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I-TECH Supports Critical TB Prevention, Screening, and Treatment for PLHIV

The global health community recognizes March 24 as World Tuberculosis (TB) Day to raise awareness of this deadly, yet preventable and curable, disease. The 2021 theme, “The Clock Is Ticking,” underlines the importance of acting now to end the global TB epidemic. According to World Health Organization, the probability of developing active TB disease is 18 times higher in people living with HIV (PLHIV), and in 2019 TB killed 1.4 million people worldwide, which includes 208,000 people who were HIV-positive.

Photo Credit: I-TECH

According to the U.S. Centers for Disease Control and Prevention, TB is one of the leading causes of death worldwide for PLHIV. To help treat and combat the spread of TB, particularly among PLHIV, the International Training and Education Center for Health (I-TECH) supports TB prevention, care, treatment, monitoring, and policy activities across the I-TECH global network. Current I-TECH work includes TB interventions in Mozambique, Namibia, and Malawi.

I-TECH supports the National TB Program in Mozambique by using the Warm Line—a telephone consultation line that supports clinicians—to deliver results for suspected drug-resistant TB cases to clinicians located at health facilities throughout the country. This collaboration with the Ministry of Health’s National TB Reference Lab allows for more timely identification and better management of drug-resistant TB cases. During 2019, 9,103 (83%) of results were delivered via the Warm Line. I-TECH’s team also engaged providers and clinicians in 383 interactions via the Warm Line to support mentoring and to monitoring complicated TB cases.

In addition to supporting clinicians with TB care and diagnosis, I-TECH supports TB prevention, diagnosis, and care among clients attending HIV clinics throughout seven regions and across 150 public health facilities in Namibia. The I-TECH team screens for active TB; monitors drug interactions for TB/HIV co-infection; provides TB screening, prevention, and management of TB/HIV co-infection for HIV-positive clients; tests for HIV at TB clinics for clients with unknown HIV status; and assesses eligibility, previous initiation, and completion of TB Preventive Therapy (TPT) to ensure no clients are missed. As of January 2021, approximately 90% of HIV-positive patients on antiretroviral therapy at supported facilities initiated their TPT course and 80% have completed their TPT course. I-TECH also works closely with healthcare workers and facilities to improve recording keeping of TPT course initiation and completion as well as the use of this data to focus day-to-day clinical efforts.

Since 2015, I-TECH has been providing technical assistance support to the Malawi National TB Program to improve the quality of TB services at all health facilities throughout Malawi. I-TECH continues to train program monitors to interpret and act on data collected using the TB Standard of Care Monitoring Tool. The tool, designed by I-TECH, collects data for case detection, treatment outcome monitoring, TB/HIV status ascertainment, and TB infection control and contact investigation. Using the collected data, I-TECH identifies performance gaps and create action plans for health facilities to improve the quality of TB services. Even with a loss of momentum due to the impact of COVID-19 pandemic, by September 2020, 85% of presumptive TB cases—those who were suspected of TB and referred for testing—knew their HIV status.

 

I-TECH’S WORK IN MOZAMBIQUE 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.

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”

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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Workforce Development in Haiti

It is critical that health care providers receive the necessary training to empower them to improve patient outcomes CHARESS supports both pre-service and in-service training efforts in Haiti. In particular, CHARESS is a key partner of MSPP in maintaining its national clinical guidelines.  Continue reading “Workforce Development in Haiti”

Nancy Puttkammer

Dr. Nancy Puttkammer

Nancy Puttkammer is an Acting Assistant Professor within the Department of Global Health at University of Washington and is the faculty co-lead of the Digital Initiatives Group at I-TECH (DIGI). Her interests are in strengthening health information systems and promoting data use and for quality improvement of health programs in resource-limited settings. She is trained as a health services researcher, specializing in using observational, routinely-collected data from electronic medical records (EMRs) to strengthen HIV care and treatment programs.

In her capacity as a Research and Evaluation Advisor at the International Training and Education Center for Health, Dr. Puttkammer works with informatics and training projects in Haiti, Kenya, and South Africa to improve large-scale implementation of EMRs, evaluate data quality and data use, support data analyses, and develop capacity for data use and implementation science research among colleagues and counterparts. Dr. Puttkammer has a PhD in Health Services from the University of Washington and an MPH in Community Health Education from the University of California, Berkeley.

Program Highlights

Continuous Quality Improvement in Haiti
In partnership with CDC, CHARESS helps the Haitian MSPP to implement the national care improvement program, HealthQual, by training providers on quality improvement concepts and using data from the EMR, iSanté, for clinical decision making and improved care ...
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Creating a Data Warehouse to Support COVID-19 Surveillance in Mauritius
The Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to implement a national laboratory information system (LIMS) using OpenELIS and expanded it to create a national-level data warehouse. The data warehouse captures all the information that has been input into OpenELIS ...
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Enhancing Quality of Healthcare Activity in Cambodia
The overall goal of the Enhancing Quality of Healthcare Activity (EQHA) program in Cambodia is to improve the quality of public and private health services in national and sub-national health systems by August 2023. The project, funded by the US Agency for International Development (USAID), is being implemented by Family ...
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Health Information Systems in Haiti
Electronic medical record (EMR) systems have the capacity to improve clinical decision making and quality of care at site level but can also be leveraged to make data-driven, population-level public health decisions. At the request of the MSPP ...
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Scott Barnhart

Scott Barnhart, MD, MPH, has an extensive background as Professor of Global Health and former Director of Global Health Programs for I-TECH at the University of Washington. He has had responsibility for leading nine country offices, projects in 14 countries, and more than 500 staff. This experience and training has included extensive clinical work, research and program management in pulmonary and environmental and occupational medicine, and more than eight years as Medical Director of a safety net/Level 1 Trauma Center hospital.

Ensuring health systems can quickly detect and respond to emerging health threats is a critical challenge in both domestic and global health. Dr. Barnhart’s major implementation projects include scale-up of voluntary medical male circumcision (VMMC) in Zimbabwe and Malawi, OpenMRS, and laboratory information systems. Dr. Barnhart deploys his expertise in multiple African countries and Haiti to strengthen health systems and health care.

An over-riding goal of Dr. Barnhart’s work is to promote country-led, country owned sustainable development. Consistent with the principles of the Paris Declaration, the goal is to transition the bulk of development work and the associated leadership, ownership, technical direction and control of funding into the countries where development occurs. This approach ensures that the entire continuum of skills necessary for development (technical expertise, administration (human resources, operations, and management and accountability for funds) is transitioned to local partners. A key indicator is to have 75% or more of a grant’s funding expended in-country on local programs and local citizens and to support the local economies in these highly resourced constrained countries. Dr. Barnhart has worked closely to advance this model through projects in Haiti with a goal to shift the majority of a project to a local organization and in Zimbabwe where the VMMC program is largely run through local partners.

Program Highlights

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 ...
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Case Finding and Retention in Care in Mozambique
I-TECH works with the Mozambique Ministry of Health (MISAU) to expand a pilot project to provide an assisted partner services intervention. The project is aimed at encouraging patients newly diagnosed with HIV infection to disclose their status to their partners, and bring them to the clinic for testing ...
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Clinical Mentoring in Haiti
I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
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Continuous Quality Improvement in Haiti
In partnership with CDC, CHARESS helps the Haitian MSPP to implement the national care improvement program, HealthQual, by training providers on quality improvement concepts and using data from the EMR, iSanté, for clinical decision making and improved care ...
Read More
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