Since 2019, I-TECH has provided increased technical assistance for 39 state healthcare facilities in eleven high HIV burden regions of Ukraine to advance assisted partner notification/services and index testing as a sustainable strategy for HIV case finding.
The International AIDS Society (IAS) virtually hosted the 11th Conference on HIV Science on 18-21 July 2021. The conference also included a “local partner hub” in Berlin, the original host city, for local experts to gather in person. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.
Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters:
- Fernanda Freistadt, MPH, I-TECH Senior Program Manager, was the presenting author for an ePoster discussing implementation findings for the adoption of differentiated service delivery models in health care facilities across Tanzania titled, “Adoption of Differentiated HIV Service Delivery in Tanzania: From Policy to Practice.”
- Farai Munyayi, MPH, I-TECH Namibia Laboratory Lead, was the presenting author for an ePoster reporting program outcomes of intensified assisted partner services implementation in Namibia titled, “A high number of HIV-positive sex partners identified through assisted partner notification services in Namibia, most previously diagnosed HIV-positive.”
Representatives from I-TECH’s partner network organizations and the Centers for Disease Control and Prevention (CDC) also presented data from I-TECH-supported programs in Malawi, India, and Zimbabwe.
- Carson Telford, MPH, CDC, presented an ePoster on the I-TECH HIV-1 surveillance program implemented in 103 facilities in Malawi titled, “Geospatial clusters of recent HIV-1 infection, Malawi, October 2019 – March 2020.”
- Anwar Parvez Sayed, MBBS, TDD, MPH, I-TECH India PLC Executive Director, presented an ePoster on HIV treatment interruption prevention during COVID-19 in India titled, “Interactive voice response system (ARTmitra) – a lifeline to prevent treatment interruption during COVID-19 in Mumbai, India.”
- Blessing Mushangwe, MBChB, MPH, Zimbabwe Technical Assistance, Training & Education Center for Health Senior Program Manager, was the presenting author for an ePoster describing the results of a community outreach program to provide HIV services and reduce COVID-19 exposure titled, “Outreach points fill HIV service gaps while health facilities were closed in Harare, Zimbabwe, August-December 2020.”
On December 18, 2019, I-TECH Ukraine facilitated its first forum on index testing, a key strategy used to identify and support HIV-positive individuals. Service providers, as well as representatives from the US Centers for Disease Control and Prevention (CDC) and the Public Health Center (PHC) of the Ministry of Health (MOH) of Ukraine, attended the forum and participated in discussions detailing the best ways to implement and adapt proven index testing methodologies in Ukraine.
I-TECH Ukraine rolled out its national program in October 2019, after shifting its programmatic focus to provide index testing development and quality assurance. The program was launched at 39 antiretroviral therapy (ART) clinics in 11 PEPFAR priority regions across the country.
The recent forum included a review of early program performance; identification of best practices that can be scaled up to improve index testing and partner notification performance; and solutions to key challenges that index testing providers are currently facing in Ukraine.
“The index testing strategy gives us all high hopes that we can reach out to the most affected groups of people living with HIV and identify many individuals in need of care much earlier than it happens currently in Ukraine,“ says Anna Shapoval, I-TECH Ukraine Country Representative. “As always, I-TECH is proud to build this new programming not just on the vast evidence and globally acknowledged best practices but also on the mountain of successful experiences in other countries where index testing programs have been initiated and implemented by I-TECH in previous years.”
To strengthen the programmatic response, the forum included a number of speakers and index testing subject matter experts. Dr. Serhii Riabokon, an infectious disease doctor in the PHC’s department of the coordination of treatment programs on HIV, viral hepatitis, and sexually transmitted infections, presented the current legal framework and the state of index testing program implementation in Ukraine. I-TECH’s program and evaluation teams also gave a brief overview of the program including the design as well as the successes and challenges to date. Four well-performing regional sites were also able to share the best practices they used during early program implementation.
In addition to the index testing program-specific presentations, the forum also included presentations by experts who shared their valuable experiences in partner services implementation, scale-up, and development:
- Matthew Golden, MD, MPH, Professor at the University of Washington (UW) Department of Medicine’s Division of Allergy and Infectious Diseases and I-TECH faculty member, reviewed the development and challenges of partner services programs around the world, as well as voiced practical recommendations for Ukrainian index testing advancement.
- Nancy Puttkammer, PhD, MPH, I-TECH faculty and DIGI faculty lead, and Jason Beste, MD, MPH, I-TECH International Clinical Advisor, were on a panel discussion on the ways of overcoming key challenges in index testing implementation.
“A key part of the program is to ensure quality results,” says Shapoval, “and consistent and collaborative learning is paramount to building local capacity.”
December’s forum is just the first of planned, quarterly forums designed to further build local capacities around index testing and quality assurance.
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.
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.
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.
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.