Migrating waterfowl from Asia, Africa, and Europe intersect in Georgia, which increases the potential for novel avian-origin influenzas to emerge. I-TECH, through the INSIGHT project, is working with the Centers for Disease Control and Prevention Georgia, the Georgia National Food Agency, and the Georgia Ministry of Environmental Protection and Agriculture, through September 2024 to assess biosecurity and influenza outbreak readiness on commercial poultry farms in Georgia, and support capacity building for and development of a national wild bird surveillance strategy. Activities include a farm biosecurity survey and peri-domestic wild bird capture, sampling, and testing, as well as training in genomic surveillance and design of surveillance programs.
Category: Surveillance
I-TECH Initiates IDASH in South America with Representatives from 5 Countries
Para mais informações sobre o encontro, em português, acesse Fundação de Vigilância em Saúde do Amazonas – Dra. Rosemary Costa Pinto.
At a February 5-8 meeting in Bogotá, the International Training and Education Center for Health (I-TECH) convened with global health leaders from 5 countries to inform the adaptation of the Informatics and Data Science for Health (IDASH) training program to South American contexts.
IDASH–part of I-TECH’s Integrated Next-generation Surveillance in Global Health: Translation to Action (INSIGHT) project–is a training program for current and future leaders in public health that aims to strengthen regional capacity to use public health information and data systems to improve health outcomes at the population level, detect and respond effectively to threats to public health, and promote health equity.
The objectives of the intensive, weeklong Executive Committee meeting included identifying priorities and key capabilities; adapting the structure of the IDASH course to local needs as well as government priorities and initiatives; and identifying government and academic resources to support teaching.
In a a website post of IDASH partner Fundação de Vigilância em Saúde do Amazonas – Dra. Rosemary Costa Pinto, INSIGHT Regional Director for South America Fernanda Freistadt said: “This initiative has the potential to create health professionals who have advanced knowledge in both epidemiology and information technology, an area in which there is a great lack today. Furthermore, IDASH can strengthen technical relations and collaborations in the area of surveillance between countries.”
The Executive Committee Meeting included representatives from Colombia, Brazil, Paraguay, Peru, and Ecuador, as well as international partners including Georgia’s National Center for Disease Control and Public Health (which has been an important partner in the IDASH training program for Eastern Europe/Central Asia). It is anticipated that the South America expansion implementation to happen later this year.
COVID-19 Sentinel Surveillance in Malawi
Despite establishing COVID-19 monitoring measures within the existing routine national surveillance system and significant efforts to conduct testing, contact tracing, and case investigations, Government of Malawi institutions at both the national and district levels faced many challenges in mounting an effective response to the COVID-19 pandemic. The existing COVID-19 surveillance system relied on retrospective data and it struggled to establish the magnitude of community transmission or identify emerging variants.
In June 2022, in collaboration with the Public Health Institute of Malawi and support from the US Centers for Disease Control and Prevention, I-TECH began sentinel surveillance monitoring of COVID-19 in seven sites. The COVID-19 sentinel surveillance system in Malawi was able to quickly detect changes in positivity rates and the emergence of variants. Read more about key findings and methods in I-TECH’s Sentinel Surveillance program brief.
IDASH Fellowship Meets in Kazakhstan for In-Person, and Virtual, Workshop
Last month, the International Training and Education Center for Health (I-TECH), in collaboration with the U.S. Centers for Disease Control (CDC) and with support from the World Health Organization (WHO), facilitated the second of three in-person workshops for the Informatics and Data Science for Health (IDASH) fellowship.
Held in Almaty, Kazakhstan, the workshop marked the mid-point of the 12-month fellowship—and a chance for participants to come together to advance their ability to apply public health informatics and data science concepts and approaches.
“This workshop included a lot of hands-on practical exercises, and it was fun to observe how engaged the participants were with these activities and with the learning in general,” said Stacey Lissit, MPH, MS, Senior Technical Advisor for the IDASH program.
Content included all things data (quality, cleaning, analysis, visualization, governance, security, privacy, and confidentiality); interoperability; project management; business process analysis; and systems architecture. Sessions were a mix of didactic lecture, small group activities to practice application of skills and concepts, peer feedback, and guided hands-on learning in R and PowerBI. Over the course of the two weeks, participants collaborated to develop a data dashboard, a database schema, and a data quality workplan.
The current fellowship, launched in April 2023, comprises a cohort of four participants each from Georgia, Kazakhstan, Kyrgyzstan, Ukraine, and Uzbekistan—a total of 20 fellows. Each four-person team includes a mix of mid-senior level epidemiologists, informaticians, data scientists, IT, and public health policy personnel.
Fellow Zhanibek Yerubayev, Director of Public Health Emergency Operations at the Kazakhstan Ministry of Health’s National Center of Public Health, says the team mix is an integral part of IDASH’s impact. “[IDASH] connects people from the public health side with people from the IT side,” he says. “These people have a lot of projects to do [together], but they are not always well connected, and they do not always understand each other well.”
“It was exciting to see the relationships and community that are being built through the IDASH Fellowship – both within the country teams where fellows can collaborate closely with colleagues outside of their typical ‘work silos,’ and across countries within the region,” said Lissit. “That peer learning element is such an important part of the fellowship.”
And all efforts were made to ensure multi-directional collaboration. The Ukrainian team did not receive permission to travel to the workshop, so I-TECH made arrangements for them to participate via Zoom. A location was identified in southwest Ukraine where the team could attend the workshop together remotely, experience fewer daily safety issues related to the war, and avoid the distractions of being in their own workplace. A simultaneous translator for the Ukrainian language was provided on the Zoom call.
While remote participation is not ideal, the Ukraine team was able to attend and hear most of the workshop sessions and engage in the group work in meaningful ways. “A lot of effort went into setting up the technology that enabled this participation,” said Lissit. “At one point the Ukraine team was participating in a peer feedback activity with two country teams in Almaty—there were live cameramen, screen sharing, Zoom translators…and it worked mostly seamlessly!”
Fellow Durbek Aliyev, Deputy CEO at IT-Med LLC, which works under the Uzbekistan Ministry of Health, was especially appreciative of the chance to learn from a wide range experts across the region. “The digitalization of health care cannot be done by only one country itself,” said Aliyev. “The advantage of IDASH over other programs is that it brings [together] specialists from neighbor countries. We are talking to each other….We are learning from each other directly.”
And these relationships will be a lasting benefit of the program, he continued. “IDASH is a place where we can establish very good networking with other countries,” said Aliyev. “Any time I can contact them and learn from their expertise.”
IDASH is a project within the Integrated Next-Generation Surveillance in Global Health: Translation to Action (INSIGHT) program. In addition to acquiring new skills and knowledge in public health informatics and data science, IDASH country teams are developing and will implement a collaborative team project that demonstrates key competencies and is aligned with their country’s needs and priorities.
HIV Drug Resistance Surveillance in Malawi
The World Health Organization recommends countries routinely implement nationally representative HIV drug resistance (HIVDR) surveys among people infected with HIV to measure the level of drug resistance. The results of HIVDR surveys are a critical component of HIV programs and can guide changes to pediatric and adult antiretroviral therapy (ART) treatment regimens, including first- and second-line regimen decisions. I-TECH has been implementing HIVDR surveys in Malawi since 2016.
HIV DR Surveys Conducted Since 2016:
- Infant HIVDR Survey: An HIVDR survey was conducted among infants aged 18 months and younger to determine the level of pediatric resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI), and protease inhibitors (PI) ART drugs through exposure during pregnancy and breastfeeding. A total of 232 eligible remnant dried blood spot (DBS) samples from nine early infant diagnosis (EID)-approved laboratories were used for the diagnosis of HIV in infants between June 2016 and December 2017.
- Antenatal Care (ANC)/Pregnant Women HIVDR Survey: An HIVDR survey was conducted to measure resistance to NNRTI, NRTI and PI drugs among ANC clients who were found to have a recent HIV infection. A total of 45 DBS samples from women with recent HIV infection were collected as part of the 2016 HIV sentinel surveillance survey and were successfully amplified and sequenced.
The next step in HIV surveillance activity is monitoring HIVDR among pregnant women initiating dolutegravir (DTG)-based regimens, as well as the potential emergence of DTG resistance in infants via mother-to-child transmission. A study of DTG resistance is currently underway in Malawi and will determine the level of DTG resistance in adults who are unable to achieve viral load suppression and DTG resistance in children < 15 years old who are unable to achieve viral load suppression.
I-TECH Presents at 2023 IAS Conference on HIV Science
The International AIDS Society (IAS) hosted the 12th IAS Conference on HIV Science on 23 – 26 July 2023 in Brisbane, Australia, and virtually. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.
This year, representatives from the International Training and Education Center for Health (I-TECH), I-TECH’s partner network organizations, and the Centers for Disease Control and Prevention (CDC) shared findings from I-TECH-supported programs in India, Malawi, and Zimbabwe. Read the ePoster abstracts below.
India:
- Ramesh Allam, MBBS, Public Health Specialist, CDC India – “Implementation Of Person-Centered Strategies To Improve Reengagement In Care In Mumbai, India” & “Improved Treatment Outcomes Using Family-Centric Care Among PLHIV, Nagaland, India-2022”
- Shrikala Acharya, MD, Professor (Addl), Dept. of Community Medicine, KEM and Former Additional Project Director, Mumbai District AIDS Society (MDACS) – “Feasibility of Implementing Advanced Disease Management Package as Part of Routine, Standard of HIV Care at ART Centres in Mumbai, India”
- Vijaykumar Karanjkar, MBBS, PGDPH, Additional Project Director, MDACS – “Saturation of Tuberculosis Preventive Therapy among People Living with HIV, Mumbai, India”
Malawi:
- Christel Saussier, PhD, Public Health Institute of Malawi/Ministry of Health Emergency Operations Center Technical Assistant, I-TECH Malawi – “Sentinel Surveillance for Early Detection of COVID-19 in Malawi”
- Alinune Kabaghe, MBBS, PhD, Epidemiologist, CDC Malawi – “Use of recent HIV surveillance data to respond to ongoing HIV transmission in Malawi”
Zimbabwe:
- Edward Dembedza, MPH, BSc HEP, DipN, DipHAE, Program Coordinator, Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH) – “Client Cohorting, Community Outreach, and On-site Sample Preparation, Increase HIV Viral Load Coverage in Western Zimbabwe”
- Charlton Muchemwa, MPH, Program Officer, Pangea Zimbabwe AIDS Trust (PZAT) – “Data Driven Programming: Using Hot Spot Mapping Data to Improve Case Detection and Linkage to HIV Prevention and Treatment Services in Harare, Zimbabwe”
- Shamiso Nyakuwa, MSc, Program Lead, Pangea Zimbabwe AIDS Trust (PZAT) – “Integrating Peer-led Problem-Solving Therapy with HIV Prevention and Treatment to Address Mental Health Issues Among Key Populations: Lessons from a Pilot Project in Harare, Zimbabwe”
- Ann Sellberg, MD, MSc Epidemiology, Clinical Mentor, Zvandiri – “Implementation of a Quality Improvement Collaborative of HIV Status Disclosure of Young People Living with HIV in Zimbabwe”
- Precious Moyo, MA, Program Coordinator, Pangea Zimbabwe AIDS Trust (PZAT) – “Establishment of Key Populations-Led Facility Monitoring Committees for Strengthening Uptake of Comprehensive HIV Prevention Services at Public Health Facilities in Harare, Zimbabwe”
- Brighet Chiururwi, MSc, Program Officer, PZAT – “Demand Creation Strategies to Increase Acceptance of HIV Pre-Exposure Prophylaxis Among Pregnant and Breastfeeding Women (PBFW) as Part of the eMTCT Strategy in Mazowe District, Zimbabwe”
John Lynch
John Lynch, MD, MPH is an infectious diseases physician focused on improving the operations and capacities of healthcare teams to improve patient care and safety. He is an Associate Medical Director at Harborview Medical Center (HMC), a mission-driven, Level-1 burn and trauma teaching hospital that is part of the University of Washington (UW) School of Medicine. At HMC, he leads the hospital’s Infection Prevention & Control (IPC), Employee Health, and Sepsis Programs, and was the lead clinician for UW Medicine’s COVID-19 emergency response. Dr. Lynch is also a Professor of Medicine in the Division of Allergy & Infectious Diseases in the University of UW Department of Medicine.
Dr. Lynch co-leads the Center for Stewardship in Medicine (CSiM), a group of physicians and pharmacists working to bridge knowledge gaps (in both directions) between academic medical centers and rural health care facilities. Their work is mainly in antimicrobial stewardship and infection prevention but also extends to building quality improvement programs in those facilities. CSiM is composed of three main activities, including UW Tele-Antimicrobial Stewardship, a telementoring program, the Intensive Quality Improvement Cohorts, and resource/tool development to support the goals of the program.
In addition, Dr Lynch also works with Dr. Peter Rabinowitz (PI) to provide subject matter expertise on a long-running project to build IPC capacity in hospitals in Kenya as part of the I-TECH Global Health Security Agenda project.
Program Highlights
Triple Border Disease Surveillance in South America
Population movement, limited public health infrastructure, different country reporting systems, and poor environmental conditions increase incidence of certain infectious diseases across borders. Communities living in border areas are at increased vulnerability for and worse outcomes from infectious diseases such as COVID-19 and other priority pathogens.
I-TECH, as part of the Integrated Next-generation Surveillance in Global Health: Translation to Action (INSIGHT to Action) project, is implementing a cross border surveillance strengthening program to improve the detection, monitoring, investigation, and response to public health threats in two triple border regions in South America.
Strengthening Public Health Disease Surveillance
The Integrated Next-generation Surveillance in Global Health: Translation to Action (INSIGHT to Action) project is a five-year cooperative agreement with the US Centers for Disease Control and Prevention to assess and strengthen global public health surveillance systems using a One Health approach. The INSIGHT project leverages the capacity building strengths of I-TECH and the One Health disease surveillance expertise of the Center for One Health Research, with a model of engaging local institutions and experts in countries where it will be working in a shared partnership model.
In its first year, the INSIGHT project focused on an in depth assessment of the public health surveillance systems in Peru, in partnership with experts from University of Peru Cayetano Heredia. The completed assessment has now catalyzed the formation of a technical working group with representation across multiple government agencies that will work with other stakeholders including the World Bank at implementing measures to strengthen regional and country capacity to detect, respond to, control, and prevent emerging disease threats to health security.
The INSIGHT surveillance work in Latin America is also now expanding to involve Paraguay, Brazil, Argentina, and Colombia.
IDASH TRAINING PROGRAM
In 2023, the INSIGHT program launched the Informatics and Data Science for Health (IDASH) training program in Eastern Europe and Central Asia. The goals of IDASH are to enhance capacity to create and use public health information systems that enable the capture, management, analysis, dissemination, and use of reliable, timely information to improve population-level health outcomes, as well as strengthen regional capacity to effectively respond to future global health challenges.
UKRAINE RECOVERY
Building on lessons learned from the Peru assessment work, the INSIGHT team is now working with the Ukraine Public Health Center on expanding sentinel and event based surveillance systems in Ukraine and strengthening the capacity of the public health system for emergency management of chemical biological, radiological, and nuclear threats. The INSIGHT team has organized a workshop in Poland bringing together key principals from the Ukraine ministry of health and local health departments to accelerate the pace of activities in support of public health in the country. INSIGHT is coordinating technical working groups on Early Warning and Response, Public Health Emergency Management, and Surveillance strengthening.
IDASH Program Launches for Eastern Europe and Central Asia Region
On April 3, the International Training and Education Center for Health (I-TECH) launched the Informatics and Data Science for Health (IDASH) fellowship training program with an in-person workshop in Tbilisi, Georgia. The program launched in partnership with the United States Centers for Disease Control and Prevention’s Eastern Europe and Central Asia (CDC/EECA) Regional Office, the World Health Organization (WHO) Europe, and country governments.
The first IDASH cohort includes 20 fellows from Georgia, Kazakhstan, Kyrgyzstan, Ukraine, and Uzbekistan. Participants include mid- to senior-level technical, analytical, and public health staff working at the national level in public health informatics or data science.
“After several whirlwind months of collaboration and engagement with stakeholders from the five countries, it’s amazing to welcome the first cohort of IDASH to Tbilisi for the first of three in-person workshops,” said Stacey Lissit, MPH, MS, Senior Technical Advisor for the IDASH program.
Fellows will participate in a 12-month in-service training program, in which each country team of four fellows will identify and develop a collaborative project. Fellows will receive sustained mentorship, and regional communities of practice will be established to ensure regional collaboration, share lessons learned and best practices, and establish linkages for future programming needs that span multiple countries.
“IDASH provides the opportunity to link learning to experience, and enables the application of new public health skills, knowledge, and techniques acquired from the training in a real-life context,” said Peter Rabinowitz, MD, MPH, Principal Investigator for the IDASH project. “It also extends benefits beyond the trainees to partner agencies and organizations, helping strengthen public health capacity in the region.”
Proposed fellowship projects include automating data analysis and visualization for diseases, expanding digital immunization registries beyond COVID-19, and developing spatial analysis modules for multi-disease surveillance and response.
“Today, the afternoon of the 4th day, the room is buzzing as the five country teams are hard at work: two engrossed in consultation with our facilitation team of public health informatics and data science experts about their country team projects; the others working on a data science methods exercise, practicing interpretation of descriptive and inferential statistics plots to assess trends in Hepatitis C,” said Ms. Lissit. “The energy and engagement have been high, and we’re looking forward to the next six days and the rest of the year-long fellowship.”
IDASH goals are to enhance capacity to create and use public health information systems that enable the capture, management, analysis, dissemination, and use of reliable, timely information to improve population-level health outcomes, as well as strengthen regional capacity to effectively respond to future global health challenges and pandemics.
“The COVID-19 pandemic made clear the importance of public health data systems that provide real time, accurate data on disease threats to allow for timely intervention and combatting of mis- and disinformation,” said Dr. Rabinowitz. “Programs like IDASH will help ensure there is a workforce prepared to detect, prevent, and respond to future global health threats.”
Story updated: April 11, 2023