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I-TECH Presents at AIDS 2014 in Melbourne

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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

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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.

Launch of HIV Programs in Zimbabwe Hits the Right Note

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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

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

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

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.