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IDASH Program Launches for Eastern Europe and Central Asia Region

Post categories: Global Health Security Health Information Systems IDASH One Health Surveillance Ukraine
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Participants gather for group discussion during the first IDASH in-person workshop in Tbilisi, Georgia. Photo credit: CDC/EECA

On April 3, the International Training and Education Center for Health (I-TECH) launched the Informatics and Data Science for Health (IDASH) fellowship training program with an in-person workshop in Tbilisi, Georgia. The program launched in partnership with the United States Centers for Disease Control and Prevention’s Eastern Europe and Central Asia (CDC/EECA) Regional Office, the World Health Organization (WHO) Europe, and country governments.

The first IDASH cohort includes 20 fellows from Georgia, Kazakhstan, Kyrgyzstan, Ukraine, and Uzbekistan. Participants include mid- to senior-level technical, analytical, and public health staff working at the national level in public health informatics or data science.

“After several whirlwind months of collaboration and engagement with stakeholders from the five countries, it’s amazing to welcome the first cohort of IDASH to Tbilisi for the first of three in-person workshops,” said Stacey Lissit, MPH, MS, Senior Technical Advisor for the IDASH program.

Fellows will participate in a 12-month in-service training program, in which each country team of four fellows will identify and develop a collaborative project. Fellows will receive sustained mentorship, and regional communities of practice will be established to ensure regional collaboration, share lessons learned and best practices, and establish linkages for future programming needs that span multiple countries.

“IDASH provides the opportunity to link learning to experience, and enables the application of new public health skills, knowledge, and techniques acquired from the training in a real-life context,” said Peter Rabinowitz, MD, MPH, Principal Investigator for the IDASH project. “It also extends benefits beyond the trainees to partner agencies and organizations, helping strengthen public health capacity in the region.”

Proposed fellowship projects include automating data analysis and visualization for diseases, expanding digital immunization registries beyond COVID-19, and developing spatial analysis modules for multi-disease surveillance and response.

“Today, the afternoon of the 4th day, the room is buzzing as the five country teams are hard at work: two engrossed in consultation with our facilitation team of public health informatics and data science experts about their country team projects; the others working on a data science methods exercise, practicing interpretation of descriptive and inferential statistics plots to assess trends in Hepatitis C,” said Ms. Lissit. “The energy and engagement have been high, and we’re looking forward to the next six days and the rest of the year-long fellowship.”

IDASH goals are to enhance capacity to create and use public health information systems that enable the capture, management, analysis, dissemination, and use of reliable, timely information to improve population-level health outcomes, as well as strengthen regional capacity to effectively respond to future global health challenges and pandemics.

“The COVID-19 pandemic made clear the importance of public health data systems that provide real time, accurate data on disease threats to allow for timely intervention and combatting of mis- and disinformation,” said Dr. Rabinowitz. “Programs like IDASH will help ensure there is a workforce prepared to detect, prevent, and respond to future global health threats.”

Story updated: April 11, 2023

I-TECH and Partners Fête Quality Improvement Teams in Côte d’Ivoire

Post categories: Cote d'Ivoire HIV Care and Treatment PrEP Quality Improvement
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Honorees from well-performing sites in the QISSEC project

In late February, the International Training and Education Center for Health (I-TECH) hosted an awards ceremony for the 10 best-performing health facility-based quality improvement teams focused on improving HIV prevention, care, and treatment services in Côte d’Ivoire. I-TECH currently operates in 80 HIV care and treatment (C&T) health facilities throughout Côte d’Ivoire.

Out of a total of 20 points, and using strict criteria, 10 sites received scores greater than or equal to 18 and were honored at the ceremony. Awards included computer equipment, printers, video projectors, blood pressure monitors, and other vital office equipment.

The ceremony was part of the U.S. Health Resources and Services Administration (HRSA)-funded Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) project, which seeks to improve interventions such as the  provision of pre-exposure prophylaxis (PrEP), decreasing treatment interruption, and improving viral load testing coverage and suppression.

“This ceremony was a way to applaud the enthusiasm from the teams, demonstrate an understanding of the methodology, and share the projects that have so far been implemented,” said Dr. Nathalie Krou Danho, QISSEC Project Director.

PEPFAR Coordinator Bibola Ngalamulume

In addition to Dr. Danho, ceremony attendees included the National AIDS Control Program (PNLS) Director, PEPFAR Coordinator Bibola Ngalamulume, HRSA representatives, QISSEC Principal Investigator Ellen MacLachlan, CDC and USAID Country Directors, and representatives from the regions, districts, and sites.

“It is important that we put an accent on service quality,” said Ms. Ngalamulume. “The CQI project that is being implemented by I-TECH is an initiative that is extremely important because not only does it ensure that we improve access to care for all the HIV population–those who are infected and affected–but also it gives us the opportunity to create some kind of a mentorship network between health facilities that are performing well and facilities that need support. [This ceremony] is going to drive even more innovation moving forward.”

Within the QISSEC project, I-TECH has been working closely with the Ministry of Health and Public Hygiene (MSHP) and implementing partners to strengthen provider and community counselor capacity in quality improvement to ensure HIV epidemic control.

I-TECH’s methodology is to build a culture of quality improvement from central, to regional, to site levels. Importantly, I-TECH supports sites to work with the community to center their needs, and patient needs, in providing quality care.

One of the sites honored, an urban health center in Libreville, had set a goal to increase individuals on PrEP from 23 in December 2021 to 78 in June 2022. Their root cause analysis revealed that training in PrEP was insufficient. After orienting prescribers and clinical advisors to PrEP, and organizing community awareness sessions where eligible individuals were identified, the site surpassed their goal by 200%, initiating 230 individuals on PrEP by June 2022. The site continued to increase that pace, reaching 353 by August of that year.

“It’s been a lot for the teams to do this work on top of their day-to-day jobs: to form a quality improvement team, brainstorm, and think of ideas on how to implement the changes,” said Dr. MacLachlan, “but they have taken great care in this work. The quality of HIV care in Côte d’Ivoire will be better for it.”

THIS PROJECT 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 Presents at ICBD 2023 Conference

Post categories: Malawi Surveillance
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Representatives from I-TECH Malawi attend ICBD 2023 in Santiago, Chile from 1-4 March 2023 to present findings from the Malawi Birth Defects Surveillance Program. L-R: Luke Chiwala, Simkonda Yamikani Malanga, George Bello. Photo Credit: I-TECH Malawi

Representatives from I-TECH Malawi attended and presented findings from the Malawi Birth Defects Surveillance Program at the 2023 International Conference on Birth Defects and Disabilities in the Developing World (ICBD 2023). ICBD 2023, hosted by the March of Dimes, took place in Santiago, Chile, from 1-4 March 2023.

The conference brought together maternal and child health practitioners and researchers from around the world who presented their latest research, tools, and approaches in surveillance, diagnosis, and care for babies born with birth defects. This year’s theme was “Accelerating Action for Birth Defects and Disabilities: Surveillance, Prevention, Diagnosis, Management and Family-Centered Care.”

The following presentations were given during the conference:

  • “Prevalence of Adverse Birth Outcomes and External Birth Defects Among Women Living with HIV in Malawi”
    Authors: Bello G, Smith-Sreen J, Williamson D, Taulo F, Kabaghe A, Kerry Thomson K, Kagoli M, Chipeta S, Namakhoma I, Nyirenda R, Babaye Y, Auld A, Kim E, Matatiyo B, Zenengeya E, Muula AS, Nyasulu I, Gomes MF, Chiwala L, Kamzati M, Mkungudza J, Valencia D, Moore C, O’Malley G, Wadonda-Kabondo AN
  • “Correct Diagnosis of Birth Defects by Health Facility Staff in Four Facilities in Malawi”
    Authors: Malanga SY, Luke Chiwala L, Kamzati M, Valencia D, Mkungudza J, Bello G, Williamson D, Moore C, Thomson K, Ireen Namakhoma I, Gondwe E, Banda F, Sangaya N, Chirwa M, Kagoli M, Chipeta S, Nyirenda R, Zenengeya E, Babaye Y, O’Malley G, Wadonda-Kabondo N, Kabaghe AN
  • “Use of Electronic Data Collection and Web-Based Portal to Ensure the Completeness, Timeliness, and Accuracy of Final External Birth Defects Diagnosis in Malawi”
    Authors: Chiwala L, Kamzati M, Valencia D, Mkungudza J, Bello G, Williamson D, Moore C, Thomson K, Namakhoma I, Gondwe E, Banda F, Sangaya N, Chirwa M, Kagoli M, Chipeta S, Nyirenda R, Zenengeya E, Babaye Y, O’Malley G, Wadonda-Kabondo N, Kabaghe AN

To learn more about ICBD 2023 conference, please visit the ICBD 2023 website and review the ICBD 2023 Agenda.

*Bolded names indicates presenting author.

I-TECH Stands with LGBTQ+ Individuals in Uganda

Post categories: Uganda
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On March 21, the Ugandan parliament passed a hardline bill criminalizing LGBTQ+ identity, giving the government wide latitude to prosecute gay Ugandans, punishable by life imprisonment. This represents a clear violation of human rights and dignity for Ugandans who identify as LGBTQ+, putting them at further risk of violence and discrimination in a country where same-sex relations were already illegal.

Global condemnation of the new legislation has been swift, within and outside of Uganda. Richard Lusimbo, a Ugandan LGBTQ+ activist, told NPR, “The LGBTQI community has basically been told, you can’t raise your head, you can’t be seen, you can’t be heard.”  The UN’s High Commissioner for Human Rights is urging Ugandan President Yoweri Museveni not to sign the bill.  “The bill would have negative repercussions on society as a whole and violates the nation’s constitution. The passing of this discriminatory bill – probably among the worst of its kind in the world – is a deeply troubling development.”

Such violations of human rights, regardless of where they occur, are antithetical to I-TECH’s values and our vision of health and flourishing for all. We strongly object to these actions by the Ugandan government and stand against the criminalization of and discrimination against LGBTQ+ individuals and communities in Uganda.

I-TECH Data Presented at CROI 2023

Post categories: Gabrielle O'Malley HIV and STI Prevention Malawi Surveillance
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Data from the International Training and Education Center for Health (I-TECH) program in Malawi were presented during the 2023 Conference on Retroviruses and Opportunistic Infections (CROI). The annual conference took place in Seattle, WA, from 19-22 February 2023, and brought together researchers, academics, and experts to discuss and present on their scientific achievements and new research.

During the “Insights into Prevention and Treatment of HIV in Women and Children” oral abstract session that was held on 20 February 2023, representatives from I-TECH Malawi presented on recent HIV infection surveillance data in breastfeeding women in Malawi:

The Centers for Disease Control and Prevention also presented a poster during the poster session that used data from the I-TECH Malawi HIV Recency Surveillance project:

To learn more about CROI, download conference resources, or to peruse the 2023 CROI program, please visit the CROI 2023 website.

Note: Bold name indicates presenting author.

 

I-TECH Supported Reference Center Serves as Critical Lifeline for People with Advanced HIV Disease

Post categories: HIV Care and Treatment HIV Co-Infection Mozambique Pamela Collins Tuberculosis
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The Alto Maé Reference Center (CRAM). Photo courtesy of I-TECH Mozambique.

Four decades into the HIV epidemic, more than 50,000 people per year in Mozambique continue to die from HIV-related conditions.

The Alto Maé Reference Center (CRAM) provides a specialized package of care and treatment services for patients with advanced HIV disease from the urban health network of Maputo, Mozambique. Since January 1, 2021, the International Training and Education Center for Health (I-TECH) has served as the Ministry of Health’s primary partner for managing CRAM, a role handed over by Médecins Sans Frontières (MSF), which established the clinic in 2010.

Since I-TECH started its activities at CRAM, the center has had 1,599 active patients in follow-up care.

“More than 80% of patients admitted to CRAM for specialized care are referred by other health centers,” explains Dr. Florindo Mudender, Country Director for I-TECH Mozambique. “Critically ill patients are treated at CRAM until they are stable, then sent back to their facilities of origin to continue treatment. In addition to acute care, CRAM also provides individualized supportive services to patients who often present with dire psychological, social, and economic conditions.”

These supportive services proved crucial to Aisha,* a 43-year-old mother of five who had difficulty accepting her HIV status, believing that her church’s pastor had cured her disease through prayer.

Referred to CRAM five years ago with a diagnosis of Kaposi’s sarcoma, Aisha was prescribed second-line antiretroviral therapy (ART). However, after losing her job due to COVID-19, Aisha was subject to food insecurity, discrimination, social stigma, and physical, psychological, and financial abuse by her partner.

After routinely presenting a high viral load and suffering severe weight loss, Aisha’s care team at CRAM assumed she had not been taking her medication – possibly because of her religious beliefs and a lack of food. She was severely depressed, to the point of attempting suicide.

Worried about her condition, the team at CRAM enrolled Aisha in wraparound services, including behavioral psychotherapy, education in self-care and self-esteem, treatment adherence support, positive prevention, couple’s therapy and socio-family integration, group therapy with other patients with depression, and antidepressant medication.

After several months, Aisha’s last viral load test showed a result of “undetectable,” and her depressive symptoms abated. Thanks in part to the support from CRAM, Aisha is now adhering to her ART, has regained her self-esteem, is working again, and eats regular meals. Her partner tested HIV-negative and has learned to support her so that she feels valued and loved. Aisha attends psychotherapeutic sessions quarterly at the CRAM to monitor her psychological and social well-being.

“[My husband] helps me a lot, so I don’t forget to take my pills, and I am very happy about that and with the improvement I made with my health,” says Aisha. “Before, we were hungry, and now, I am back to work. With the little I earn I can help with the household expenses.”

CRAM is considered a center of excellence and the main training site for AHD for Mozambique Ministry of Health clinicians and PEPFAR-funded implementing partners.

“I-TECH is currently refining a referral and counter-referral system between CRAM and Maputo City’s health centers, to ensure patient care continues after discharge,” says Dr. Mudender “The system will include a free mobile line to assist clinicians with advice from senior specialists.”

*Name has been changed to protect privacy.

 

Expanding Two-Way Texting for Voluntary Medical Male Circumcision Clients in South Africa

Post categories: Caryl Feldacker Male Circumcision South Africa
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I-TECH, in close partnership with voluntary medical male circumcision (VMMC) implementing partner, the Aurum Institute and technology partner, Medic, is conducting a five-year study funded by the National Institutes of Health to further evidence on the efficiency, safety, and scalability of two-way text-based (2wT) follow-up for VMMC services.

An example of the 2wT tab display options.
An example of the 2wT tab display options. Image Credit: © 2022 Marongwe et al. via PLoS Digital Health, Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe.

2wT is SMS-based telehealth, providing direct patient to provider communication that improves the quality of post-operative VMMC care. A daily educational message is sent to each participant, requesting a response to report potential complications. 2wT allows the nurse to triage men to care when needed or desired while supporting most men to heal independently at home. 2wT-based follow-up dramatically reduces unnecessary post-operative visits, saving patient and provider costs, while improving patient care quality through swift identification and referral for potential adverse events. In South Africa, the 2wT intervention benefits were similar across routine VMMC programs in both rural and urban settings.

This 2wT intervention in South Africa builds on the I-TECH work previously done in Zimbabwe, which found that “2wT reduced client visits by 85%, increased AE identification, and reduced costs.”

Transitioning OpenELIS Training and Implementation to Local Professionals in Côte d’Ivoire

Post categories: Cote d'Ivoire DIGI Jan Flowers Laboratory Systems Leadership & Management
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For nearly a decade I-TECH has worked in Côte d’Ivoire in collaboration with the US Centers for Disease Control and Prevention to develop and implement an electronic laboratory information system (LIS) in key laboratories. In order to respond to evolving data needs and ensure timely access to quality laboratory data, an electronic LIS requires ongoing development and continuous user training and technical support.

Previously, from 2015-2017 I-TECH worked closely with the Ivorian Ministry of Health and Public Hygiene (MSHP)’s Directorate of Informatics and Sanitary Information (DIIS) to identify, develop and reinforce the capacity of local professionals to lead and conduct LIS training, deployment, and maintenance activities in anticipation of national roll-out of the LIS at 96 general hospital laboratories. As part of this effort, and in collaboration with the DIIS, I-TECH trained users and deployed LIS at 13 national and regional level laboratories. Between 2013 and 2015, the total number of local professionals competent in LIS deployment increased to 24 local LIS support providers, while the number of in-country LIS trainers increased to 27. Within ten months, local IT providers and trainers trained over 75 health care workers to use an LIS and implemented an LIS at 36 laboratories. During supervision visits to 26 laboratories, within 4 to 6 months post-installation, 25 out of 26 (96%) of laboratories were actively using the LIS.

More recently, Côte d’Ivoire International Training and Education for Health (I-TECH CIV), I-TECH’s local partner in Côte d’Ivoire, has started working directly with CDC and DIIS and continued to engage I-TECH computer developers and deployment strategists to continue the progress with LIS.

I-TECH continues to make considerable progress with code base development for OpenELIS. For more information, visit the OpenELIS Global website.

I-TECH and Zim-TTECH Publish Paper on Transitioned Programs

Post categories: Best Practices Health Systems Strengthening Integrating Research and Practice Scott Barnhart Stefan Wiktor Transition & Sustainability Zimbabwe
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Faculty and staff from the International Training and Education Center for Health (I-TECH) and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) have published a new paper in the journal PLOS One.

Working toward sustainability: Transitioning HIV programs from a USA-based organization to a local partner in Zimbabwe catalogs the challenges and lessons learned as I-TECH laid the groundwork to transition the voluntary medical male circumcision (VMMC) and HIV care and treatment programming in Zimbabwe to the newly established Zim-TTECH, a fully independent local organization.

“I-TECH prides itself on working collaboratively with our international partners. We held the principle from day one that the most successful programs happen when the locus of control sits in-country,” said Marrianne Holec, Senior Program Manager at I-TECH. “We had the foundation in place with our local staff, what was missing was the organizational structure to allow the team in-country to truly lead the project. With the formation of Zim-TTECH, I’m happy to say we are there.”

Among USG funders, it’s recognized that future models for sustainable healthcare rely on local country ownership and leadership.[1] But making the transition from US-based ownership to country ownership isn’t a one-time event, added Holec, “It’s a process that takes time. We wanted to document our process so that other international organizations who are looking to pursue decolonizing global health programming can learn from our experience.”

Through 16 key informant interviews, the team gathered views on transition planning, implementation, and technical support, ethics, and success. Five themes emerged from the data collected:

  • Develop a vision and empower leadership for change by delegating clear roles and supporting local ownership;
  • Plan and strategize for transition in a manner that accounts for historical context;
  • Communicate with and inform stakeholders to understand transition perceptions, understand barriers to transition, and enable open communications related to risks and benefits;
  • Engage and mobilize staff by constructing necessary infrastructure and providing technical assistance as needed; and
  • Define short-term and long-term success.

“Sustainability of successful donor funded public health programs is critical if we want to maintain the important gains that have been made over the years,” says Dr. Batsi Makunike, Executive Director of Zim-TTECH. “Strong local organizations with good governance, management, and technical capacities are an important cornerstone of sustainability.

“The process of transitioning from an international to a local organization is daunting,” she continues. “We hope that this study is helpful to other organizations in their efforts to transition.”

[1] Goosby E, Von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the Bar: PEPFAR and New Paradigms for Global Health. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;60.

Nurses Complete Infectious Disease Specialization with CHARESS Support

Post categories: Haiti HIV Care and Treatment HIV Co-Infection Human Resources for Health Nancy Puttkammer Nursing/HCW Cadres
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This story was first reported in Vant Bèf Info.

With the support of the Haitian Center for Health System Strengthening (CHARESS), I-TECH’s primary partner in Haiti, 17 clinical nurses recently completed specialty training in infectious diseases.

The initiative, conducted in partnership with the U.S. Centers for Disease Control and Prevention (CDC) and the Faculty of Medicine and Pharmacy (FMP) of the Université d’État d’Haïti, aims to contribute to the strengthening of human resources in health, increasing the number of qualified clinicians in Haiti. The year-long training comprises theoretical and practical components; this cohort’s practica took place at seven different university hospitals and other health institutions around the country.

“Haiti faces a serious problem of shortage of human resources in health, due in part to the ‘brain drain’ abroad,” says Dr. Jean Guy Honoré, Executive Director of CHARESS. “In some health facilities located in remote parts of the country, there are no physicians, and patients are seen by nurses who sometimes have limited knowledge of the management of infectious pathologies. This training aims to improve the skills of these nurses.”

This aptly fits the vision of CHARESS, which is “to be the reference center, in terms of training, research and technical assistance, allowing populations to receive quality care, with humanity,” says Dr. Honoré. Two other cohorts of nurses have already started this specialized training.

Dr. Bernard Pierre, Dean of the FMP, expressed a wish to strengthen the collaboration between the FMP and CHARESS to extend similar specialized training to doctors — in particular, general practitioners.

I-TECH and its partners have been working in Haiti since 2006, delivering training, clinical mentoring, health information systems, and other health systems strengthening interventions.