and methods. Continue reading »

Case Finding and Retention in Care in Mozambique

I-TECH works with the Mozambique Ministry of Health (MISAU) to expand a pilot project to provide an assisted partner services intervention. The project is aimed at encouraging patients newly diagnosed with HIV infection to disclose their status to their partners, and bring them to the clinic for testing. Continue reading »

VMMC for HIV Prevention in Mozambique

I-TECH assists the Mozambique Ministry of Health (MISAU) to improve the quality, safety and performance of the VMMC sites through external quality assurance visits and mentoring of site staff. I-TECH has helped to design and conduct an evaluation of demand creation activities that were designed to motivate men age 15-49 years to choose VMMC.

 

Quality Improvement (QI) of HIV Care and Treatment, and Expanded Clinical Mentoring in Mozambique

I-TECH provides assistance to MISAU in implementation of the national Quality Improvement for HIV Services (QIHS) Strategy, with the goal of improving HIV clinical care through the training of clinicians in QI cycles (Plan-Do-Study-Act) and mentoring to improve weak performance indicators. To expand the impact of its programming, ART Committees and distance learning have been used to reach health workers in more rural settings.

Continue reading »