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HIV Pre-Exposure Prophylaxis (PrEP) in Ukraine

The Government of Ukraine prioritized pre-exposure prophylaxis (PrEP) as part of combination prevention for HIV in 2019.1 Since 2020, I-TECH has focused its programmatic efforts in Ukraine on improving PrEP services uptake and strengthening PrEP delivery at selected stat healthcare facilities.

Continue reading “HIV Pre-Exposure Prophylaxis (PrEP) in Ukraine”

Expanding HIV Care and Treatment in Zimbabwe

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.

Empowering Young Mothers in Namibia

A young woman learning to weave a basket during the September 9-13, 2019 craft-skills training session.
A young woman learning to weave a basket during the September 9-13, 2019 craft-skills training session.

Young mothers enrolled in the DREAMS program in the Zambezi region of Namibia had the opportunity to learn the traditional art of basket weaving through a series of craft-skills trainings facilitated by the International Training and Education Center for Health (I-TECH) and the Integrated Rural Development and Nature Conservation (IRDNC).

The all day, weeklong trainings taught the young women the basics of basket weaving and also empowered them to create marketable items that could lead to greater economic independence. For the trainings, I-TECH and IRDNC invited a Master Weaver to teach women about the technique, the types of natural fibers and dyes, and the necessary tools used in the craft. All of the women who participated in a training made at least one basket by the end of the week.

“Basket weaving is a traditional craft in this area and it is often a source of income for families,” explains Sharon Zambwe, Program Lead for DREAMS Zambezi. “One of the best parts about this program is that it not only teaches women the skills needed for basket weaving but it also connects them to a market for their works, and with each other for ongoing support and encouragement.”

The baskets that the young women crafted were made available for purchase during an event marking the end of their training. The event was attended by representatives from the Society of Family Health; Zambezi Regional Council; and Regional Ministries of Health & Social Services, Education, Arts & Culture, and Youth and Sport. The special event provided attendees with a background of the DREAMS program and included a keynote address from the special advisor of the Zambezi Governor’s Office who presented the future vision of the DREAMS program.

A basket woven by one of the participants at the September 9-13 craft-skills training session.
A basket woven by one of the participants at the September 9-13 craft-skills training session.

I-TECH launched the DREAMS program in the Khomas region in February 2018 and expanded the program to the Zambezi region in June 2018. Since the launch, I-TECH has enrolled over 20,000 girls and young women aged 9-24 years old in the program. DREAMS is a PEPFAR-funded initiative that aims to give girls and women the tools to be Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS). The program not only addresses the HIV epidemic through prevention and treatment, but it also focuses on the structural drivers of the epidemic, such as gender-based violence (GBV) and poverty.

“The DREAMS program has been able to provide girls and young women with the mentoring and social support needed to help encourage them to make positive and healthy decisions in their everyday lives,” says Ellen MacLachlan, DREAMS Program Director for I-TECH. “The activities in Khomas and Zambezi have had a profound impact on the girls and young women in the program. Economic strengthening activities such as the basket weaving classes can directly empower women by giving them a way to make their own money so they are less dependent on a male partner, especially one who may put her at risk of HIV.”

Since the DREAMS program first launched in the Zambezi region, it has provided social and health services (such as pre-exposure prophylaxis, or PrEP) as well as HIV/GBV prevention education to girls and young women and in August 2019, the program expanded into the field of economic empowerment by providing craft-skills trainings. Since the beginning of the service expansion, I-TECH and IRDNC have trained 82 young mothers, aged 15-24, in the art of basket weaving.

While the craft-skills training program in Zambezi is still in its infancy, there are plans to expand the scope of the training to incorporate other crafts skills such as clay pot artistry, knitting, and needlework. In addition to expanding the scope, DREAMS Zambezi plans to partner with tourism organizations as a way for the women participating in future trainings to showcase and sell their wares.

“We have been impressed with the response from the women who have participated in the program over these past four weeks,” says Zambwe. “We can’t wait to expand this program to incorporate more skills that will benefit not only the young women and their families but the community.”

Aaron Katz

Aaron Katz is a principal lecturer emeritus of Health Services, Global Health (adjunct), and Law (adjunct) at the University of Washington School of Public Health where he teaches several graduate level courses in health policy. He also has an adjunct appointment at the University of Queensland (Australia) School of Public Health. Aaron has held numerous academic leadership positions, including his current role as faculty coordinator of the Health Systems and Policy Concentration of the Health Services Master of Public Health (MPH) program and was founding director of the Leadership, Policy, and Management track of the Global Health MPH program. He was director of the UW Health Policy Analysis Program from 1988 until 2003 and editor-in-chief of the School’s biannual journal, Northwest Public Health, from 1999 to 2008.

Aaron received the American Public Health Association’s Award for Excellence in November 2006 and the Outstanding Teaching Award from the UW School of Public Health in 2004. At the 2011 “State of Reform” Washington Health Policy Conference, Aaron received the Health Reform Leadership Award.

Aaron has developed a deep understanding of the U.S. health care system and its strengths and weaknesses during a career that has spanned 40 years and four “bouts” with health care reform. He has worked in health policy and planning in Washington state since 1978, serving as a health planner, policy and planning consultant, lobbyist, and political adviser. Aaron has directed numerous policy analysis and policy development projects for legislative bodies, state and local public agencies, and private sector clients, including work on health system reform, public health reform, managed care, rural access, HIV/AIDS, workers compensation, long term care, medical economics, and services for people with low incomes. Since 1999, Aaron has collaborated on policy development and advocacy projects with colleagues in various countries in southern Asia, sub-Saharan Africa, Latin America, and Japan.

Aaron has served as a peer reviewer of articles for the International Journal for Equity in Health, Health Affairs, Journal of Health Care for the Poor and Underserved, Global Health Action, and the American Journal of Public Health. He has served on numerous community boards, including the Washington State Budget and Policy Center, Northwest Health Law Advocates, Washington Physicians for Social Responsibility, and Health Alliance International.

Aaron received a bachelor of science degree from the University of Wisconsin – Madison in 1974 and a certificate [master] of public health degree from the University of Toronto in 1975.

Program Highlights

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Stefan Wiktor

Stefan Wiktor, MD, is a physician with more than 25 years of experience in epidemiologic research and public health programs related to the control of infectious diseases. He leads I-TECH’s work on hepatitis prevention and control, and is Acting Professor in the Department of Global Health. Prior to joining I-TECH, Dr. Wiktor was the Team Lead of the World Health Organization’s Global Hepatitis Programme.

Dr. Wiktor previously worked at the U.S. Centers for Disease Control and Prevention (CDC) where he conducted research studies of HIV-1 and HIV-2 in Cote d’Ivoire, West Africa, and led a large-scale HIV/AIDS prevention and treatment program in Tanzania. His research showed that anti-retroviral medications were effective in preventing mother-to-child HIV transmission. Other research he did proved that antibiotics reduced bacterial infections in HIV-infected adults, a finding that led to the WHO recommendation for use of antibiotic prophylaxis to prevent deaths in HIV-infected adults.

Program Highlights

Expanding HIV Care and Treatment in Zimbabwe

The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary ...
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Using Innovative Technology for Better Data in Zimbabwe

The ZimPAAC consortium has supported high-quality health care worker (HCW) knowledge and skills in Zimbabwe with technologies such as applications ...
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Driving Collaboration with Local Implementation Partners in Zimbabwe

I-TECH builds local ownership and sustainability through collaborations throughout Zimbabwe. Under the CDC and PEPFAR awards, I-TECH has formed and ...
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Expanding Cervical Cancer Screening in Zimbabwe

I-TECH began the expansion of cervical cancer screening for women living with HIV aged 25-49 in Zimbabwe in 2019. I-TECH ...
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Gabrielle O’Malley

Gabrielle O’Malley, MA, PHD, is I-TECH’S Director of Implementation Science. Dr. O’Malley has worked as an applied research and evaluation professional for over 25 years. Her experience includes a wide variety of international and domestic programs including child survival, private agricultural enterprise, medical education, community technology, reproductive health, HIV prevention (PrEP), and care and treatment as well as applied research for private industry. Her research interests include innovative practices for program evaluation and improvement, formative research, qualitative methods, and the relationship of gender and health.

Dr. O’Malley received her PhD from UW, an MA from Johns Hopkins University and a BA from Smith College.

Program Highlights

Birth Defects Surveillance in Malawi
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 ...
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Cervical Cancer Screening and Treatment in Namibia
I-TECH supported the Ministry of Health and Social Services in 2017 and 2018 in the development and dissemination of the national Cervical Cancer Prevention Guidelines including algorithms for screening, referral, and post cryotherapy instrument disinfection, and monitoring and evaluation tools ...
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Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women (DREAMS) 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 ...
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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 ...
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