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I-TECH

Category: HIV Care and Treatment

I-TECH Zimbabwe Office Transitions to Local Organization

Post categories: Caryl Feldacker HIV Care and Treatment Male Circumcision Scott Barnhart Stefan Wiktor Transition & Sustainability Zimbabwe
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Zim-TTECH staff supports Kowoyo Clinic in Goromonzi District, Mashonaland East Province, Zimbabwe. Photo credit: Macpherson Photographers.

The International Training and Education Center for Health (I-TECH) has transitioned another office to an autonomous entity. The Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) was officially launched on April 1, 2020, as a locally registered health trust. Zim-TTECH is the administrative and managing partner for the two existing I-TECH CDC/PEPFAR funded grants in Zimbabwe, each grant having a consortium of local partners:

  • ZimPAAC (Zimbabwe Partnership to Accelerate AIDS Control) is a partnership between Zim-TTECH, Africaid, Pangaea Zimbabwe AIDS Trust, and I-TECH. ZimPAAC collaborates with the Ministry of Health and Child Care (MoHCC) on context-appropriate health interventions to improve access to, as well as strengthen the quality of HIV prevention, treatment, care, and support services. ZimPAAC provides services at 373 facilities in 17 districts.
  • ZAZIC is a partnership between Zim-TTECH, I-TECH, and two local implementing partners—Zimbabwe Association of Church Related Hospitals (ZACH) and Zimbabwe Community Health Intervention Research Project (ZiCHIRe). ZAZIC supports voluntary medical male circumcision (VMMC) services at 38 static facilities in 13 districts.

“The transition from an I-TECH country office to a fully fledged independent local organization is exciting,” states Dr. Batsirai Makunike-Chikwinya, Zim-TTECH’s Executive Director. “Zim-TTECH is committed to continue to provide high-quality support to the MoHCC and to the health sector as a whole. Special thanks go to management and staff of both I-TECH/UW [University of Washington] and UZCHS-CTRC [University of Zimbabwe College of Health Sciences Clinical Trials Research Centre], who played pivotal roles during this transition.”

I-TECH has worked in Zimbabwe since 2003, collaborating with the MoHCC and other partners to improve clinical services and strengthen health systems.  “It is a pleasure to support the launch of Zim-TTECH, which is the right next step toward country ownership and, importantly, recognizes the high level of skill and professionalism of the prior I-TECH country office and now Zim-TTECH team,” remarks Dr. Scott Barnhart.

Expanding HIV Care and Treatment in Zimbabwe

Post categories: Cervical Cancer Differentiated Care Gender/Women & Girls Health Systems Strengthening HIV Care and Treatment Index Testing/Partner Notification Key Populations PrEP Stefan Wiktor Zimbabwe
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The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:

  • Diagnose 95% of all persons living with HIV through integrated testing
  • Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained in care, and are virally suppressed using differentiated service delivery models

Using a Differentiated care model, a patient-centered model of service delivery designed to meet the diverse needs and expectations of all people living with HIV, ZimPAAC oversees activities such as:

  • facility and community-based HIV testing;
  • HIV self-testing, index case testing;
  • ART initiation; and
  • ART delivery through multi-month refills for stable patients, Family ART Refill Groups, and Community ART Refill Groups (CARGs). CARGs benefit group members—through decreasing health center visits, offering peer support, and allowing clients to take responsibility for their health—and staff, by decreasing workload and allowing greater time for patient care.
I-TECH Zimbabwe Care and Treatment Sites and Districts
A map of I-TECH’s Care and Treatment Sites and Districts in Zimbabwe.

In addition to differentiated service delivery, ZimPAAC conducts site-level mentoring at health facilities to strengthen health service delivery towards the “95-95-95” UNAIDS targets by improving patient linkages between HIV testing, initiation on treatment, and retention in care rates. This is accomplished in part by several hundred dedicated HIV testers and nurses who support ART initiation and management of opportunistic infections alongside MoHCC staff.

ZimPAAC also supports index testing through community linkages activities that help clients access HIV testing, especially sexual partners and biological children of existing HIV-positive clients who present to the health facilities. In an effort to improve index testing within MoHCC health facilities, ZimPAAC has implemented an assisted partner service model, known as Enhanced Index Case Testing. This program emphasizes reaching clients recently diagnosed with HIV and those whose blood tests show a high HIV viral load. Quality Improvement activities are a key part of ZimPAAC’s approach to improving outcomes for index testing. In 2019, a “change package” describing the interventions that have improved index testing was developed by ZimPAAC for national scale-up of the model.

ZimPAAC program activities also support retaining people living with HIV in care. Programs engage community linkage facilitators who work with facilities and communities to identify patients who have defaulted from treatment and return them to services.

In addition to HIV care and prevention for adults, ZimPAAC supports increased access to services for children and adolescents through Africaid’s community adolescent treatment supporters (CATS). CATS are HIV positive 18-to-24-year-olds trained to provide peer support, conduct demand-creation activities, build community engagement, and mobilize targeted HIV testing and outreach activities to bring services to this hard-to-reach group.

In addition to the first two objectives, ZimPAAC collaborates with MoHCC towards two additional objectives:

  • Strengthen and expand access to cervical cancer screening and treatment of precancerous cervical lesions among women living with HIV
  • Increase uptake of pre-exposure prophylaxis (PrEP) services through training, technical assistance and direct client support

In 2019, ZimPAAC began the expansion of cervical cancer screening for women living with HIV, beginning with a situational analysis to identify sites for implementation of a program serving women with visual inspection with acetic acid and cerviography.

Under the direction of PZAT, ZimPAAC also works closely with the MoHCC to support key-population-friendly programming in the public health sector facilities in Harare. PZAT supports health worker training at selected facilities and builds demand and knowledge of these services through community champions and engagement with vulnerable populations and advocacy and civil society organizations. PZAT also works to promote PrEP services for adolescent girls and young women in Mazowe district and among key populations in Harare.

Two-Way Texting for Post-Operative VMMC Follow-Up RCT in Zimbabwe

Post categories: Caryl Feldacker Health Information Systems HIV Care and Treatment Male Circumcision Zimbabwe
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Voluntary medical male circumcision (VMMC) is considered safe and the vast majority of men heal without complication. However, guidelines require multiple follow-up visits, which can burden staff and facilities with clients who are typically healing well. With funding from the National Institutes of Health (NIH), ZAZIC recently conducted a prospective randomized control trial (RCT) to determine if two-way texting (2wT) was as safe as routine post-operative visits and if it reduced workload in two high-volume VMMC sites near Harare, Zimbabwe.

Image of the 2wT App used to support the study.

Both clients and providers felt satisfied with the 2wT system and felt it could be ready for scale. Many clients reported feeling confident, comfortable, satisfied, and safe with text follow-up. Importantly, clients felt that 2wT saved them time and money. Providers also noted 2wT saved them time, empowered their clients to engage in the healing process, and addressed gaps in MC service quality.

The results strongly suggest that 2wT is highly usable and acceptable for providers and patients. Men with concerns appeared confident and comfortable to receive guidance via text and providers noted that men engaged proactively in their healing.

It was recommended in the study that 2wT between providers and patients should be considered for future adaptation in other short-term care contexts. 2wT also appears far less expensive than active follow-up to improve patient safety: on average, post-VMMC follow-up under 2wT was $0.098 compared to $0.955 under routine care. 2wT was both less costly and more effective in identifying AEs relative to the expected rate of AEs.  As such, I-TECH aims to scale 2wT in further testing among rural clients and guardians to improve patient care at lower cost.

The trial is registered on ClinicalTrials.gov, trial NCT03119337, and activated on April 18, 2017. https://clinicaltrials.gov/ct2/show/NCT03119337. This RCT was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.

Driving Collaboration with Local Implementation Partners in Zimbabwe

Post categories: Caryl Feldacker HIV and STI Prevention HIV Care and Treatment Scott Barnhart Stefan Wiktor Zimbabwe
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I-TECH builds local ownership and sustainability through collaborations throughout Zimbabwe. Under the CDC and PEPFAR awards, I-TECH has formed and leads two consortia – ZAZIC and ZimPAAC.

Continue reading “Driving Collaboration with Local Implementation Partners in Zimbabwe”

I-TECH Helps to Improve Health Regulatory Systems and Training Programs in Cambodia

Post categories: Ann Downer Cambodia Health Policy Health Systems Strengthening HIV Care and Treatment Human Resources for Health Jeff Lane Leadership & Management Uncategorized
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Pictured are mannequins used at two regional training centers for nurses, midwives, and dental nurses in Kampong Cham and Battambang, Cambodia. I-TECH has supported the procurement of new mannequins to replace those that are old or broken, as well as new teaching tools that will expand the centers’ ability to conduct simulation training. Photo credit: Ann Downer/I-TECH.

The International Training and Education Center for Health (I-TECH) is working on a project led by FHI360, and funded by the U.S. Agency for International Development (USAID), to empower health care managers and national and provincial stakeholders to improve service quality, safety, and utilization, as well as strengthen overall health systems in Cambodia.

The project’s four objectives include:

  1. Improving policies, guidelines and standards for streamlined quality assurance.
  2. Increasing the efficiency and effectiveness of service delivery.
  3. Strengthening regulatory framework, implementation, and enforcement.
  4. Supporting pre-service public health training.

Given I-TECH’s deep experience in health workforce development, supporting the environments that enable strong health systems, and working with stakeholders at all levels, the team was a natural fit for Objectives 3 and 4.

In service of this critical work, I-TECH is supporting implementation of regulations among private and public health workers, as well as helping to lay the foundation for a sustainable accreditation program for public and private health facilities. I-TECH’s team also works with national stakeholders to develop the capacity of pre-service training institutions to deliver high-quality programs aligned with current evidence and national health priorities.

“We are excited to work with our partners to strengthen these critical components of quality health services in Cambodia,” said Jeff Lane, Principal Investigator and Assistant Professor in the Department of Global Health.

“By leveraging I-TECH’s broad experience in health policy, regulation, and workforce development,” he continued, “we can help Cambodia build an accreditation program to recognize high-performing hospitals, strengthen health professional councils to regulate health practitioners, and build sustainable pre-service training institutions that deliver competency-based education to train Cambodia’s health care workers of tomorrow.”

I-TECH Shares Work at IAS 2019

Post categories: HIV Care and Treatment Index Testing/Partner Notification Malawi Mozambique
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Yusuf Babaye, MBA, MSc, presents his poster at IAS 2019.
Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presenting a poster at IAS 2019.

Representatives from the International Training and Education Center for Health (I-TECH) attended the 10th Annual International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City, Mexico on 21-24 July 2019. The IAS Conference on HIV Science is a biennial conference that brings together approximately 6,000 researchers, advocates, policy makers, funders, and community leaders. It showcases advances in HIV care, prevention, and treatment; explores new directions for HIV care, prevention, treatment, and research; and features the latest in HIV research.

Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presented a poster titled, “A Cross-Sectional Study on Levels of Knowledge on Provision of Second-Line Antiretroviral Therapy in Malawi in 2016.” The poster focused on the need to build capacity for providing second-line antiretroviral therapy following first-line treatment failure.

I-TECH’s partner notification services work in Mozambique was also highlighted in an article that was included in the Journal of the International AIDS Society (JIAS) supplement published prior to IAS 2019. The supplement, “The Power of Partners: Experiences from implementing and scaling-up HIV partner notification and index testing services,” shares key lessons learned from programs implementing, evaluating, and scaling up partner notification services.

Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania

Post categories: Clinical Mentoring Differentiated Care Health Systems Strengthening HIV Care and Treatment HIV Co-Infection Human Resources for Health Tanzania
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High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization’s (WHO) recommendation to “Treat All,” eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) is eliminated, and all populations and age groups are linked in one universal policy. This recommendation change erases the distinction between all groups. However, a substantial number of PLHIV still present late to care and have advanced disease, and require interventions that prioritize clinical packages to reduce mortality and morbidity and eventually enable them to become clinically stable [1].

Continue reading “Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania”

Renewed Awards Totaling $24 Million Help Usher Zimbabwe Toward HIV Epidemic Control

Post categories: Ann Downer HIV Care and Treatment Male Circumcision Scott Barnhart Uncategorized Zimbabwe
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Dr. Batsi Makunike (L), I-TECH ZImbabwe Country Director, presents Dr. Ann Downer, I-TECH Executive Director and former PI of the Zimbabwe Care and Treatment project, with a farewell gift. The batik was made by using sadza porridge to apply the dye to the fabric.

Last Saturday, 1 December 2018, marked the 30th World AIDS Day, with a focus on urging all people to know their HIV status, as well as on ensuring access to prevention, care, and treatment services for those affected by the disease. Two programs at the International Training and Education Center for Health (I-TECH) are working in concert with local partners to help make those goals a reality in Zimbabwe.

A center in the University of Washington (UW) Department of Global Health, I-TECH has worked in Zimbabwe since 2003, starting with a $150,000 grant for an assessment of the need for HIV training in the country. Since then, work in the country has expanded to two awards totaling more than $24 million for the current year—one of which focuses on HIV testing, care, and treatment and the other on voluntary medical male circumcision (VMMC) for HIV prevention.  Both projects are funded by the U.S. Centers for Disease Control and Prevention, through the President’s Emergency Plan for AIDS Relief (PEPFAR), and operate through consortia comprising I-TECH and local partners.

The consortium for the VMMC award, ZAZIC, will continue to be led by Dr. Scott Barnhart, Professor in the UW Department of Global Health and School of Medicine. However, the consortium for the care and treatment award, the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC), has undergone a change in leadership: its new Principal Investigator (PI) is Dr. Stefan Wiktor, Professor in the UW Department of Global Health. Dr. Wiktor was handed the baton by the project’s previous Principal Investigator, Dr. Ann Downer, I-TECH Executive Director and also a Professor in the department, during a ceremony in Harare in October 2018.

“We are all so grateful to Dr. Downer for the past five years; for gently, but firmly leading us through the transition from a training and mentoring grant to a high-impact service delivery grant in five provinces,” said Dr. Batsi Makunike, I-TECH Zimbabwe Country Director. “Looking ahead, we welcome Dr. Wiktor to our team and the opportunity to tap into the wealth of experience that he brings as our new PI.”

Dr. Wiktor expressed hope that, through the continued hard work of the Zimbabwe consortium, the country will achieve its national and global targets. “Zimbabwe is one of the countries in Africa closest to reaching the UNAIDS 95-95-95 targets, and ZimPAAC is a critical partner to the Ministry of Health in that effort,” said Dr. Wiktor. “I am delighted to be working with such an outstanding team of public health professionals.”

Through ZimPAAC, I-TECH provides direct service delivery and site support for care and treatment at 372 public sector health facilities to strengthen health systems and improve the quality of care and treatment services and increase enrollment, initiation and adherence.

The VMMC project has already performed 313,267 VMMCs, as of October 2018, surpassing PEPFAR targets. The new award aims to circumcise 500,000 men over five years, resulting in the prevention of approximately 100,000 new cases of HIV.

“It has been such a privilege to work in Zimbabwe, a country that has a real chance to control the AIDS epidemic—both because of generous funding from PEPFAR and, more importantly, because of the caliber of the Zimbabwean people who live and work here,” said Dr. Downer at the handover ceremony.

“Our Zimbabwe team, consisting of both Harare- and Seattle-based members, is one of the finest I’ve ever worked with,” she continued. “Dr. Wiktor inherits a highly productive consortium that is partnering with ZAZIC and the Ministry of Health to propel Zimbabwe toward a healthier future and an AIDS-free generation.”

Strengthening Health Service Delivery in India

Post categories: Ann Downer Best Practices Clinical Mentoring Differentiated Care HIV Care and Treatment India Key Populations Quality Improvement
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  • I-TECH India PL has successfully designed and implemented four differentiated ART service delivery models, including models for key population clients, in collaboration with other stakeholders in states of Maharashtra, Nagaland, Manipur and Mizoram to develop a proof of concept for the national level scale up;
  • Improved delivery of health services through onsite technical mentoring and supervison of health care staff in 9% of the ART centers of the country in the last three years;
  • Technically assisted successful implementation of newer initiatives such as treatment of TB through the ART centers, the “Treat All” initiative, and routine viral load monitoring at 48 ART centers; and
  • Conducted/participated in health service delivery assessments of facilities such as the national HIV/AIDS Centers of Excellence, ART Centers, Link ART Centers, and other care and support centers for the NACO.