Category Archives: Quality Improvement

I-TECH in Côte d’Ivoire Hosts National HIV QI Conference

On 18-19 May 2022, the International Training and Education Center for Health (I-TECH), in collaboration with the Programme National de Lutte Contre le Sida (PNLS; National AIDS Control Program) under the coordination of the General Directorate of Health, hosted its first national HIV prevention, care, and treatment quality improvement (QI) conference in Abidjan, Côte d’Ivoire. The conference brought together over 100 representatives from the Centers for Disease Control and Prevention, United States Agency for International Development, the Human Resources and Services Administration (HRSA), US President’s Emergency Plan for AIDS Relief (PEPFAR), and PEPFAR implementing partners from around the country to agree on a national approach to QI; update the national strategic plan for improving Quality, Health, and Safety; and learn about the unique QI approach being implemented by I-TECH through the Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) program.

Dr. Nathalie Krou Danho

I-TECH QISSEC Project Director, Dr. Nathalie Krou Danho, describes the QISSEC approach at the National HIV QI Conference. Photo Credit: I-TECH

“This is an historic workshop. [There have been] many conversations and meetings with the PNLS/Ministry of Health and USG agencies [over the years] to gather all the stakeholders to harmonize QI interventions,” says Dr. Jean T. N’Guessan, QISSEC QI Consultant. “This national QI workshop was a success because the leadership was carried by the PNLS, the national Program to fight AIDS, and supported by I-TECH.”

The goal of the conference was to elevate QI practices on a national level and work with stakeholders to adopt and integrate the QISSEC QI approach into their own HIV prevention, care, and treatment programs to improve HIV services while identifying and addressing gaps in care (e.g., viral load monitoring, antiretroviral therapy uptake).

“In Côte d’Ivoire, all hospitals—both public and private—are required to implement continuous quality improvement for all care and services, which can lead to a one-size-fits-all approach to QI,” explains Dr. Nathalie Krou Danho, I-TECH QISSEC Project Director. “This workshop made it possible for us to identify gaps in national standards for the prevention, care, support, and treatment of HIV infection, while also providing an effective QI framework that helps clarify the roles and responsibilities of the stakeholders implementing QI initiatives across the country.”

QI interventions are often applied unilaterally across all sites regardless of analysis of the sites’ specific needs, but I-TECH’s approach tailors each QI intervention and related activities to the needs of the site according to self-identified gaps by the sites. This approach allows sites to be involved in each step of the process, reinforces skills and knowledge, and ultimately creates a sustainable approach to QI. By using the QISSEC approach, HIV programs around Côte d’Ivoire will be able to align their QI work and substantially improve HIV services, while also fulfilling PEPFAR priorities and targets.

“Since I-TECH’s approach works in collaboration with all levels (national, district, and site) of the health system pyramid, we are able to coach sites to develop a QI plan based on the identified gaps, implement it, as well as monitor and evaluate it,” says Dr. Nathalie Krou Danho. “Through data analysis of MER indicators and SIMS data, the approach takes into account the organizational improvement of the quality and the services offered to the patients.”

The QISSEC project, a five-year cooperative agreement with HRSA under PEPFAR, works with local partners to implement customized site-level QI interventions using patient-centered approaches in clinics to ensure a facility-owned and locally led response to the persistent challenges seen in HIV prevention, care, and treatment programs (e.g., HIV testing, retention, suppression, PrEP, TB prevention) and support Côte d’Ivoire in reaching the UNAIDS 95-95-95 targets. The project has initially been focused on 60 priority sites throughout the country but plans to expand to Abidjan’s 75 high-impact sites next year, bringing the total number of sites to 101.

“The QISSEC project aims to strengthen ownership of continuous QI at all levels of the health system pyramid,” says Dr. Nathalie Krou Danho. “To do this, I-TECH collaborates with all national stakeholders, including PEPFAR implementing partners and civil society organizations who can help motivate beneficiaries to take part in QI efforts and extend its QI approach to the community.”

I-TECH’S WORK IN CÔTE D’IVOIRE IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER 1 U1NOA45176-01-00 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.

Improving Data Quality and Strengthening Capacity in Côte d’Ivoire

Through a five-year cooperative agreement with the United States (US) Health Resources and Services Administration (HRSA) under the US President’s Emergency Plan for AIDS Relief (PEPFAR), I-TECH recently began implementing the Quality Improvement (QI) Solutions for Sustained HIV Epidemic Control (QISSEC) project in Côte d’Ivoire. This project aims to support Côte d’Ivoire in reaching the UNAIDS 95-95-95 Fast-Track Targets, which to date have not been consistently achieved with specific populations faring worse than others.

The QISSEC approach supports Côte d’Ivoire’s National AIDS Council, Côte d’Ivoire’s International Training and Education for Health (I-TECH CIV), and other implementing partners to help close HIV-related service delivery gaps across clinics and communities, aiming to reach the UNAIDS 95-95-95 targets. Initially focused on 60 priority sites throughout the country, QISSEC will work closely with local clinic- and community-based partners to implement customized site-level QI interventions; integrate community or civil society groups into QI approaches; establish national QI learning networks; and disseminate QI successes and lessons learned across the learning networks. Using this patient-centered approach, QISSEC aims to ensure a facility-owned and locally-led response to persistent challenges in patient testing, retention, and suppression.

I-TECH Remembers Transgender Activist and Leader Brandy Rodriguez

Brandy Rodriguez gives feedback to a clinician during the pilot training of I-TECH’s Key Population Preceptorship program in Trinidad & Tobago. Photo credit: Lauren Dunnington/I-TECH.

In honor of Transgender Awareness Week (November 13-19), the International Training and Education Center for Health (I-TECH) pays tribute to Trinidad & Tobago transgender activist and esteemed community leader Brandy Rodriguez, who passed away in late October.

Ms. Rodriguez leaves a legacy of leadership as president of the Trinidad and Tobago Transgender Coalition and a member of the Pan Caribbean Partnership against HIV and AIDS. She improved countless lives among those she supported in her many years as a peer navigator at the Family Planning Association of Trinidad and Tobago. Countless more lives were touched – and perspectives broadened – through her tenacity and compassion.

Staff at I-TECH are honored to have worked with Ms. Rodriguez, who served as a patient-trainer for I-TECH Caribbean’s Key Populations Preceptorship program in Trinidad & Tobago.

“A tireless champion for the trans community, Brandy held an open door and a willing ear to any lost children of our LGBTQ tribe,” says Conrad Mitchell, I-TECH’s Program Coordinator in Trinidad & Tobago. “Her fiery tongue and sharp wit kept us all in check, whilst her warm heart overflowed with a love that was unsurpassed. Her fearlessness was legendary both within the community and across local, regional, and international platforms. We are shaken to the core by this loss. The world is forever a little less ‘fierce’ with Brandy gone.”

The Key Populations Preceptorship program’s intensive trainings use targeted role-play scenarios to build clinicians’ capacity to provide nonjudgmental, high-quality comprehensive HIV care to communities most at risk: men who have sex with men, transgender people, and sex workers. Through this work with I-TECH, Ms. Rodriguez contributed to critical efforts to break down stigma and barriers to care experienced by marginalized communities. The first physician trained as part of the program in Trinidad & Tobago, Dr. Vedavid Manick, shared his experience with Ms. Rodriguez beautifully in a Trinidad and Tobago Newsday letter to the editor.

To learn more about the impact Ms. Rodriguez’s work, see these tributes at Trinidad and Tobago Newsday and UNAIDS.org.

Kayla Cody-Lushozi Reflects on I-TECH’S Global Health Leadership Development Program

Kayla Cody-Lushozi

By Chelsea Elkins

For the past 10 months, Kayla Cody-Lushozi has served as the inaugural Global Health Program Officer for I-TECH’S Global Health Leadership Development Program. The aim of this program is to support the development of skills in global health program implementation, management, and leadership for recent master’s degree graduates with diverse backgrounds who are transitioning into the public health field.

This program is structured to directly support the programmatic needs of multiple I-TECH projects while providing the Program Officer with mentorship across the I-TECH network and supporting the transition into a non-temporary global health position. In 2019, Cody-Lushozi received her Master’s in Social Work (MSW) from the University of Washington (UW) and has used this background, along with her unique experiences and expertise, to inform her work at I-TECH.

During her time as a Program Officer, Cody-Lushozi has worked with three teams across the I-TECH network, plunging into a few of the many areas of work I-TECH implements and supports. In collaboration with partners from FHI 360 and leaders from the Cambodian Ministry of Health, Cody-Lushozi supported a health informatics program, working to streamline databases and strengthen health systems in Cambodia. Additionally, she explored how to revive Community Advisory Boards for people living with HIV (PLHIV) in Jamaica in a sustainable and community-centered way with I-TECH network partner the Caribbean Training and Education Center for Health (C-TECH). She worked with community partners in Zimbabwe, as well, exploring the support systems in place for case managers supporting young PLHIV. This work was done with I-TECH partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH).

September marks the end of Cody-Lushozi’s time with I-TECH. Below, she shares some reflections on her time in the Leadership Development Program, as well as what might come next.

What has the experience of being a Program Officer at I-TECH meant to you?

This has been an incredible experience, and it came at a perfect time. Right before I-TECH, I was working at the Washington State Department of Social and Health Services doing direct service social work with economically marginalized clients with mental and physical health needs. While I enjoyed this role and understood its importance, this was not the type of social work practice that I wanted to pursue in the long run.

My passion and interests lie in research, especially community-centered research that allows me to work directly with Black communities in improving access to health justice. I-TECH came along at the right time and allowed me to dive deeper into the world of global health implementation.

The projects I’ve done at I-TECH have been really varied, and I’ve gotten an inside look and experience across different areas. I am constantly learning at I-TECH. I-TECH does a million things, which might have been overwhelming to a new person entering the organization, but I always felt very supported by my teams. They made it clear that I didn’t need to have all the answers.

I also appreciate that this program aims to attract a diversity of experience, background, and perspective. It encourages more than just a singular lens. I’ve been able to share my unique background and experiences as a Black woman social worker in global health. I’m excited to see where this program goes and how it continues to support I-TECH’s evolution.

This has been a beautiful experience for me. Working at I-TECH served as a great affirmation that this is the area of work that I want to continue to grow in.

How has your background in social work shaped how you’ve entered the global health field?

Before getting my MSW I already had an interest in public health, even before I was calling what I was doing public health. I wanted to use the framework and the lens that social work provides within a public health setting. I always gravitate toward work that is community-centered and centers the voices and expertise of those in the margins. These are some of the values that I bring with me into the global health space and that I hold very close to my professional and personal practice.

These values have helped me in this field because public and global health work is not always operating from the pillars of anti-oppressive practice. There’s so much historical and contemporary discourse that needs to be addressed and often isn’t in this field. You can’t be ahistorical if you’re truly trying to get to the root causes of global health inequity and injustice. Many of the issues that we see in global health are connected to issues of global white supremacy, imperialism, and resource extraction. It’s a tension that I hold in this field but something I try to do my part to shed light on.

You have done a lot of meaningful work during your time with I-TECH. What does your life look like when you’re not working?

I’ve gone through a lot of life changes these past 10 months. I’m a newlywed; I got married in June to my now husband Mawande. Being a new wife is really exciting.

A big chunk of my husband’s and my time outside of work is dedicated to our small homemade skincare business, K+M Homemade Skincare, that we officially launched during COVID. We do a lot of farmer’s markets and pop-ups on the weekends. Ask anyone and they can tell you that we love making and talking about our skincare.

In what direction do you see yourself moving after I-TECH?

After I-TECH, I see myself continuing to engage in global and public health spaces that are truly committed to community work and radical racial and social justice transformation. I am not comfortable doing this work in the absence of working directly with community members and local stakeholders. Top-down approaches have colonial and imperialist roots. I believe in doing “with” and not doing “to” and actively partnering with communities for long-term sustainability and quality health care reform.

I will be packing up and moving to South Africa in 2022 and am currently open to a position that will allow me to continue to practice in this exciting field. My interests lie in research, project management, and implementation work related to HIV care and treatment, maternal and child health, and mental health. I am also contemplating pursuing an MPH or a PhD in global health and implementation science sometime in the future. It’s been an incredible past 10 months with I-TECH and I am excited to stay in contact with this global network. I thank everyone who has been part of this journey with me!

The I-TECH network thanks Kayla Cody-Lushozi for her work and wishes her well as she continues to forge her path in global health!

If you are interested in participating in the Global Health Leadership Development Program, more information is available here.

Reducing HIV through Voluntary Medical Male Circumcision in Zimbabwe

Since 2013, the ZAZIC Consortium has been implementing Voluntary Medical Male Circumcision (VMMC) as part of a combination HIV prevention package approved by the Ministry of Health and Child Care (MoHCC) in Zimbabwe. Unlike other VMMC programs in the region, the ZAZIC model uses an integrated approach, blending local clinic staff supported by MOHCC with partner staff. The ZAZIC consortium supports:

  • Training using MoHCC approved curricula, health workers in the supported districts are trained on the surgical technique as well as on demand creation
  • Development and implementation of age appropriate demand creation strategies
  • Support service delivery in 13 districts from consent procedures to post-surgical care and linkage to other services
  • Comprehensive monitoring and evaluation including continuous quality improvement and operations research

From 2013-2018, ZAZIC performed over 300,000 VMMCs with a reported moderate and severe adverse event rate of 0.3%. The safety, flexibility, and pace of scale-up associated with the integrated VMMC model appears similar to vertical delivery with potential benefits of capacity building, sustainability and health system strengthening. Although more complicated than traditional approaches to program implementation, attention should be given to this country-led approach for its potential to spur positive health system changes, including building local ownership, capacity, and infrastructure for future public health programming. Over 80% of the circumcisions occur in outreach settings, an approach that ensures wide coverage and expanded services in hard-to-reach locations.

Achieving Targets through Performance-Based Financing in Zimbabwe

ZAZIC employs an innovative performance-based financing (PBF) system to speed progress towards ambitious voluntary medical male circumcision (VMMC) targets. The PBF schedule, which started at $25 USD and now varies from $6.50-$14 USD depending on the location and the circumcision team, is continually refined to set the program up for sustainable transition. The PBF is an incentive that is intended to encourage underpaid healthcare workers (HCWs) to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports HCWs who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels.

I-TECH conducted a qualitative study to assess the effect of the PBF on HCW motivation, satisfaction, and professional relationships. The study found that the PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace and create divisiveness. To reduce workplace tension and improve the VMMC program, ZAZIC increased training of additional HCWs to share the PBF incentive more widely and strengthened integration of VMMC services into routine care.

Laboratory Quality Stepwise Program in Cambodia

From September 2013 to September 2016, I-TECH conducted an implementation science research project to improve laboratory quality in Cambodia. The primary objective of the project was to implement a mentored laboratory quality stepwise implementation (LQSI) program to strengthen the quality and capacity of Cambodian hospital laboratories. As a result, target laboratories improved their operations in the areas of: biosafety, organization, personnel, equipment maintenance, purchasing and inventory, testing accuracy, process management, documentation and communication.

The project recruited and trained four laboratory technician to be mentors, training staff from 12 referral hospital laboratories in quality management systems (QMS), and reinforcing skills acquisition through in-person mentoring. Participating laboratories reported a 36% increase in quality management, 29% improvement in data management, and 25% improvement in specimen collection and handling. The laboratories established the foundational practices of a QMS, and the LQSI program has improved the recognition of the laboratory within the hospitals.

Improving Laboratory Quality in Cambodia

The I-TECH Cambodia Lab team. L to R: Sophanna Song, Cat Koehn , Siew Kim Ong, and Sophat Sek

I-TECH’s laboratory program began in Cambodia in 2013 with the goal to improve operations and regional biosurveillance and biosecurity through improved laboratory quality assurance and management practices. In collaboration with the Cambodian Ministry of Health, the World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC), and with funding provided by the Department of Defense and DTRA, I-TECH strengthens the Cambodian laboratory system through:

  • Implementation of an intensive mentoring program at 12 national and provincial public health laboratories;
  • Leadership and management capacity building of MoH laboratory leaders;
  • Mentoring and capacity building the National Animal Health and Production Research Institute (in collaboration with Washington State University);
  • Job specific training delivered in service and through educational programs such as the Quality Assurance Certificate Course (in collaboration with the University of British Columbia);
  • Support for laboratory workforce development through on-site technical assistance and training;
  • Support for national laboratory system policy development.

Nursing Efficiency and Task-Sharing in Tanzania

I-TECH Tanzania led the development of the task-sharing policy guidelines for Health Sector Services approved in 2016 as well as the policy’s operational plan. While task-sharing is a widely known HIV service delivery efficiency strategy, still there is continues gaps between national strategies and actual implementation at the site-level [1,2].

Continue reading »

I-TECH Presents Laboratory Systems Strengthening Data at ASLM 2018

Representatives from the International Training and Education Center for Health (I-TECH) attended the fourth international African Society for Laboratory Medicine (ASLM) conference in Abuja, Nigeria, on 10-13 December 2018.

The theme this year focused on the role of laboratories in preventing and controlling the next pandemic. I-TECH had seven abstracts accepted at the conference that highlighted the laboratory systems strengthening work done by I-TECH in Cambodia, Côte d’Ivoire, and Zambia. The full abstracts presented by I-TECH can be found in the ASLM 2018 Conference Abstracts Conference Book.

Below is a summary of I-TECH presentations:

I-TECH Laboratory Systems Strengthening Team at ASLM 2018.

I-TECH Laboratory Systems Strengthening Team at ASLM 2018. Pictured (L to R): Sitting – Lucy Perrone, Felicity Golopang, Larissa Koffi; Standing – Sylvestre Kone, Nayah Ndefru, Siew Kim Ong.

Oral Abstracts

  • Siew Kim Ong, I-TECH Cambodia Project Coordinator, was lead author and presenter for the “Improved Laboratory Compliance to Quality Standards in Cambodian Laboratories through On-site Trainings.” This abstract reviewed the effect of training in 12 I-TECH-mentored laboratories in Cambodia on laboratory processes (Page 27).

Poster Sessions

  • Nayah Ndefru, I-TECH Seattle Laboratory Strengthening Specialist, presented an abstract titled, “Effectiveness of Using a Mixed Approach of On-site Mentoring and Tele-mentoring for Improving Laboratory Quality Management Systems: Lessons From Cambodia.” The presentation looked at the lessons learned in the implementation of a Quality Management System (QMS) in 12 national hospital laboratories throughout Cambodia and the 2018 pilot approach to addressing the QMS gaps identified in an earlier baseline survey (Page 55).
  • Larissa Koffi, I-TECH Côte d’Ivoire RTCQI Specialist, presented two posters: One titled, “Analysis of EQA HIV Serology Data in Côte d’Ivoire Reveals Gaps in Quality Testing.” The second poster was “Analysis of HIV Point of Care Testing Sites in Côte d’Ivoire Reveals Gaps in Tester Competence.” The posters displayed the results of a retrospective study that can inform strategies and interventions for improved quality at HIV testing sites (Page 200).
  • Sylvestre Kone, I-TECH Côte d’Ivoire Laboratory Quality Specialist, presented a poster titled “Improving Quality and Capacity of the Laboratory System in Côte d’Ivoire.” The poster detailed the work the team is doing to train and mentor laboratory staff in hospital laboratories towards achieving international quality standards (Page 242).
  • Felicity Gopolang, I-TECH Laboratory Mentor Consultant, presented a poster titled, “Implementation of a Professional Development Program in Laboratory Leadership and Quality Management in Zambia from 2016-2018.” The poster outlined the impact of the Program on quality improvement (Page 206).
  • Pat Sadate-Ngatchou, I-TECH Seattle Senior Laboratory Advisor, was lead author on the poster titled “Improvement of Quality Practices within HIV Point-of-Care testing (POCT) Sites in Côte d’Ivoire Through Implementation of the Rapid Test Continuous Quality Improvement (RTCQI),” which explored the impact of the implementation of RTCQI in POCT site audits (Page 246).

About ASLM
The mission of ASLM is to improve clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks. Based on five strategic pillars, ASLM serves the community of laboratory professionals and promotes the value of strong medical laboratories to key stakeholders such as the Ministries of Health, research laboratories, and universities. ASLM is an independent, non-profit organization endorsed by the African Union and headquartered in Addis Ababa, Ethiopia.

http://www.aslm.org/