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I-TECH and Zim-TTECH Publish Paper on Transitioned Programs

Faculty and staff from the International Training and Education Center for Health (I-TECH) and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) have published a new paper in the journal PLOS One.

Working toward sustainability: Transitioning HIV programs from a USA-based organization to a local partner in Zimbabwe catalogs the challenges and lessons learned as I-TECH laid the groundwork to transition the voluntary medical male circumcision (VMMC) and HIV care and treatment programming in Zimbabwe to the newly established Zim-TTECH, a fully independent local organization.

“I-TECH prides itself on working collaboratively with our international partners. We held the principle from day one that the most successful programs happen when the locus of control sits in-country,” said Marrianne Holec, Senior Program Manager at I-TECH. “We had the foundation in place with our local staff, what was missing was the organizational structure to allow the team in-country to truly lead the project. With the formation of Zim-TTECH, I’m happy to say we are there.”

Among USG funders, it’s recognized that future models for sustainable healthcare rely on local country ownership and leadership.[1] But making the transition from US-based ownership to country ownership isn’t a one-time event, added Holec, “It’s a process that takes time. We wanted to document our process so that other international organizations who are looking to pursue decolonizing global health programming can learn from our experience.”

Through 16 key informant interviews, the team gathered views on transition planning, implementation, and technical support, ethics, and success. Five themes emerged from the data collected:

  • Develop a vision and empower leadership for change by delegating clear roles and supporting local ownership;
  • Plan and strategize for transition in a manner that accounts for historical context;
  • Communicate with and inform stakeholders to understand transition perceptions, understand barriers to transition, and enable open communications related to risks and benefits;
  • Engage and mobilize staff by constructing necessary infrastructure and providing technical assistance as needed; and
  • Define short-term and long-term success.

“Sustainability of successful donor funded public health programs is critical if we want to maintain the important gains that have been made over the years,” says Dr. Batsi Makunike, Executive Director of Zim-TTECH. “Strong local organizations with good governance, management, and technical capacities are an important cornerstone of sustainability.

“The process of transitioning from an international to a local organization is daunting,” she continues. “We hope that this study is helpful to other organizations in their efforts to transition.”

[1] Goosby E, Von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the Bar: PEPFAR and New Paradigms for Global Health. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;60.

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.

Preliminary results of the assessment, led by the MOH and ICAP, show 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 90.9% 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.

Technical Support to the National HIV Response in Malawi

I-TECH seconded staff work in collaboration with government officers and program managers, and bring technical expertise to efforts to strengthen health systems. Continue reading “Technical Support to the National HIV Response in Malawi”

I-TECH Shares Research at CUGH 2018

CUGH Logo
Logo courtesy of the Consortium of Universities for Global Health (CUGH):  https://www.cugh.org/.

Representatives from the International Training and Education Center for Health (I-TECH) are headed to New York for the 9th Annual Consortium of Universities for Global Health (CUGH) Conference. The conference—held on March 16-18, with satellite sessions on March 15—will be co-hosted by Columbia University, Stellenbosch University, and the University of Peradeniya.

Featured speakers include Richard Horton, Editor of The Lancet, and Natalie Kanem, Deputy Executive Director of the United Nations Population Fund.

Building on the theme of “Health Disparities: A Time for Action,” staff and faculty from I-TECH will be presenting on the following topics:

  • King Holmes, MD, PhD, founding chair of the Department of Global Health and a co-Principal Investigator of I-TECH’s IAETC award, will join a morning plenary session and discussion about global health disparities. The discussion will be moderated by Director of the Fogarty International Center Roger Glass. Dr. Holmes will be joined for the discussion by Rose Leke, Gairdner Foundation Global Health Committee member and Emeritus Professor at Universite de Yaounde, and K. Srinath Reddy, President of the Public Health Foundation of India.
  • Kate Wilson, PhD, Clinical Assistant Professor, is presenting a poster titled “Evaluation of a New Field Epidemiology Training Program (FETP) Intermediate Course to Strengthen Public Health Preparedness in Tanzania.” The locally adapted course significantly improved trainee knowledge and skills in field epidemiology, and the evaluation also showed evidence of improvement in data quality and performance at trainees’ workplaces and districts.
  • Lindsay Mumm, MPA, Program Manager, is presenting a poster titled “Creating Relevant Change towards Reaching the UNAIDS 90-90-90 Target with High-Impact Leadership Training – Afya Bora Fellowship in Global Health Leadership.”

In addition to the research being shared at CUGH, I-TECH was represented earlier this month at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston. Nancy Puttkammer, PhD, MPH, presented a poster titled “Multi-Month Scripting (MMS) and Retention on HIV Antiretroviral Therapy (ART) in Haiti.” The retrospective study used data from the iSanté electronic medical record system in Haiti and found promising results that MMS for ART in virally suppressed patients improved retention and engagement in treatment.

 

About CUGH

The mission of CUGH is to build interdisciplinary collaborations and facilitates the sharing of knowledge to address global health challenges while promoting mutually beneficial, long-term partnerships between universities in resource-rich and resource-poor countries, developing human capital and strengthening institutions’ capabilities to address these challenges. Read more about CUGH: https://www.cugh.org/.

About CROI

Established in 1993, The Conference on Retroviruses and Opportunistic Infections (CROI) was provides a forum for scientists and clinical investigators to present, discuss, and critique their research. The goal of the conference is to provide a forum for researchers to translate their laboratory and clinical findings into tangible progress against the HIV pandemic. Read more about CROI: http://www.croiconference.org/.

Field Epidemiology Training Program (FETP) in Tanzania

A training participant takes part in a handwashing exercise as part of a cholera outbreak investigation.

For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country.

To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and Prevention (CDC) and the Ministry of Health Community, Development, Gender, Elderly and Children in Tanzania, launched a new Intermediate Field Epidemiology Training Program (FETP) for mid-level health professionals.

Continue reading “Field Epidemiology Training Program (FETP) in Tanzania”

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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Pamela Kohler

Pamela Kohler, BSN, MPH, PhD, co-directs the UW Center for Global Health Nursing and holds a joint appointment in Child, Family, and Population Health Nursing and the Department of Global Health. Dr. Kohler completed her nursing training at Johns Hopkins University, and worked clinically in the HIV Care and Emergency Departments. She holds a PhD in Nursing and an MPH in Health Services from the University of Washington.

At I-TECH, she leads the Tanzania Intermediate Field Epidemiology Training Program (FETP) and evaluates HIV/STI programs and policies in several African countries. Dr. Kohler’s research explores social and programmatic barriers to uptake of services along the HIV care continuum, including prevention of mother-to-child transmission (PMTCT), referral to and retention in HIV care, and sex education for pregnancy and STI prevention. She has a particular interest in improving HIV prevention, testing, and treatment services for adolescents, and in quality improvement of HIV and STI service delivery.

Publications

McConnico C, Jed SL, Marumo E, Mazibuko S, Mema GM, DeKadt J, Holmes K, Kohler PK. Systems Mapping of Sexually Transmitted Infection Services at Three Clinical Sentinel Surveillance Sites in South Africa: Opportunities for Integrated Care. J Assoc Nurses AIDS Care. 2017 Jan-Feb. pii: S1055-3290(16)30121-2. doi: 10.1016/j.jana.2016.09.004.

Kohler PK, Marumo E, Jed SL, Mema G, Galagan S, Tapia K, Pillay E, DeKadt J, Naidoo E, Dombrowski JC, Holmes KK. A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa. Sex Transm Infect. 2017 Jan 27. pii: sextrans-2016-052930. doi: 10.1136/sextrans-2016-052930.

Kohler PK, Tippett Barr BA, Kangʼombe A, Hofstee C, Kilembe F, Galagan S, Chilongozi D, Namate D, Machaya M, Kabwere K, Mwale M, Msunguma W, Reed J, Chimbwandira F. Safety, Feasibility, and Acceptability of the PrePex Device for Adult Male Circumcision in Malawi. J Acquir Immune Defic Syndr. 2016 Jun 1;72 Suppl 1:S49-55. doi: 10.1097/QAI.0000000000000774.

Kohler PK, Namate D, Barnhart S, Chimbwandira F, Tippet-Barr BA, Perdue T, Chilongozi DA, Tenthani L, Phiri O, Msungama W, Holmes KK, Krieger JN. Classification and rates of adverse events in a Malawi male circumcision program: impact of quality improvement training. BMC Health Serv Res. 2016 Feb 17;16(1):61. doi: 10.1186/s12913-016-1305-x.

Program Highlights

Field Epidemiology Training Program (FETP) in Tanzania
For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country. To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and ...
Read More
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] ...
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Strengthening National Health Systems through Task Shifting and Training in Namibia

Working with the Ministry of Health and Social Services (MoHSS) to roll out treatment in the country, I-TECH supported the training of physicians to provide antiretroviral therapy (ART) soon after the first national ART guidelines were published in 2003. I-TECH subsequently began supporting the training of nurses in both ART (2006) and Integrated Management of Adolescent and Adult Illness (IMAI, 2007) to increase health system capacity to expand delivery of ART services.

In 2010, I-TECH implemented a task shifting demonstration project to determine whether nurse-initiated management of antiretroviral treatment (NIMART) is a feasible alternative to doctor-led models. I-TECH subsequently supported an evaluation of this project which confirmed its feasibility for use in certain countries. In Namibia, NIMART was adopted by the MoHSS for use nationwide in 2013. I-TECH continues to hold NIMART trainings: five were held in 2016, with 125 health care workers trained.

Support for Pediatric HIV Care and Treatment in Namibia

I-TECH works to strengthen the quality of pediatric HIV care and treatment in Namibia through the development of a “model” pediatric HIV clinic and supporting decentralization of quality pediatric care to other facilities. In collaboration with the Ministry of Health and Social Services, I-TECH developed an innovative, structured, culturally-relevant intervention to help guide health care workers and caregivers of HIV-positive children through the process of disclosing a child’s HIV-positive status to the child.

An evaluation of the disclosure program showed that it increased health care worker and caregiver confidence and communication in pediatric disclosure, as well as demonstrating improved viral suppression, adherence, and HIV knowledge among pediatric patients. I-TECH clinicians have also worked at the site level to support the development, implementation, and monitoring of strategies to improve adolescent HIV services and transition of adolescents from pediatric to adult care.