Since 2020, the Digital Initiatives Group at I-TECH (DIGI) has worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to optimize and improve workflows across health systems in Mauritius to ensure the rapid processing and notification of COVID-19 test results.
In collaboration with the Mauritius MOHW, DIGI deployed OpenELIS, an open-source electronic LIMS, to increase capacity at the national reference laboratory and optimize the workflow between regional flu clinics and reference labs.
DIGI also digitized the COVID-19 screening declaration form that is used for all passengers arriving at the Mauritius International Airport and supported MOHW in opening a COVID-19 reference laboratory at the airport to rapidly process tests and notify passengers of their COVID-19 test results. Since opening in December 2020, the airport reference laboratory has returned over 250,000 tests and continues to process thousands of tests daily.
DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.
The Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to implement a national laboratory information system (LIMS) using OpenELIS and expanded it to create a national-level data warehouse.
The data warehouse captures all the information that has been input into OpenELIS by the two reference labs and all ten regional flu clinics and creates real-time, easy-to-read data dashboards. These dashboards are used by the MOHW staff and public health officials to track national COVID-19 cases numbers and trace ongoing and potential outbreaks of COVID-19 and other infectious diseases.
DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.
Since 2020, the Digital Initiative Group at I-TECH (DIGI) has worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to deploy a national laboratory information management system (LIMS) using the OpenELIS platform. The LIMS connects the national reference laboratory to regional laboratories and flu clinics around the country to quickly process COVID-19 tests, as well as send results notifications to patients via text message or email.
The OpenELIS system, while implemented to support COVID-19 surveillance, was also designed to be able to support most routine lab workflows, including HIV viral load testing and other other infectious diseases (e.g., HIV, Ebola, Zika, Chikungunya), which ensures MOHW can quickly trace, respond to, and manage cases.
DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.
As a measure to help stop the spread of COVID-19, the Government of Mauritius began requiring that all arriving passengers submit to COVID-19 health screenings upon arrival in Mauritius. To rapidly process the influx of tests and quickly notify passengers of their results, the Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to digitize the COVID-19 screening declaration form for all passengers arriving to the Mauritius International Airport and supported MOHW in opening a COVID-19 reference laboratory at the airport to rapidly process the tests and send notifications of COVID-19 tests passengers.
The airport laboratory is connected to the National Reference Laboratory via OpenELIS, which allows all the data captured on the digital form, such as passenger information and COVID-19 screenings/test results, to assist public health officials from all over Mauritius to carry out surveillance and contact tracing efforts.
Since opening in December 2020, the airport reference laboratory has returned over 250,000 tests and continues to process thousands of tests to passengers and citizens of Mauritius daily.
The Extension for Community Healthcare Outcomes (ECHO) Project® was developed by the University of New Mexico to improve care for underserved populations using a hub-and-spoke approach of knowledge-sharing by video-conferencing technology. The Lighthouse ECHO project provides a platform for sharing critical, timely, and life-saving information and data with health care workers (HCWs) located in different locations and facilitates peer-to-peer interactions among local, regional, and international experts using real-time, video-conferencing technology.
Lighthouse, a long-standing I-TECH implementing partner, is a World Health Organization-recognized clinic for integrated HIV prevention, treatment, and care in Malawi, serving approximately 60,000 antiretroviral therapy patients across the country. Lighthouse is an established HIV education site and has been involved in capacity building in pre- and in-service trainings for staff from the Ministry of Health as well as non-governmental organizations and implementing partners for many years.
Since April 2020, Lighthouse’s Project ECHO has conducted 67 sessions and has served 4,150 participants on COVID-19, HIV, and tuberculosis topics.
Malawi is one of first countries in Southeast Africa to respond to the World Health Organization’s call for robust birth surveillance systems. Routine surveillance is essential for public health monitoring of pregnancy outcomes and birth defects, especially in high-HIV burden settings where women living with HIV initiate the use of antiretroviral therapy before or during pregnancy.
Since 2016, the International Training and Education Center for Health, in collaboration with the Centers for Disease Control and Prevention, has supported the implementation of an active hospital-based birth surveillance system at four high-volume facilities in Malawi. To date, a total of 165,608 of births have been assessed. A subset of women are also enrolled in an ongoing nested case control study to assess associations between external birth defects and maternal exposures such as prior health conditions, medications, and environmental and lifestyle factors.
Anticipated use of these data include:
Establish a baseline prevalence of external birth defects in Malawi
Evaluate the impact of introducing new drugs for the management of HIV (e.g., dolutegravir) on the prevalence of external birth defects
Advocate for investment in programs and interventions to reduce the occurrence of birth defects and adverse pregnancy outcomes.
The International Training and Education Center for Health (I-TECH), under the leadership of Government of Namibia ministries overseeing child welfare and health and in close collaboration with the Namibia Statistics Agency (NSA), UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC), supported the implementation of Namibia’s first Violence Against Children and Youth Survey (VACS).
VACS are national surveys that measure the prevalence and impact of violence on children and youth around the world. The survey results help inform future program decisions and policy approaches to ensure the safety of children and youth. On 28 September 2021, the Day of the Namibian Child, the Government of Namibia published the final Namibia VACS report.
The survey, funded by the U.S. President’s Emergency Plan for AIDS Relief and led by the Ministry of Gender Equality, Poverty Eradication and Social Welfare (MGEPESW), interviewed households with children aged 13-24 years in all 14 regions of Namibia from March 2019 through June 2019.
Survey operations—including data collection by field teams, data generation, and analysis—were carried out by the NSA, the central statistical authority responsible for all official statistics in Namibia. “It has been a pleasure working together with the Ministry of Gender Equality, the University of Washington, I-TECH, and CDC on this important survey,” says Ottilie Mwazi, Namibia’s Deputy Statistician General. “Our team has learned a lot from the process and is very proud to have contributed important data that will help to improve child welfare in Namibia.”
Prior to data collection, I-TECH alongside CDC colleagues hosted a two-week training for 130 enumerators, focused on best practices for data collection, interview techniques, and key aspects of the survey protocols. In addition to supporting VACS training, I-TECH and the Ministry of Health and Social Services (MoHSS) ensured all selected enumerators were trained and certified by the Namibia Institute of Pathology to conduct HIV rapid testing so any survey respondent aged 14-24 years who did not know their HIV status and wanted a test during their interview could immediately be tested.
In total, 5,191 individual interviews among 6,042 households (86.35% overall response rate) and 3,232 HIV rapid tests were conducted as part of data collection. Any respondent testing positive for HIV during the survey was linked to psychosocial and HIV/AIDS care and support in line with well-established MoHSS guidelines and the survey protocol.
Expanding Post-Violence Clinical Care
The survey results have informed important initiatives across Namibia’s wider social welfare and health systems. MGEPESW has moved forward with drafting the National Action Plan on Violence against Children and has accelerated the training of various child welfare stakeholders such as police officers and social workers, while operationalizing the establishment of more child shelters in several regions.
“The data coming out of Namibia’s VACS have really brought home how prevalent and serious violence against children and adolescents really is,” says Helena Andjamba, Director for Child Welfare at MGEPESW. “Having these hard facts readily available has helped greatly during our policy and planning engagement with multiple stakeholders during the past year. We are now moving forward with the Ministry of Justice in drafting a new Child Justice Bill, and at the same time we are engaged with the Ministry of Education on strengthening the National School Safety Framework.”
Following the completion of the survey, the MoHSS convened a technical working group with I-TECH, the World Health Organization, UNFPA, Project Hope, and other stakeholders to coordinate and strengthen first-line post-violence clinical care in primary health care facilities across Namibia. I-TECH also supported the compilation of clinical guidance on emergency care for survivors of sexual violence and its inclusion in the 2021 edition of the Namibia Standard Treatment Guidelines published by the MoHSS.
Much of the focus during the second half of 2021 was on integrating post-gender-based violence (GBV) clinical care in MoHSS HIV/AIDS clinics and antiretroviral therapy (ART) services throughout Namibia. As part of this work, I-TECH conducted a mentorship training-of-trainers for 28 HIV clinical providers, nurses, and testing services staff. These mentors now provide ongoing technical guidance and supportive supervision to frontline health workers through monthly facility visits.
To further improve post-violence care in clinics, I-TECH compiled a GBV care implementation guide for Namibian healthcare providers. This includes elaboration of best practices, as well as a suite of materials including posters, pamphlets, job aids, and a pocket booklet for communities, clients, health workers, and health facility managers, respectively. An intimate partner violence/GBV screening tool to be administered to ART patients with persistent high viral loads is also currently being piloted in ten health facilities.
On World AIDS Day, December 1, staff from the International Training and Education Center for Health (I-TECH) convened with the Ministry of Health (MOH), Columbia University’s ICAP, and other national stakeholders in Malawi to present the results of the 2020-21 Malawi Population-based HIV Impact Assessment (MPHIA). The commemoration, with the theme of “End Inequalities, End AIDS, End Pandemics,” was held at Bumba Primary School grounds in Rumphi District.
Preliminary results of the assessment, led by the MOH and ICAP, show that the national HIV testing program, supported by I-TECH, has achieved a significant increase in the awareness of status among HIV-positive adults—from 77% in 2016 to 90.9% in 2020-21.
Malawi has also made great strides toward reaching the UNAIDS 95-95-95 Fast Track targets, surpassing both the second 95 (results indicate that 98% of those who know their status are initiated on treatment) and third 95 (results indicate 97% of those on treatment are virally suppressed).
The assessment will be critical to informing future programming, says Dr. Rose Nyirenda, Director of the Ministry of Health’s HIV and AIDS Department. “The 2020-21 MPHIA has produced a wealth of information that will be critical for tailoring our services and to refine strategies for closing the remaining gaps,” says Dr. Nyirenda.
The HIV and AIDS Department also exhibited commodities (antiretroviral medications, testing kits, opportunistic infection (OI) and sexually transmitted infection (STI) medicines, condoms, voluntary medical male circumcision kits) that are procured and managed through the Supply Chain and Logistics Unit.
Correction: A previous version of this article misstated the organization that conducted the 2020-21 Malawi Population-based HIV Impact Assessment. This assessment was led by the Malawi Ministry of Health and Columbia University’s ICAP.
For the past 10 months, Kayla Cody-Lushozi has served as the inaugural Global Health Program Officer for I-TECH’S Global Health Leadership Development Program. The aim of this program is to support the development of skills in global health program implementation, management, and leadership for recent master’s degree graduates with diverse backgrounds who are transitioning into the public health field.
This program is structured to directly support the programmatic needs of multiple I-TECH projects while providing the Program Officer with mentorship across the I-TECH network and supporting the transition into a non-temporary global health position. In 2019, Cody-Lushozi received her Master’s in Social Work (MSW) from the University of Washington (UW) and has used this background, along with her unique experiences and expertise, to inform her work at I-TECH.
During her time as a Program Officer, Cody-Lushozi has worked with three teams across the I-TECH network, plunging into a few of the many areas of work I-TECH implements and supports. In collaboration with partners from FHI 360 and leaders from the Cambodian Ministry of Health, Cody-Lushozi supported a health informatics program, working to streamline databases and strengthen health systems in Cambodia. Additionally, she explored how to revive Community Advisory Boards for people living with HIV (PLHIV) in Jamaica in a sustainable and community-centered way with I-TECH network partner the Caribbean Training and Education Center for Health (C-TECH). She worked with community partners in Zimbabwe, as well, exploring the support systems in place for case managers supporting young PLHIV. This work was done with I-TECH partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH).
September marks the end of Cody-Lushozi’s time with I-TECH. Below, she shares some reflections on her time in the Leadership Development Program, as well as what might come next.
What has the experience of being a Program Officer at I-TECH meant to you?
This has been an incredible experience, and it came at a perfect time. Right before I-TECH, I was working at the Washington State Department of Social and Health Services doing direct service social work with economically marginalized clients with mental and physical health needs. While I enjoyed this role and understood its importance, this was not the type of social work practice that I wanted to pursue in the long run.
My passion and interests lie in research, especially community-centered research that allows me to work directly with Black communities in improving access to health justice. I-TECH came along at the right time and allowed me to dive deeper into the world of global health implementation.
The projects I’ve done at I-TECH have been really varied, and I’ve gotten an inside look and experience across different areas. I am constantly learning at I-TECH. I-TECH does a million things, which might have been overwhelming to a new person entering the organization, but I always felt very supported by my teams. They made it clear that I didn’t need to have all the answers.
I also appreciate that this program aims to attract a diversity of experience, background, and perspective. It encourages more than just a singular lens. I’ve been able to share my unique background and experiences as a Black woman social worker in global health. I’m excited to see where this program goes and how it continues to support I-TECH’s evolution.
This has been a beautiful experience for me. Working at I-TECH served as a great affirmation that this is the area of work that I want to continue to grow in.
How has your background in social work shaped how you’ve entered the global health field?
Before getting my MSW I already had an interest in public health, even before I was calling what I was doing public health. I wanted to use the framework and the lens that social work provides within a public health setting. I always gravitate toward work that is community-centered and centers the voices and expertise of those in the margins. These are some of the values that I bring with me into the global health space and that I hold very close to my professional and personal practice.
These values have helped me in this field because public and global health work is not always operating from the pillars of anti-oppressive practice. There’s so much historical and contemporary discourse that needs to be addressed and often isn’t in this field. You can’t be ahistorical if you’re truly trying to get to the root causes of global health inequity and injustice. Many of the issues that we see in global health are connected to issues of global white supremacy, imperialism, and resource extraction. It’s a tension that I hold in this field but something I try to do my part to shed light on.
You have done a lot of meaningful work during your time with I-TECH. What does your life look like when you’re not working?
I’ve gone through a lot of life changes these past 10 months. I’m a newlywed; I got married in June to my now husband Mawande. Being a new wife is really exciting.
A big chunk of my husband’s and my time outside of work is dedicated to our small homemade skincare business, K+M Homemade Skincare, that we officially launched during COVID. We do a lot of farmer’s markets and pop-ups on the weekends. Ask anyone and they can tell you that we love making and talking about our skincare.
In what direction do you see yourself moving after I-TECH?
After I-TECH, I see myself continuing to engage in global and public health spaces that are truly committed to community work and radical racial and social justice transformation. I am not comfortable doing this work in the absence of working directly with community members and local stakeholders. Top-down approaches have colonial and imperialist roots. I believe in doing “with” and not doing “to” and actively partnering with communities for long-term sustainability and quality health care reform.
I will be packing up and moving to South Africa in 2022 and am currently open to a position that will allow me to continue to practice in this exciting field. My interests lie in research, project management, and implementation work related to HIV care and treatment, maternal and child health, and mental health. I am also contemplating pursuing an MPH or a PhD in global health and implementation science sometime in the future. It’s been an incredible past 10 months with I-TECH and I am excited to stay in contact with this global network. I thank everyone who has been part of this journey with me!
The I-TECH network thanks Kayla Cody-Lushozi for her work and wishes her well as she continues to forge her path in global health!
If you are interested in participating in the Global Health Leadership Development Program, more information is available here.
In a time of increased barriers, disruptions, and restrictions due to the COVID-19 pandemic, the International Training and Education Center for Health (I-TECH) and its network partners have implemented new approaches and adapted existing programs to support continued access to antiretroviral therapy (ART).
As a result of the pandemic, many organizations and health systems have had to shift to offering virtual care, which allows ART initiation and other HIV services to persist while minimizing patients’ risk of exposure to COVID-19. However, not all patients have access to the technology that makes virtual services possible, and additional approaches are needed to support ART treatment access during this time.
“Globally, the pandemic has generated innovative responses from communities and health systems that are striving to keep people connected to care,” says Dr. Pamela Collins, I-TECH Executive Director. “One challenge is to recognize how (or when) some adaptations increase disparities in access. We’ve learned that the right combinations of technological and no-tech solutions can also be innovative if they help provide the care that’s needed.”
One way I-TECH has helped to provide innovative care during the pandemic is by centering solutions within the affected communities themselves. A few of the community-oriented approaches that the I-TECH network has implemented include decentralized ART centers, community outreach, home delivery, community adherence refill groups (CARGs), and multi-month dispensing (MMD) of antiretroviral (ARV) medication.
Decentralized ART Refill Sites and Community Outreach
Decentralized refill sites have been an essential strategy during lockdown restrictions for I-TECH’s network partners because they allow ART to be distributed at more convenient locations, minimizing travel and treatment interruptions. Some programs have also started providing mobile outreach to improve ART access during the pandemic, at times even providing doorstep delivery to those who are unable to go to a clinic or refill center.
I-TECH’s network partner in India, the UW International Training & Education Centre for Health Private Limited (I-TECH India) launched the ARTMitra helpline in Mumbai, an outreach effort designed to map the location of unreachable PLHIV and aid in planning decentralized ART refill sites. SMS messages were delivered to 13,103 PLHIV who had missed appointments during the pandemic, resulting in the identification of 42 decentralized ART refill centers in Mumbai in 2020. A similar helpline was launched in five districts of the state of Mizoram in partnership with the State AIDS Control Society. In total, I-TECH India, in close coordination with government partners in the PEPFAR states in Northeast India and in Mumbai, has ensured uninterrupted ART delivery through 145 decentralized ART refill sites.
Through outreach efforts, clients were notified about how they could access medication, and which decentralized ART refill site they should visit. Additionally, ART home delivery was provided to 255 PLHIV living in Mumbai who were unable to pick up their medication.
Thank you for calling and informing me about the availability of medicine at the nearby ART Centre, as I had no idea whom to contact and how to collect medicine.
—an ARTMitra client in Mumbai
I-TECH network partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) has also utilized community outreach to support PLHIV during the pandemic. Zim-TTECH has supported the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium—along with PEPFAR partners, the U.S. Centers for Disease Control and Prevention (CDC) and in close collaboration with national efforts—to provide mobile HIV care, including prevention services and integrated services at ART events. In the Harare District, 8,257 clients were supplied ART during outreach events from 28 March through 17 July 2021.
Community Adherence Refill Groups and Multi-Month ART Dispensing
Through CARGs, a community of PLHIV access treatment more easily by sending a representative to receive ARVs for the entire group. The I-TECH network implements CARGs in a number of countries, using the person-centered approach to simplify HIV care and reduce the need for in-person services. This approach is often used in tandem with MMD, allowing a group to access multiple months of medication at a time.
While ARVs have traditionally been prescribed monthly, MMD allows patients to pick up medication for 2 to 6 months and reduces traditional barriers, such as access to transportation and taking time off work, as well as barriers specific to COVID-19, such as lockdown restrictions and limited capacity of health care facilities. I-TECH and its network partners have scaled up MMD in many programs during the COVID-19 pandemic, effectively minimizing the number of in-person visits and encouraging ART adherence.
In response to COVID-19 and in partnership with CDC, the Ministry of Health and Social Services (MoHSS) in Namibia introduced a new MMD policy in April 2020 for eligible ART patients, making more people eligible for this service than ever before. In addition to policy support, I-TECH Namibia is engaged in technical support to the national HIV/AIDS program through clinical mentors who work in more than half of Namibia’s health districts. This national engagement has contributed to a rapid increase in the number of eligible ART patients who now receive between 2 to 6 months’ supply of ARVs at a time.
‘’As the number of ART patients on MMD increased, waiting areas in Namibia’s health facilities have rapidly decongested, enhancing COVID-19 infection prevention and control measures,” says Dr. Norbert Forster, I-TECH Namibia’s Country Director. “At the same time, our HIV clinicians now have more time to focus their care on patient engagement and on enhancing viral load suppression and other interventions.”
I-TECH’S WORK IN INDIA 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.