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I-TECH Helps to Fight Cervical Cancer in Haiti

Post categories: Haiti Health Systems Strengthening Human Resources for Health Noncommunicable Disease
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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.

Launch of HIV Programs in Zimbabwe Hits the Right Note

Post categories: Clinical Mentoring Demand Creation eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention Male Circumcision Monitoring & Evaluation Scott Barnhart Zimbabwe
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Zim_launch

To the brass beats of the Prince Edward School Jazz Band, on Feb. 6, a crowd of approximately 150 government officials, health professionals, and members of the press celebrated the launch of three programs in Zimbabwe, two of which are implemented by I-TECH Zimbabwe and partners. These vital programs aim to build local capacity and provide comprehensive services to prevent and combat HIV/AIDS in the country.

Speaking at the festivities were David Bruce Wharton, U.S. Ambassador to the Republic of Zimbabwe; Dr. Owen Mugurungi, director of the AIDS and TB Unit at the Ministry of Health and Child Care (MOHCC); Dr. King Holmes, Chair of the Department of Global Health at the University of Washington; Dr. Ann Downer, Executive Director of the International Training and Education Center for Health (I-TECH); and Dr. Batsirai Makunike-Chikwinya, Country Director of I-TECH Zimbabwe.

“Preventing the spread of HIV/AIDS is important to all of us, as is providing the best level of care to those living with this disease,” said Amb. Wharton. “Today we celebrate the launch of programs that will help us reach these goals together – programs that were designed together, by dedicated teams of collaborating partners from Zimbabwe and from the United States.”

In this spirit of collaboration, the programs, totaling $65 million over five years, support the Zimbabwe MOHCC with grant funding by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), technical support from the Centers for Disease Control and Prevention, and implementation by local and U.S.-based partners. These partners include I-TECH; Zimbabwe Association of Church-Related Hospitals; Zimbabwe Community Health Intervention Research Project; Compre Health Services; The Newlands Clinic and Newlands Clinic Training Centre; Pangaea Global AIDS Foundation, Zimbabwe; and the University of Zimbabwe-University of California, San Francisco Collaborative Research Programme.

The Training and Mentoring Program seeks to develop and deliver in-service training on antiretroviral therapy, including the medical management of HIV/AIDS, women’s reproductive health, tuberculosis (TB), and TB/HIV co-infection to 8,000 health care workers across the country over five years. A mentorship component will also provide health care workers with access to ongoing learning and feedback on clinical issues. Health workers will receive refresher trainings via distance learning technologies, and the effectiveness of the program will be measured through a training database.

Also celebrated – and accompanied by a ribbon-cutting and presentation of 17 new vehicles – was the launch of the Voluntary Medical Male Circumcision Program. The program, building on work that started last spring, seeks to deliver services to 412,000 men in Zimbabwe between the ages of 15 and 49 years over the next five years. Medical male circumcision has proved very effective in preventing the spread of HIV. Randomized controlled trials in Uganda, Kenya, and South Africa have shown that this intervention reduces the risk of female-to-male sexual transmission of HIV by approximately 60%.

“Together, these two programs will improve the effectiveness and quality of prevention, treatment, and care services for those affected by HIV/AIDS – and create better health systems for all Zimbabweans,” said Dr. Holmes.

New Article Examines Effect of Training Approaches on Malaria Case Management

Post categories: Health Systems Strengthening Human Resources for Health Malaria Uganda
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Martin Mbonye

Martin Mbonye

In Uganda, the country with the world’s highest malaria transmission rate, effective training of frontline health workers is especially critical. A new article reports the positive effects of the Integrated Infectious Disease Capacity Building Evaluation (IDCAP)’s training approaches on malaria case management in the country.

“Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” was lead-authored by Martin K. Mbonye, Msc., a researcher at the Infectious Diseases Institute (IDI) in Kampala, Uganda, and published in open-access journal PLOS ONE on Jan. 8; the full text is available online.

“This project made huge strides toward improving the capacity of health workers,” said Mbonye. “These findings have positive implications for Uganda’s increasing ability to take ownership of its malaria interventions and better fight infectious diseases – which account for the majority of the disease burden in the country.”

The IDCAP provided classroom training, distance learning, and on-site support to mid-level practitioners through two interventions: the Integrated Management of Infectious Disease (IMID) training program and on-site support, which integrated site visits and continuous quality improvement. Building on the work of the Joint Uganda Malaria Program (JUMP), IDCAP tackled a wider scope, including malaria, pneumonia, tuberculosis, HIV, and related infectious diseases. (Read more about the interventions and other results here.)

The evaluators then measured the effects of the interventions and the performance of 36 facilities. The results were promising; the combination of interventions was found to improve emergency triage, assessment and treatment processes, and malaria care, a topic of particular importance in Uganda, where steady temperatures and rainfall enable high levels of malaria transmission year-round.

As the IDCAP’s monitoring and evaluation team specialist, and then as program manager, Mbonye oversaw the project’s data surveillance system. He reported improvements in the use of diagnostic tests for malaria suspects, the prescription of the appropriate antimalarials for patients who were determined to need one, and a reduction in the prescription of antimalarials among patients who tested negative for malaria. This decrease in presumptive diagnosis is an important element in reducing drug stockouts and resistance.

I-TECH was one of four partners in the now-completed IDCAP grant to the Accordia Global Health Foundation, and University of Washington professor Marcia Weaver is the IDCAP principal investigator. This article is one of the first in a series of papers describing the study’s results.

Five-Year Cooperative Agreement with CDC to Train and Mentor Zimbabwe Medical Staff

Post categories: eLearning/Distance Learning Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Zimbabwe
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A new award to I-TECH seeks to fight the spread of HIV in Zimbabwe by rapidly scaling up training and mentoring of the country’s medical staff.

I-TECH South Africa Hosts I-TECH’s First Training for Standardized Patients

Post categories: Health Systems Strengthening Monitoring & Evaluation South Africa
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I-TECH South Africa is using Standardized Patients to measure the quality of care for sexually transmitted infections (STIs) for an operations research (OR) study in the Northwest Province. Ten South African actors, five men and five women, will visit 40 clinics before a new STI training program and at two time periods after the training.

Record Numbers for India Online Seminar

Post categories: eLearning/Distance Learning India
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I-TECH India set a new attendance record for its twice-monthly online learning series on HIV/AIDS.

The “Nutritional Aspects in HIV infected Children” lecture—part of the National Distance Learning Seminar Series (NDLS)—was attended by 342 participants from across the country, including all 10 Centres of Excellence (CoEs ) and 71 ART Centres.

The lecture was presented by Dr. Pushphalatha, Professor of Pediatrics, Bowring CoE Bangalore. The last record was 285 participants for Dr. Rewari’s sessioNDLS 1n on National ART Guidelines in 2012.

The series is aimed at health care workers and physicians working with HIV/AIDS patients. National experts present on variety of advanced care, comprehensive management, and treatment topics via live webcast sessions across several states and districts around the country. The goal is to create a dialogue amongst clinicians in regard to management of moderately complex cases. These 60-minute sessions are conducted in English and use a case-based format during the live session and allows participants to engage in follow-up communication across the sites.

I-TECH launched the Global Health Clinical Seminar Series (CSS) in July 2007. With the goal of improving the quality of HIV care delivered by health care workers in resource-limited settings, the series brought together expert clinicians and health care workers in a web-based, interactive format from around the world. India was the first country in the I-TECH network to use this model to design and implement their own series in 2010.

To support country programs in the global network, I-TECH  developed The Global Health Webinar Series Program Package as a resource for organizations interested in creating a successful global health webinar series. Drawing from the experience of I-TECH’s Global Health Clinical Seminar Series (CSS), this program package offers critical tools for the planning, implementation, and evaluation of a webinar series in a variety of settings. The package also offers lessons learned and best practices by I-TECH’s CSS in the four years it was running.

Five Questions For Misti McDowell, I-TECH Ethiopia Country Director

Post categories: Ethiopia Health Systems Strengthening
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Editor’s Note: This is a first in an occasional series featuring I-TECH staff.

Misti McDowell joined I-TECH Ethiopia in February, assuming leadership of I-TECH’s largest country program. In Ethiopia, I-TECH’s work is primarily in the Amhara, Afar, and Tigray regions, which account for nearly 50% of the national HIV burden. I-TECH is focused on strengthening the country’s public health systems, including hospitals and health centers, laboratories, public universities and medical schools. Prior to joining I-TECH,  McDowell worked for five years in Dhaka, Bangladesh, for FHI360 where she oversaw projects on HIV/AIDS, nutrition, family planning, TB, hospital accreditation, and neglected tropical diseases.

Misti McDowellYou just became the Country Director for I-TECH Ethiopia. What has been the biggest surprise in your first few weeks at I-TECH?
I wouldn’t say that it is a surprise, but I was very impressed with the quality of work that I-TECH has accomplished over the years in Ethiopia, especially around all the infrastructural upgrades to hospitals and universities, the capacity building and training to providers delivering quality HIV care, treatment to patients, and strengthening universities to deliver comprehensive pre-service and in-service training.

What will your primary focus be over the next 18 months? 
My primary focus will be to diversify funds, build a stronger team, and improve morale. I think with a stronger team we can accomplish more than we already have and continue to make a greater impact in the health care system of Ethiopia.

Tell us about a leader who inspires you. 
Dalai Lama: “If you think you are too small to make a different, try sleeping with a mosquito.”

You have brought your family to Ethiopia, including your husband and two young girls. What do your girls like best about their new life in Addis? 
I think what my girls love best about Addis is the mountains and that they can go hiking and rock climbing.

What’s the most interesting challenge you think I-TECH’s programs are tackling in Ethiopia? 
The transition of programs to the government with a quick timeline.  I think the government of Ethiopia really wants to have everything transitioned; however with the planned timeline, it will be difficult to transition everything and maintain quality.  There are many systems in the government that need to be streamlined to ensure sustainability and quality of the programs that are now being supported by NGOs and to change those systems will take a long time.