Category Archives: HIV Counseling and Testing

HIV Impact Assessment Shows Significant Progress in Malawi

Tiwonge Chimpandule, I-TECH Malawi’s Strategic Information Officer, presents the results of the 2020/21 Malawi Population-based HIV Impact Assessment (MPHIA) to guest of honor Chrissy Kalamula Kantaso, Deputy Minister of Health (right). Looking on are Jeremy Neitzke, Deputy Chief of Mission, U.S. Embassy (center) and Dr. Rose Nyirenda, Director, HIV and AIDS Department in the Ministry of Health (left). Photo credit: I-TECH Malawi

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.

The assessment, led by the MOH and ICAP, shows 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 88% 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.

HIV Recency Surveillance in Malawi

The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection by integrating point-of-care testing for recent infection into routine HIV testing services (HTS). A rapid test for recent infection is given to consenting clients 13-years-and-older who screen HIV positive within routine HTS across participating health facilities. Between April 2019-2020, I-TECH and MOH activated 485 testing points at 155 facilities in Malawi. All 155 facilities implemented recent HIV infection surveillance and reported data. The project has reached 11 of 28 districts to date.

These data allow the detection and characterization of recent HIV infection among newly diagnosed individuals and identify geographic areas associated with recent HIV-1 infection to inform geographic prioritization of HIV prevention and treatment strategies. The project has demonstrated high uptake and allowed characterization of recent infections according to socio-demographic and geographic factors. PEPFAR implementers in Malawi will collaborate with MOH to further investigate the reasons for high recent infection prevalence in identified clusters. Based on the findings of these responses, Malawi may focus on interventions such as youth-focused programs that aim to limit HIV acquisition and transmission among young people.

I-TECH Announces Launch of Independent Local Organizations B-TECH and C-TECH

The B-TECH team implements innovative, high-yield testing approaches to increase HIV case identification and yield.

On October 1, the International Training and Education Center for Health (I-TECH) celebrated the launch of the local and independent Botswana Training and Education Center for Health (B-TECH) and Caribbean Training and Education Center for Health (C-TECH).

For more than 17 years, these teams have worked within the regional Botswana and Caribbean offices of I-TECH to respond to the health needs of individuals and communities infected and affected by HIV. B-TECH and C-TECH, as locally registered non-governmental organizations, will continue to build on those years of experience implementing innovative, locally driven HIV prevention, care, and treatment programs, as well as expand their work to tackle other pressing health issues within the Batswana and Caribbean communities.

As part of the I-TECH network, B-TECH and C-TECH are able to access the academic depth and regulatory structures of UW and, together with local and regional clinical and programmatic expertise, scale up best practices and strengthen health systems. As local entities, B-TECH and C-TECH will also be able to take advantage of expanded partnership opportunities.

The C-TECH team also has broad experience with clinical mentoring at HIV treatment sites.

Both teams have supported pioneering work in their regions to provide comprehensive, patient-centered care for the most vulnerable populations. The C-TECH team has implemented a groundbreaking preceptorship program to improve provider communication with key populations affected by HIV in Jamaica and Trinidad and Tobago. It has also implemented a successful telementoring program through a Project ECHO®-based platform and model, reaching 465 providers. The program connects groups of providers to form communities of practice throughout the region to facilitate clinical updates, case consultations, and strengthened practice in HIV treatment and care and, recently, COVID-19.

“We look forward to remaining within the I-TECH family,” said Natalie Irving-Mattocks, Executive Director of C-TECH. “But our team is equipped and ready to move into this next chapter, deepening our local relationships, expanding our reach throughout the Caribbean, and building on our commitment to support access to high quality health care for the region’s most vulnerable.”

For its part, the B-TECH team has made an enormous impact on the health systems of Botswana, enabling the policy environment for HIV clinical case management; developing and implementing an interoperable, standards-based health information system; and enhancing the capacity of the health workforce at all levels. The team has also implemented innovative, high-yield testing approaches to increase HIV case identification. Targeted HIV testing strategies include partner testing services; HIV self-testing; testing among presumptive tuberculosis cases; and the expansion of afterhours and weekend testing to target men.

“We are excited to begin this new endeavor to promote innovative, locally driven, and effective programs to respond to the HIV epidemic in Botswana,” said Dr. Odirile Bakae, Executive Director of B-TECH. “With a high level of technical assistance from I-TECH, combined with B-TECH’s boots-on-the-ground approach, we are a winning team. We look forward to a fruitful partnership with both I-TECH/UW and the Government of Botswana.”

I-TECH has worked closely with UW Global Operations Support over the past decade to inform the internal procedures and structures necessary for international office registrations. This work has promoted operational effectiveness by enabling a safe, compliant, and legal environment for conducting international work. I-TECH’s close work with Global Operations Support has also helped to create the administrative and policy structures necessary to enable the successful launch of B-TECH and C-TECH.

Over the past two years, three other I-TECH offices – in Haiti, India, and Zimbabwe – have launched local organizations, signaling I-TECH’s bedrock commitment to transition, sustainability, and country ownership.

“These new organizations reflect our shared goals of serving communities, building capacity, and supporting expert leadership across the I-TECH network,” said Dr. Pamela Collins, I-TECH Executive Director. “We look forward to continued strong collaboration that saves lives.”

Read more about the B-TECH and C-TECH leadership teams below.

Dr. Odirile Bakae, Executive Director, B-TECH

Dr. Bakae is a physician with over 15 years of clinical experience in providing services to people living with HIV, as well as a deep understanding of structuring health programs to optimize client outcomes. He has several years of experience practicing medicine in public health settings in Botswana, including the management of the Infectious Disease Control Centers (IDCC), specializing in ART failure clients, complicated TB and HIV cases, and cervical cancer patients.

In addition to his role as B-TECH Executive Director, Dr. Bakae is the Principal Investigator for the CDC funded Cervical Cancer (GH20-2009) and Strategic Information Services (GH20-2007) awards.

He joined I-TECH Botswana in 2015 and led one of the most successful HIV testing programs in the country, focusing on a client-centered approach. Under his leadership, the country program performed exceptionally well, in terms of quality of service delivery and in meeting donor targets and expectations.

Thulaganyo Kauta, Deputy Executive Director, B-TECH

Ms. Kauta is a seasoned operations management professional with over 20 years of experience across a wide range of industries. She joined I-TECH Botswana in April 2009 and, as the Deputy Executive Director for B-TECH, she oversees operations, finance, and human resources, and is responsible for design and implementation of internal controls and compliance oversight at all levels of the organization.

In her management role, Ms. Kauta provides planning and coordination of efficient and effective support services to enable delivery of quality work to B-TECH clients and stakeholders. A key function of her role is to identify solutions to address operational challenges within B-TECH as well as ensure the implementation and adherence to the organization’s operational systems, policies and procedures.

Natalie Irving-Mattocks, Executive Director, C-TECH

Ms. Irving-Mattocks is a public health program director with extensive experience in managing projects focusing on health systems strengthening. She is also a business development practitioner with 13 years of experience in the field of social development. Her expertise includes financial management, budget management, project proposal writing, program design/development, planning, implementation and monitoring, strategic planning, and institutional development.

To her role as C-TECH Executive Director, Ms. Irving-Mattocks also brings deep experience and a proven track record in mobilizing and managing grants from international funding agencies such as United States Department of Human Services Health Resources and Services Administration (HRSA), PANCAP Global Fund, United States Agency for International Development (USAID), Clinton Foundation and National Institutes of Health (NIH).

Dr. Clive Anderson, Board Chair and Technical Advisor, C-TECH

Dr. Anderson has 30 years of experience as a primary care physician, specializing in HIV and STI care and prevention, as well as dermatology. He comes to his role as Board Chair and Technical Advisor after serving as Country Director of I-TECH Jamaica for the past three years.

He remains Technical Advisor to I-TECH Jamaica, where his experience also includes extensive experience as Technical Lead of the Caribbean Quality Improvement Collaborative (CareQIC), Lead HIV Project ECHO® Facilitator and Mentor, and clinical mentor at HIV treatment sites throughout Jamaica.

Dr. Anderson is currently a Clinical Assistant Professor in the Department of Global Health, University of Washington.

Facility-Based HIV Testing Services in Namibia

As a key component of I-TECH’s support to HIV care continuum strengthening in Namibia, I-TECH supports the Ministry of Health and Social Services in efforts to achieve the UNAIDS target of “90% of people living with HIV will have a known status.” I-TECH supports above-site HIV testing activities at region-and national-levels, as well as technical assistance and direct service delivery at the site-level across 78 facilities in 6 regions in Namibia.

I-TECH implements evidence-based HIV-testing strategies to maintain efficient programs while increasing HIV-positive yield including optimized provider-initiated testing and counseling (PITC) and index testing.

  • I-TECH’s clinical and technical teams place emphasis on offering PITC to high-risk populations including STI patients, clients attending family planning services, presumptive and confirmed TB cases, and patients attending in-patient hospital services. In addition, efforts will be made to increase testing among men through the above strategies, as well as encouraging more flexible hours for HIV testing through extended hours of operation.
  • I-TECH participates in the national-level index testing work group, helping to finalize paper tools and training materials for national deployment. At the site level, I-TECH strategic information staff ensure complete documentation of partner status of all enrolled patients, with testing offered to identified partners. I-TECH in Namibia is also working with I-TECH country offices across the network to leverage expertise in index testing training and monitoring and evaluation. I-TECH is currently supporting discussions at the national-level concerning the role of self-testing as an extension of services offered to facility-based clients, as another option for ensuring that more partners are tested.

I-TECH is currently supporting facilitation of stepped training for HIV recency testing in 5 high-volume districts in Namibia. Recency testing provides insight into the timeline of a client’s HIV infection. As Namibia approaches epidemic control, identifying, and targeting efforts and interventions to hard to reach populations most at risk for HIV acquisition will be essential.

I-TECH Ukraine Conducts In-Service Nurse Training Pilots for Achieving 90-90-90

Recent public health care reform in Ukraine has called for the growing role of primary health care, task shifting, and decentralization of HIV services while providing care and treatment for people living with HIV (PLWH). In June 2018, the International Training and Education Center for health (I-TECH) Ukraine conducted two back-to-back, five-day in-service training programs on HIV testing services for two cohorts of participants from twelve regions across Ukraine.

Dr. Serhii Rabokon facilitates a training on the role of nurses in achieving UNAIDS 90-90-90 targets.

Dr. Serhii Rabokon, Head of the Treatment Programs at the CPH of the MoH of Ukraine, delivers a presentation on the nurse’s role in achieving UNAIDS 90-90-90 targets. Photo source: I-TECH Ukraine.

The concept and design of these unique pilot training programs were influenced by the recent reform to actively involve general practice/primary care nurses into the process of achieving UNAIDS 90-90-90 targets in Ukraine.

A group of 10 national HIV and health care reform experts, I-TECH’s international consultant-nurse practitioner, and the I-TECH Ukraine training development team carefully designed the learning objectives and content of the training program with consideration of the specifics of the national HIV epidemic, participant backgrounds, as well as anticipated task shifting. Together, these experts synthesized and presented international and national clinical and nursing best practices in the area of serving PLWH.

Training participants included nurses from primary care facilities, specialized HIV clinics, as well as faculty of seven local nursing colleges, including I-TECH Ukraine’s national partners – Ternopil State Medical University and the Nursing College of Poltava Ukrainian Medical and Dental Academy.

The training programs outlined roles for general practice/primary care nurses in achieving UNAIDS 90-90-90 targets, taught HIV basics, helped develop skills for HIV testing services with rapid HIV test kits, and coached participants on conducting counseling for PLWH using a non-discriminatory, patient-centered approach.

Participants working in small groups at the June 2018 training.

Participants in the second pilot training work in small groups. Photo source: I-TECH Ukraine.

Facilitators used interactive training tools and approaches during the program to fully engage participants and strengthen the capacity of the nursing college’s faculty to teach up-to-date HIV content in an appealing and efficient way.

One of the central elements of the program was to educate the participating nurses about the challenges surrounding HIV-related stigma and discrimination with a major goal to overcome it in the nursing community and encourage respectful delivery of services for PLWH.

“[I-TECH Ukraine and its partners are] doing such a[n] important thing,” says Valentyna Borysova, lecturer of Zaporizhzhia Nursing College. “Educating nurses on HIV has been so much underestimated and under-invested in Ukraine.”

In addition to feeling as though this training addressed a critical gap in education, participants also provided positive feedback about the content and facilitation of the training, especially the parts of the training that were facilitated by the international and national peer nurses.

Participants attend a training about HIV fundamentals.

Participants in the first pilot training focus on a presentation about HIV Fundamentals. Photo source: I-TECH Ukraine.

“The knowledge on testing and post-exposure prophylaxis are badly needed at our clinic,” says Liudmyla Samolelis, Senior Nurse of the Psychiatric Clinic in Poltava, Head of Poltava Oblast Nurse Association. “I plan to conduct an on-the-job training for the nurses, using the materials from the training.”

Due to the success of the pilot trainings, I-TECH Ukraine intends to finalize training materials, institutionalize the course through its local partners, and develop a manual that could be used in different training formats, including state-owned colleges and medical universities. In addition, an ambitious regional rollout of the training program is anticipated during the next year of the project.

 

Health Information Systems in Botswana

I-TECH has worked with the Ministry of Health and Wellness (MOHW), Centers for Disease Control and Prevention (CDC), and other implementing partners to develop and implement robust national health information systems (HIS) that enable greater efficiency and accountability and strategic use of information. These HIS include: Continue reading »

National-Level Quality Improvement in Botswana

I-TECH Botswana provides technical assistance at the national-level to improve HIV care and treatment, TB/HIV, and HIV testing and counselling programs through continuous quality improvement activities. Continue reading »

Laboratory CQI in Botswana

I-TECH Botswana works to strengthen external quality assurances (EQA) for HIV-related testing by conducting regular on-site proficiency testing support visits, conducting competency assessments and carrying out CQI activities at 22 I-TECH supported labs (45% of the labs in the country). I-TECH Botswana also provides technical assistance and support to the Botswana National Quality Assurance Lab (BNQAL).

HIV Testing Services in Botswana

I-TECH Botswana conducts facility-based HIV testing at selected PEPFAR supported scale-up sites in seven PEPFAR districts. Testing is carried out by Health Care Assistants and includes expanded provider initiated testing, counseling, and partner notification. In addition, I-TECH Botswana conducts regular continuous quality improvement (CQI) visits at I-TECH-supported facilities and provides support for linkage to care. Continue reading »

Differentiated HIV Service Delivery Models in Tanzania

In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania.

Continue reading »