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Collaborative Creates ‘Culture of Quality Improvement’ in Jamaica

A JaQIC team's storyboard illustrates inspiration points and accomplishments.

A JaQIC team’s storyboard illustrates inspiration points and accomplishments on the journey toward quality improvement. Storyboards are a creative way for teams to learn from one another.

Despite strong clinical capacity, systemic barriers may prevent local care teams from executing CD4 count and HIV viral load tests. These tests are critical for monitoring the health of people living with HIV — and their response to antiretroviral therapy (ART).

In response to this challenge, in October 2013, ten treatment sites from the four Regional Health Authorities kicked off the Jamaica Quality Improvement Collaborative, or JaQIC (Ja-quick).

The collaborative is led by the International Training and Education Center for Health (I-TECH), in partnership with the Caribbean HIV/AIDS Regional Training Network (CHART), and supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Health Resources and Services Administration (HRSA).

The project is coordinated by I-TECH Senior Quality Improvement Advisor Shay Bluemer-Miroite, with Dr. Chris Behrens, Clinical Associate Professor of Medicine, Family Medicine & Global Health at the University of Washington, serving as clinical advisor.

“The aim of the project was to significantly increase CD4 and viral load testing by March 2014, and it succeeded in that in all ten sites,” said Bluemer-Miroite, noting that within six months, JaQIC was seeing measurable results. (In fact, from baseline to March 2014, sites improved incidence of CD4 testing by up to 34 percentage points.)

“But,” she added, “the collaborative has achieved so much more than that.”

Working Together to Improve Quality

Building on the existing investment in training and capacity development, quality improvement collaboratives such as JaQIC empower frontline health care workers to implement best practices and improve quality of care.

They also rely on the knowledge of existing clinical care teams, who are most familiar with health systems challenges and best positioned to identify solutions to resolve them. These challenges run the gamut from the availability of patient forms, to problems with transport of samples, to equipment failures during sample processing.

Through the collaborative, sites identify potential problems that can crop up at each step in the process, test these ideas via plan-do-study-act (PDSA) cycles, and share learning. As JaQIC teams gathered during a series of Learning Sessions to “share seamlessly, steal shamelessly,” they not only improved the quality of care, they also built excitement for quality improvement and demonstrated that frontline staff can make impactful changes.

Far-Reaching Impact

“Programs struggle with obtaining the data to prove that they are having an impact,” said Bluemer-Miroite. “Through the collaborative, tracking data became particularly meaningful to the health care teams – because they were the ones who were using the data. By tracking patient-level data from the outset, it’s easy to see how the quality of care is being affected, and it increases the data quality, too.”

The success of the program has led to the buy-in of the Jamaican Ministry of Health (MOH) – so much so that the MOH has added the role of QI Coach to its Treatment, Care and Support Officers (TCSOs), and all of the collaborative’s activities will fully transition to the MOH in December.

The collaborative has also spread to four additional countries in the Caribbean (CaReQIC): Trinidad and Tobago, Barbados, the Bahamas, and Suriname, which have joined a new group from Jamaica to form CaReQIC. While gearing up for CaReQIC Learning Sessions, coordinators realized that more foot soldiers would be needed to liaise with the sites directly, so I-TECH helped to develop training for a cadre of QI Coaches in all five countries.

The effects of this program will be far-reaching, even after its transition.

“What’s really exciting about JaQIC is its potential for a sustained impact on multiple levels,” said Dr. Behrens. “JaQIC has dramatically increased rates of CD4 and viral load testing via systemic changes that are likely to persist into the future. More importantly, however, JaQIC has introduced a ‘culture’ of quality improvement in the region that has been enthusiastically adopted across a broad spectrum of local and regional stakeholders.”

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.

Stories of Success from Ethiopia: The Tsadkane Holy Water Well

Samuel Tadessa at the Tsadkane monastery.

Samuel Tadesse found consolation at the Tsadkane monastery, but he saw that more needed to be done.

The following is the first in a three-part series of I-TECH success stories from Ethiopia.

Samuel Tadesse discovered he was infected with HIV in 2004, after undergoing a routine test as part of a U.S. visa application. He spent the next four years feeling utterly hopeless.

Although not a church-going man, Samuel visited one of the country’s largest holy water springs as a last resort: The Tsadkane monastery, located within the Amhara region of Western Ethiopia.

The holy water site is visited daily by up to 5,000 pilgrims, all in search of a cure to their ailments by way of prayer, holy water consumption, and bathing. The majority of these pilgrims are extremely ill, and a large group have been diagnosed with advanced HIV/AIDS.

Samuel immediately experienced consolation and decided to live at the site of the well. However, he soon realized that many of the people living by the well, waiting for a miracle, were dying. He also understood that the strict diet of holy water and a single daily portion of dried barleycorn flour was inadequate nutrition for those who were sick. He resolved to try to improve the welfare of the stricken community.

Samuel’s fundraising efforts, launched at local bus stations, quickly gained momentum, and soon he was able to buy and distribute bread and blankets to the dying pilgrims at Tsadkane. In just a few months, the number of people benefiting from the new funds had grown from 115 to 1,200.

But Samuel knew that blankets, bread, and water were only a short-term solution.

“I realized that many of these people were dying,” says Samuel. “It was frightening because there was no medical care, and I knew many more would die if we did not create a link between the well and a nearby health center.”

So he approached the local Church.

Historically, the relationship between medical science and the Ethiopian Orthodox Christian community — the country’s largest religious group — has been contentious. When the AIDS epidemic began to spread rapidly in Ethiopia, any discussion in favor of antiretroviral treatment (ART) was discouraged. According to the Church, there was only one treatment for HIV patients: faith, prayer, and holy water.

The Church donated a small thatched hut to shelter HIV victims, but despite Samuel’s commitment, he didn’t have the capacity to accommodate the ever-growing numbers.

A Successful I-TECH Partnership

The facilities at Tsadkane

The facilities at Tsadkane provide HIV testing, counseling, treatment, and care.

It wasn’t long before the International Training and Education Center for Health (I-TECH) learned about the growing HIV community living at the Tsadkane holy water site and the urgent need to scale up Samuel’s operation. In response, I-TECH formed a partnership with the Ministry of Health in 2008, based on a commitment to promoting access and adherence to ART as well as providing care and support services for HIV-positive people seeking a holy water cure.

Between 2009 and 2013, with funds made available through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), I-TECH provided more than US$200,000 in support to the shelter. During this period, 1,370 HIV patients were successfully rehabilitated after being brought to the shelter in a critical health state.

“I-TECH was a lifeline for me,” says Samuel. “I was feeling very overwhelmed and frightened at how many people were going to die as a result of limited support to people with HIV. Up to five people a day were dying in my arms.”

With I-TECH support, Samuel was now able to offer and deliver extensive counseling on HIV testing and ART services to the community of people that had gathered in search of his help.  “It was a huge relief” to have I-TECH’s support, says Samuel.

Within a year, the project had sourced a hub of buildings as a base for the rehabilitative shelter 5 kilometers from the holy water site and was accommodating a steady influx of HIV patients. HIV testing, counseling, ART treatment, and care had been made available to the holy well community.

Fighting Stigma and Discrimination

The shelter community is widely recognized for having succeeded in empowering a large HIV community to overcome fear and stigma and reach out for ART.

With the support of I-TECH management and training, the shelter has been one of the few places in Ethiopia to offer rehabilitation and care to those who have been excluded from their family and community because of their HIV status, says Misti McDowell, Country Director for I-TECH Ethiopia.

“Tsadekane has provided support and acceptance to people living with HIV when so many others have rejected them,” she says. “The shelter offers them a safe place to receive health services as well as working with their home communities to reduce stigma and discrimination.”

Strengthening the Community

The bakery at Tsadkane provides nutritious food.

The bakery at Tsadkane supplies both nutritious food and income for patients.

To help patients rehabilitate, I-TECH funded the installation of a bakery, a dairy, a restaurant, and a seed-oil extraction mill to offer income-generating activities. The aim of these activities was to provide economic empowerment and livelihood training for patients so that they could have an active role in their home community.

The Tsadkane shelter also prioritizes the security and welfare of children born to HIV-infected mothers by providing a dormitory, a playground, schooling, and immediate HIV testing of all children entering the shelter.

According to Dr. Manuel Kassaye,I-TECH’s Care and Treatment Programs Director, “I-TECH played a key role in transforming an informal community group into a community-based organization dedicated to increasing access to HIV care services including mental and spiritual health, as well as increasing the number of ART users.”

To help the shelter improve its service delivery, I-TECH conducted an organizational capacity assessment in 2012.

Another Story of Hope

In early 2014, Tsige Birhanu, 38, arrived at the shelter center on a stretcher. She was weak and emaciated; many feared she would not survive another week. She had been sleeping on a plastic sheet by the well for nine months. Like many pilgrims, she had been subsisting on a diet of holy water and small amounts of barleycorn flour. After suffering frequent bouts of vomiting and diarrhea,she was carried to a nearby hospital where she was diagnosed with TB and HIV.

With a fast deployment of care, nutrition, and ART at the shelter, Tsige’s health improved dramatically in just two months. “The shelter saved me,” she says. “Because of the treatment and care I received, I can now look forward to living a normal, healthy life. …Living, working, and serving here has given me a renewed sense of purpose and confidence.”

PLOS ONE Publishes IDCAP Facility Performance Results

The International Training and Education Center for Health (I-TECH) is proud to have been a partner on the first randomized trial of educational outreach and continuous quality improvement (CQI) in Africa. The evidence in a new IDCAP Overview article published in PLOS ONE — “Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” — by Dr. Marcia Weaver et al. supports I-TECH’s work in three ways:

  1. The pre/post comparisons showed that high quality training, educational outreach, and CQI significantly improved the quality of care for emergencies, malaria, and pneumonia, and enrollment in HIV care.
  1. IDCAP demonstrates I-TECH’s capacity to measure the effects of training and other interventions to improve care and treatment, such as case scenarios/clinical vignettes, clinical observation, facility performance measures, and population-based mortality.
  1. The Overview article reports that efforts to improve data collection had an independent effect on the quality of care for two facility performance indicators. In other words, improving health information systems also serves as an intervention to improve the quality of care. 

“I am grateful for the curriculum development ‘dream team,'” said Dr. Weaver, “including Ann Miceli and Lisa Rayko Farrar from I-TECH, for outstanding implementation by the Infectious Diseases Institute and University Research Co, LLC, and to Accordia Global Health Foundation for project leadership and Sarah Burnett’s excellent data management and analysis.”

The following recap was first published in AccordiaNews, Aug. 26, 2014. 

In a new paper, published today, Professor Marcia Weaver and colleagues report an overview of the findings from the Integrated Infectious Disease Capacity-Building Evaluation (IDCAP).

Accordia Global Health Foundation, with funding from the Bill & Melinda Gates Foundation, launched IDCAP to better equip mid-level practitioners to manage infectious diseases and to advance the global health community’s understanding of the cost-effectiveness of innovative training approaches. IDCAP created a state-of-the-art package of training interventions that incorporated three key elements: 1) a focus on mid-level practitioners, 2) integration across infectious diseases, and 3) on-site support.

The impact of training was tested on three levels: individual clinician capacity and practice, facility performance, and patient health outcomes. Professor Weaver’s article, entitled Improving Facility Performance in Infectious Disease Care in Uganda: a Mixed Design Study with Pre/Post and Cluster Randomized Trial Components, describes the impact of the IDCAP interventions on 23 facility performance indicators.

IDCAP improved the quality of care in several areas with a combination of infectious disease training, on-site team training and mentoring, and quality improvement interventions. The IDCAP interventions resulted in statistically significant improvements in six facility performance indicators related to emergency triage, assessment and treatment (ETAT), malaria diagnosis and treatment, pneumonia assessment, and enrollment in HIV care. However, the on-site support intervention alone, significantly improved performance in only one of the 23 facility indicators.

Kelly Willis, Accordia’s Executive Director and a co-author, explained, “The majority of research in medicine and public health focuses on a single disease and a single outcome, which is often appropriate.  This vertical focus however, may sometimes be to the detriment of professional training and processes of care at a clinic. Accordia is proud to be at the forefront of exploring the integration of training and clinical care.”

I-TECH and DGH Leadership Visit I-TECH Ethiopia, Speak at Outpatient Clinic Launch

Dancers prepare to perform at the University of Gondar's Diamond Jubilee.

Dancers prepare to perform at the University of Gondar’s Diamond Jubilee.

Earlier this month, a distinguished group from the University of Washington’s International Training and Education Center for Health (I-TECH) and Department of Global Health (DGH) visited Addis Ababa and Gondar, Ethiopia, for several days of discussion, workshops, events, and celebration — including the University of Gondar’s 60th anniversary Diamond Jubilee and the inauguration of the University of Gondar Comprehensive Outpatient Center.

Workshops and discussion at the I-TECH Ethiopia offices

I-TECH has had a presence in Ethiopia since 2003, and in that time, has become a guiding force in antiretroviral therapy service delivery and human resources for health, building the capacity of the Regional Health Bureaus (RHBs), universities, and health facilities; introducing innovative initiatives such as task sharing; activating effective monitoring and evaluation interventions; advocating for and implementing TB prevention programs, including MDR-TB; and building the capacity of health facilities and regional labs. The team acts in close partnership with the RHB offices of the Ministry of Health in Afar, Amhara, and Tigray and will be transitioning most of its programs to the RHBs in September 2014.

In advance of this transition, Dr. King Holmes, Chair of the DGH, and Dr. Ann Downer, I-TECH Executive Director, met with staff in Addis Ababa during a July 4 coffee ceremony. The meeting was an opportunity to say farewell to some incredibly valuable members of the I-TECH Ethiopia team who are leaving as projects are transitioned to the RHBs and discuss highlights of more than a decade of outstanding work in Ethiopia.

Bryan Verity, I-TECH HQ Director of Human Resources, was earlier on hand to facilitate a four-day career transition series with materials adopted from the UW career center. The series was co-facilitated by Tigist Dagne, Human Resources Manager at I-TECH Ethiopia.

“We had a great level of involvement by the staff, especially during the ‘assessing personal strengths’ workshop,” said Verity. During this exercise, a staff member shared experiences, while “listeners” tracked skills/strengths that the speaker employed during the experience.

The series also covered writing curriculum vitae (CV), conducting a job search, and strengthening interview skills. In addition, Verity presented a 60-minute training on personal financial management.

“It’s been a tremendous honor to work with such a dedicated and talented group of people,” said Dr. Downer. “I am so pleased that King and I had the opportunity to express our gratitude in person for the fine work this team has done to combat HIV/AIDS in Ethiopia. Everywhere we went in Ethiopia we heard about the positive reputation and valued contributions of our I-TECH Ethiopia team.”

Much to celebrate at the University of Gondar

Ethiopian Prime Minister Hailemariam Desalegn

Ethiopian Prime Minister Hailemariam Desalegn

Speaking alongside Ethiopian Prime Minister Hailemariam Desalegn and U.S. Ambassador to Ethiopia Patricia Haslach, Dr. Holmes delivered a keynote address at the inauguration of the Gondar Comprehensive Outpatient Center on July 6. The launch was bookended by the university’s graduation ceremony and its 60th anniversary Diamond Jubilee conference.

The center was a collaborative effort of I-TECH, UW, the University of Gondar, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) representatives in Ethiopia: the U.S. Centers for Disease Control and Prevention (CDC) and the Health Resource and Services Administration (HRSA).

The construction of this center was critical to address the significant burden and impact of disease in Ethiopia to comply with the Ethiopian Ministry of Health’s (MOH) mandate to increase the number of health care workers and to support the goal of PEPFAR to improve delivery of acute and preventive services related to HIV, TB, and malaria.

To meet these goals, the building can provide care to approximately 350,000 patients per year and serve as a training center for clinical outpatient care in TB, infectious disease, adult medicine, surgery, pediatrics, and emergency care. It houses a state-of-the-art TB facility.

Dr. Holmes visits his namesake CPD center.

Dr. Holmes visits his namesake CPD center.

I-TECH and the UW, through funding from PEPFAR, were instrumental in the conception and execution of the center, serving as consultants for both facility design and curriculum development. In this work, I-TECH helped to ensure that the facility allows for the integration of clinical care, teaching, and training. Dr. Scott Barnhart, an I-TECH principal investigator and a UW professor of medicine and global health, brought in Christine Kiefer, a Harborview Medical Center architect, to consult on the project.

In the days following the inauguration, Dr. Holmes and Dr. Downer led conference sessions on Innovations in Global Health and Effective Teaching, respectively.

Dr. Holmes also had the opportunity to visit a namesake training hall at the University of Gondar: the King Holmes Continuous Professional Development Center. “What a wonderful and humbling experience,” Dr. Holmes said of the visit. “And what a great way to end the trip.”

I-TECH Presents at AIDS 2014 in Melbourne

AIDS2014image

On July 20-25, the biennial International AIDS Conference, AIDS 2014, will be held in Melbourne, Australia. Dr. Gabrielle O’Malley, I-TECH’s Director of Implementation Science, is heading down under to present two posters:

  • Evaluating the Effectiveness of Patient Education and Empowerment to Improve Patient-Provider Interactions at ART Clinics in Namibia, lead authored by Dr. Ellen MacLachlan, I-TECH Senior Research and Publications Advisor
  • “If I Take My Medicine, I Will Be Strong”: Evaluation of an Innovative Pediatric HIV Disclosure Intervention in Namibia, lead authored by Dr. O’Malley

For full versions of these posters, contact Anne Fox, Communications Officer, at foxanne@uw.edu.

As always, the conference is a tremendous opportunity for those working in the field of HIV, policy makers, civil society, and persons living with HIV to share perspectives and knowledge — with a focus on the diversity of response in the Asia Pacific region.

The theme of AIDS 2014 is “Stepping Up the Pace,” and speakers including former President Bill Clinton; new U.S. Global AIDS Coordinator Deborah Birx; and Dr. Tony Fauci, Director of the National Institute of Allergy and Infectious Disease, will examine scientific developments, human rights, and lessons learned in the effort to map our next steps in the fight against the pandemic.

Read more about the conference — as well as the 2012 Melbourne Declaration in support of human rights in the march toward an AIDS-free generation — at www.aids2014.org.

Ukrainian Medical University Delegation Visits I-TECH HQ

Ukraine_MOU_image

From L to R: Dr. King Holmes, Dr. Olga Vystoska, and Dr. Ann Downer present the signed MOU.

On June 12 and 13, representatives from Ukraine’s Bogomolets National Medical University (NMU) visited I-TECH HQ offices at Harborview Medical Center and the University of Washington (UW) Department of Family Medicine.

NMU is the leading medical school in Ukraine, with more than 150 years of history. This visit formally launched the partnership between NMU and the UW’s I-TECH, Department of Global Health, School of Nursing, School of Medicine, and Family Medicine Department. Steps toward partnership began this spring, with a Memorandum of Understanding (MOU) signed by all parties.

The visit started off with a two-hour planning meeting, during which Dr. King Holmes, chair of the UW Department of Global Health (DGH), gave an introduction to the department. This was followed by presentations by Olga Vystoska, Director of the Ukrainian Family Medicine Training Center at NMU, and other UW department representatives, who explored possible areas of collaboration.  The meeting wrapped up with the exchange of signed originals of the MOU.

The Ukrainian delegation particularly appreciated the opportunity to meet I-TECH’s Executive Director, Dr. Ann Downer, and staff; learn about I-TECH’s activities; and tour the UW’s Family Medicine Clinic and Harborview Madison Clinic, which provides medical care and social services for persons living with HIV/AIDS. The group was especially impressed by a tour of the UW Institute for Simulation and Interprofessional Studies (ISIS) lab at Harborview, and Dr. Vystoska expressed interest in starting a similar lab at NMU.

The delegation also had a working meeting with Dr. Chris Behrens to discuss next steps in developing an HIV in-service training curriculum for family practitioners that I-TECH plans to pilot in Kyiv in October with Dr. Behrens’s co-facilitation.

The new Project Director of I-TECH Ukraine, Anna Shapoval, was a driving force behind this collaboration and visit.

“The I-TECH Ukraine team is excited to promote the HIV response and health care reform in Ukraine,” said Ms. Shapoval, who added that she was very pleased with how the meetings went. “We look forward to growing I-TECH’s presence in country, focusing on the most urgent issues of streamlining HIV into primary health care, advancing quality assurance and quality improvement models — as continuation of its unique experience with CLASS.”

Other potential areas of collaboration include joint research activities, publications, and library exchanges; the exchange of faculty members and students for study, teaching, and research; and joint hosting of distance education broadcasts and online courses and seminars.

Julie Stein, Technical Officer for Training Development on the I-TECH Ukraine team, expressed enthusiasm as well. “This visit was incredibly fruitful,” said Ms. Stein. “The meetings and tours generated a lot of excitement from everyone about possible future collaboration.”

I-TECH Presents at CUGH 2014

Optimized-CUGH 2014 (1)

I-TECH staff will head to Washington, D.C., this week to the Fifth Annual Consortium of Universities for Global Health (CUGH) Conference, which will take place at the Washington Hilton from May 10-12. More than 1,300 participants from 50 countries are expected to attend the conference, co-hosted by the George Washington University and Stanford University.

This year’s theme is “Universities 2.0: Advancing Global Health in the Post-MDG Era,” and I-TECH teams will present on forward-looking topics ranging from the implementation of electronic medical records to partnership with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Confirmed speakers include President of the World Bank Jim Kim; former Head of UNAIDS and current Director of the London School of Hygiene and Tropical Medicine Peter Piot; and Head of the Earth Institute at Columbia University Jeff Sachs. Dr. King Holmes, I-TECH Principal Investigator and 2013 Gairdner Global Health Awardee, will also speak at CUGH’s Gairdner Lecture on May 12.

For those planning to attend the conference, don’t forget to check out the University of Washington Department of Global Health table — and to stop by the I-TECH presentations, listed below.

Kenya

  • Electronic Medical Record (EMR) Implementation at Scale in the Public Health Sector: Lessons Learned in Kenya

Haiti

  • Using an electronic medical record system to identify factors associated with attrition from the HIV antiretroviral therapy program at two hospitals in Haiti
  • Before and After the Earthquake: A Case Study of Attrition from the HIV Antiretroviral Therapy Program in Haiti

South Africa

  • Successes and challenges in liaising with PEPFAR partners and stakeholders in the TB/HIV Management Program
  • Evaluation of a comprehensive HIV prevention program in North West Province, South Africa: results from the pilot
  • Integrating research into program design: Conducting a situational analysis to inform comprehensive HIV prevention and care in North West Province, South Africa
  • Mystery patients: Training actors to serve as unannounced standardized patients to evaluate training outcomes for sexually transmitted infections in South Africa

Lab Leadership and Management

  • Certificate Program in Clinical and Public Health Laboratory Leadership and Management

Contact Anne Fox in Communications to see any of these completed posters.

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.

The Bill & Melinda Gates Foundation provided the leadership and funding to plan this consortium. The Rockefeller Foundation provided a grant to help develop the organizational structure of CUGH in its first year of existence.

HRSA Delegation Witnesses I-TECH’s Vital Work in South Africa

Members of the HRSA delegation and officials from a Department of Correctional Services (DCS) health facility in Witbank, South Africa

In late March, I-TECH South Africa hosted a delegation from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA).

Led by Dr. Mary Wakefield, HRSA Administrator, the delegation also included Ambassador Jimmy Kolker, Assistant Secretary for Global Affairs, U.S. Department of Health and Human Services (HHS); Dr. Austin Demby, Director – PEPFAR, Office of Global Affairs, HHS; and Dr. Jose Rafi Morales, Director HRSA/HAB PEPFAR Global HIV/AIDS Program.

The group was accompanied in-country by Steven T.  Smith, Health Attaché and HHS Regional Representative for Southern Africa;  Dr. Nancy Knight, CDC Country Director; Rehmeth Fakroodeen, CDC HSS lead and HRSA Activity Manager; and the I-TECH Senior Management Team.

The purpose of the visit was to observe the following activities, funded by HRSA through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Training Correctional Health Workers

With 165,000 inmates incarcerated in 237 correctional facilities, South Africa has the fourth-highest global incarceration rate, and the country’s facilities are operating at 137% of intended capacity.[1]Overcrowding leads to insufficient ventilation and poor physical and mental health, all of which fuel the spread of HIV and tuberculosis (TB). HIV prevalence in these facilities is as high as 34.6%,[2] and the reported TB cure rate is less than 40%, compared to 70% in the general population.[3]

Ensuring adequate skills among health care providers in correctional facilities is essential to fight the spread of HIV and other communicable diseases. During its first visit, to a DCS health facility in Witbank, the HRSA delegation witnessed first-hand I-TECH’s work to conduct a situational analysis and support the training of health care workers on the care and management HIV and AIDS, tuberculosis, and sexually transmitted infections (STIs). This work was conducted in two regions: Limpopo, Mpumalanga, and North West (LMN) and KwaZulu-Natal.

Supporting Continuing Professional Development for Nurses

In 2012, the SANC started the process of developing a Continuing Professional Development (CPD) Program for the 262,000 nurses in South Africa[4]; however, due to funding constraints and lack of capacity, I-TECH South Africa was asked to support them in the program’s development. Through the CPD Program, nursing practitioners will be required to attain a minimum number of CPD points as a prerequisite for annual renewal of their license to practice.

The HRSA delegation met with the Chair of the Board of Directors of SANC and its Registrar, as well as representatives from the National Department of Health and academic institutions. Members of the delegation were briefed on achievements to date, which include technical assistance to establish a CPD technical working group and a draft CPD framework for nurses, a situational analysis of feasibility and acceptability of CPD, and a CPD pilot study outline developed for two provinces.


[1] Institute of Medicine. Key Populations, Key Solutions – A Gap Analysis & Recommendations for Key Populations and HIV in South Africa. Accessed 17 March 2013. http://southafrica.iom.int/publication/key-populations-key-solutions-a-gap-analysis-recommendations-for-key-populations-and-hiv-in-sa/

[2] South African Department of Correctional Services. 2007 Prevalence Survey for HIV.

[3]Verbal communication with South African National Department of Correctional Services on 28 March 2013.

[4] South African Nursing Council Licensure Register.

I-TECH Helps to Fight Cervical Cancer in Haiti

I-TECH's Dr. Jean Guy Honoré and nurses assess supplies.

On International Women’s Day, March 8, Radio France Internationale’s Atelier de Medias posted a piece highlighting I-TECH’s work to fight cervical cancer in Haiti. The following is a summary of the post.

According to the World Health Organization (WHO), cervical cancer is ​​the second most common cancer in women worldwide and remains a leading cause of death, with approximately 86% of new cases and deaths occurring in middle- and low-income countries.1 Among women who die from this disease, the percentage of them from developing countries has increased from 80% in 2002 to 88% in 2008, and it may reach 98% by 2030.2

Haiti — a country with limited resources and a population of 10 million — is no exception. Currently, it is estimated that, every year, 568 women are diagnosed with cervical cancer in Haiti, and 353 of them succumb to the cancer.3 According to the WHO, if nothing is done by 2025, there will be an approximately 55% increase in cases of cervical cancer in Haiti.

In answer to this threat, the Haitian Ministry of Public Health and Population (MSPP), through the Direction of Family Health (DSF), launched a Cervical Cancer Prevention program in Haiti. Since 2011, I-TECH — with funding from the U.S. Health Resources and Services Administration through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR — has supported DSF/MSPP in facilitating the training of trainers (ToT) and participating actively in the drafting of standards for screening and treatment of precancerous lesions on the cervix.

In March 2013, I-TECH in collaboration with Dr. Frantz Montès from MSPP and two other Haitian experts, Dr. Christophe Millien and Dr. Eddy Jonas from Partners in Health/Zanmi Lasante, conducted a training in visual inspection with acetic acid (VIA) and cryotherapy for caregivers from these institutions.

This program grew under the leadership of I-TECH’s Technical Director Dr. Jean Guy Honoré. In December 2013, I-TECH began to assist institutions in implementing the program, and in the months that followed, it was launched at six institutions across the country. This has resulted in hundreds of patients screened, several of whom have received cryotherapy and cervical biopsies.

The full text of the article (in French) can be found at http://atelier.rfi.fr/profiles/blogs/halte-au-cancer-du-col-en-ha-ti-i-tech-s-investit.

Sources:

1. Human Papillomavirus and Related Cancers in Haiti. Summary Report 2010. World Health Organization / ICO Information Centre on HPV and Cervical Cancer HPV (HPV Information Centre), 2012. Accessed on May 25, 2014.

2. Strategies for cervical cancer prevention using visual inspection with acetic acid and cryotherapy treatment screening. Report of the PAHO workshop for Latin America and the Caribbean. Guatemala City, June 1-2, 2011. Washington, DC: Pan American Health Organization, 2011.

3. Globocan 2008: Cancer Incidence and Mortality Worldwide. International Agency for Research on Cancer / World Health Organization, 2010.