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”
This piece was first posted on the University of Washington Department of Global Health’s website.
Voluntary medical male circumcision (VMMC) safely reduces the risk of female-to-male HIV transmission by up to 60%. Few men have any post-operative VMMC complication. However, current practice in Zimbabwe and throughout most of sub-Saharan Africa requires VMMC patients to return for multiple, in-person post-operative visits. With low complication rates, and severe healthcare worker shortages, these required visits are a burden for providers and patients — threatening achievement of critical HIV prevention targets. A two-way texting model studied by University of Washington researchers in Zimbabwe offers a new way to address this barrier by reducing provider workload while also safeguarding patient safety.
“These visits can be a barrier to male circumcision uptake and expansion in countries with severe health care worker shortages, as well as negatively impacting patients who needlessly pay for transport, miss work, and wait for unnecessary reviews,” said Principal Investigator Caryl Feldacker, PhD, MPH, at the International Training and Education Center for Health (I-TECH) in the University of Washington Department of Global Health.
The study included 721 VMMC patients in two locations in urban Zimbabwe. In the study, patients communicated directly with a health care worker through interactive text messaging for the critical 13 days post-VMMC, rather than returning for required in-person visits. By giving men the option to heal safely at home, or return to care when desired or if complications arose, the method dramatically reduced in-person visits by 85%. Texting also reduced follow-up costs by about one-third while improving the quality of care.
As compared to routine in-person care, the study yielded twice the number of reported complications. “This increased identification and reporting is a positive result that is likely attributable to improved counseling and men’s engagement in care. Through texting, men were empowered to observe their healing and report potential issues promptly, before they worsened,” said Feldacker.
Currently, most text-based health care efforts blast pre-defined messages to many people simultaneously, removing patients’ ability to communicate back with health care workers. In contrast, two-way texting between providers and patients provides interactive care, and the short time frame heightened participation: in the study, 93% of men responded to texts. Both providers and clients reported confidence in the texting option, feeling safe and highly recommending it for scale.
“With the current system, Zimbabwe could perform millions of unnecessary follow-up visits over the coming five years. The workload burden for health care workers and time lost for patients who are healing without complication is a significant burden for health care workers and clients alike,” said Feldacker. “Potential gains in efficiency and reduced costs through using two-way messaging are large.”
With funding from the U.S. Centers for Disease Control and Prevention (CDC), and in partnership with the Society for Family Health, the model will soon be tested in urban South Africa. The new, field-based research will further test two-way texting in a different geographical and patient context to better inform the model for adaptation and widespread scale-up.
Feldacker added that “while our findings are grounded in studies on male circumcision, our results are largely attributable to the methods rather than to a specific disease or condition.
“With minimal adaptation,” she continued, “two-way texting could streamline other post-operative care contexts or be re-configured for other similarly acute, episodic conditions where continuity of care within a short period is critical for patients, such as short-course TB treatment, post-operative healing, post-natal care or early childhood illnesses — diarrhea, pneumonia, malaria — laying the foundation for generalizing to other diseases and contexts.”
For more on the study, see the paper pre-published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS):
The study was led by Caryl Feldacker, and co-investigators are Vernon Murenje (International Training and Education Center for Health (I-TECH), Harare, Zimbabwe); Mufuta Tshimanga (Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe); Scott Barnhart, Isaac Holeman, and Joseph B. Babigumira (Department of Global Health, University of Washington); Sinokuthemba Xaba (Ministry of Health and Child Care, Harare, Zimbabwe); and technology partner Medic Mobile (Nairobi, Kenya).
The Zimbabwe 2wT study was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.
I-TECH began supporting the implementation of pre-exposure prophylaxis (PrEP) as part of Namibia’s combination HIV prevention strategy in 2017. Continue reading “Pre-Exposure Prophylaxis for HIV Prevention in Namibia”
Since 2017, I-TECH worked closely with the Ministry of Gender Equality and Child Welfare, Ministry of Health and Social Services, UNICEF, Centers for Disease Control and Prevention, and the Namibia Statistics Agency to implement a nationally representative survey on youth experiences as well as HIV incidence and prevalence. Survey results will inform policy and practice to improve the overall well-being of children and young people in Namibia and further focus HIV prevention efforts.
Survey collaborators are in the process of data analysis with a final report expected in early 2020. I-TECH will continue to support these efforts as well as continue to work to strengthen HIV prevention and promote the overall well-being of youth in Namibia.
In 2017, I-TECH began the DREAMS program in Khomas and Zambezi regions. The DREAMS program aims to reduce HIV infections among adolescent girls and young women (AGYW) through a core package of evidence-based interventions across health, education, and social sectors. At a safe space such as a school or community center, participants meet with a mentor who is trained to deliver a curriculum focused on the prevention of HIV and gender-based violence (GBV). Mentors help AGYW build strong social networks and empower them to make healthy and positive decisions. AGYW can also access on-site services like HIV testing, family planning, PrEP, counseling, and screening for GBV to protect against HIV infection. I-TECH has supported over 150 safe spaces since its launch and enrolled over 20,000 AGYW in the program.
I-TECH also supports programming for caregivers through the Families Matter! Program, which promotes healthy communication between parents and AGYW around HIV and GBV topics. I-TECH works closely with the Ministry of Education, Arts, and Culture; Ministry of Gender Equality and Child Welfare; Ministry of Health and Social Services; Centers for Disease Control and Prevention; and other implementing partners.
In Namibia, the prevalence of HIV infection among adults aged 15 to 49 is nearly 14%.[1] A key component of national efforts to prevent the spread of HIV is voluntary medical male circumcision, or VMMC, which has proved to reduce the rate of male-to-female transmission by upwards of 60%.
Since 2010, the International Training and Education Center for Health (I-TECH) has supported the VMMC efforts of the Namibian Ministry of Health and Social Services (MOHSS) in the Oshana and Zambezi regions. I-TECH not only supports health care worker training in the provision of VMMC, it is also engaged in critical efforts to create demand for the procedure.
A key element of these efforts is the recognition of schools and school leadership who are supportive of VMMCs. In February, Ashitenga Primary School in Oshana Region was awarded a platinum certificate by I-TECH Namibia for achieving 96% saturation of boys receiving a VMMC. Platinum is the highest honor, with bronze signifying 55-69% saturation, silver awarded for 70-79% saturation, and gold given for 80-89% saturation.
Present at the event was the Oluno Circuit Education Inspector Levi Vries. In his remarks, Mr. Vries encouraged other schools to emulate Ashitenga’s good example. He emphasized the importance of student health to attaining educational goals and urged students to spread the VMMC message to others in their families, villages, and neighborhoods.
As part of the Life Skills curriculum, older boys are instructed on HIV prevention, while the younger boys are taught personal hygiene – messages that are reinforced by I-TECH community mobilizers. Teopolina Mupetami, the Life Skills teacher at Ashitenga, encouraged Life Skills teachers at other schools in the area to support the VMMC program. Ashitenga principal Edward Asser echoed the importance of the school’s recognition; he promised to display the certificate proudly in his office.
Three of the circumcised students were interviewed by the Ministry of Information Communication and Technology, which is charged with spreading the message about “the smart cut” in the government media. The boys responded that “they feel clean and protected from sexual related disease,” said Helena Ferdinand, I-TECH community mobilizer. The students prompted boys at other schools to enroll in the VMMC program and expressed their satisfaction with the service.
“The atmosphere at the handover was joyful and a lot of excitement,” said Ms. Ferdinand. “The principal indicated that they will continue to work hard to get a second platinum certificate.”
[1] UNAIDS; http://www.unaids.org/en/regionscountries/countries/namibia
As a key member of the Kenya electronic medical record (EMR) system technical working group, I-TECH works to implement and standardize the EMR systems used in the management of national HIV and AIDS care and treatment data. Similar efforts have focused on ensuring that different electronic systems can communicate with one another (interoperability) and that health care workers, administrators, and staff are well trained to use and maintain them.
Peter Rabinowitz, MD, MPH, directs the Center for One Health Research and has multiple faculty appointments including Professor, Global Health, at UW. The “One Health” center explores linkages between human, animal, and environmental health. Dr. Rabinowitz has expertise in zoonotic infectious disease; diseases of animal workers; microbiome sharing between humans and animals; emerging infectious disease; antimicrobial resistance animal sentinels of environmental health hazards; and noise and hearing loss.
Dr. Rabinowitz also directs the Canary Database, an online resource for evidence about animals as sentinels of environmental health threats from both toxic and infectious hazards. He was a visiting scientist at the Global Influenza Program of the WHO, and also in the Animal Health Division of the U.N. Food and Agriculture Organization (FAO). He completed a Family Medicine residency through the University of California San Francisco, and completed fellowships in General Preventive Medicine and Occupational and Environmental Medicine at the Yale School of Medicine.
Matthew Golden, MD, is a Professor, UW Division of Allergy and Infectious Disease, and he is Director of a the UW and Public Health, Seattle & King County (PHSKC) – HIV/STD Control Program, a collaborative project aimed at evaluating new public health interventions to control sexually transmitted infections (STIs), including HIV. This project also provides a fellowship training opportunity to teach how to integrate research and public health practice.
Dr. Golden works on research and public health projects related to HIV partner services in several countries in sub-Saharan Africa. He is the principal investigator of a CDC grant aimed at providing assistance to U.S. health departments in high-impact HIV prevention and training opportunities for persons interested in careers in HIV/STD-related public health practice. His research includes evaluations of population-based interventions to improve HIV care, a study of seroadaptive behaviors among men who have sex with men, research on new treatments for gonorrhea and HIV/STD surveillance projects, and program evaluations.
I-TECH’s long engagement with clinician education in Mozambique includes support for improvements to the national undergraduate (“pre-service”) curriculum for laboratory technicians (Técnicos Medio de Laboratório) to make the content more current and reflect the health care priorities of the country, including advances in HIV diagnostics and treatment monitoring. The curriculum is now standardized so that students at all health training institutes (HTIs) are taught using the same material and methods. Continue reading “Human Resources for Health in Mozambique”