I-TECH Ukraine Hosts First Index Testing Forum Following Launch of National Index Testing Program

Index Testing/Partner Notification Ukraine

Posted on January 23, 2020May 2, 2023

Attendees brainstorm at the Index Testing Forum in Ukraine. — A group of forum attendees meet to brainstorm and discuss the index testing program. Photo credit: I-TECH Ukraine.

On December 18, 2019, I-TECH Ukraine facilitated its first forum on index testing, a key strategy used to identify and support HIV-positive individuals. Service providers, as well as representatives from the US Centers for Disease Control and Prevention (CDC) and the Public Health Center (PHC) of the Ministry of Health (MOH) of Ukraine, attended the forum and participated in discussions detailing the best ways to implement and adapt proven index testing methodologies in Ukraine.

I-TECH Ukraine rolled out its national program in October 2019, after shifting its programmatic focus to provide index testing development and quality assurance. The program was launched at 39 antiretroviral therapy (ART) clinics in 11 PEPFAR priority regions across the country.

The recent forum included a review of early program performance; identification of best practices that can be scaled up to improve index testing and partner notification performance; and solutions to key challenges that index testing providers are currently facing in Ukraine.

“The index testing strategy gives us all high hopes that we can reach out to the most affected groups of people living with HIV and identify many individuals in need of care much earlier than it happens currently in Ukraine,“ says Anna Shapoval, I-TECH Ukraine Country Representative. “As always, I-TECH is proud to build this new programming not just on the vast evidence and globally acknowledged best practices but also on the mountain of successful experiences in other countries where index testing programs have been initiated and implemented by I-TECH in previous years.”

To strengthen the programmatic response, the forum included a number of speakers and index testing subject matter experts. Dr. Serhii Riabokon, an infectious disease doctor in the PHC’s department of the coordination of treatment programs on HIV, viral hepatitis, and sexually transmitted infections, presented the current legal framework and the state of index testing program implementation in Ukraine. I-TECH’s program and evaluation teams also gave a brief overview of the program including the design as well as the successes and challenges to date. Four well-performing regional sites were also able to share the best practices they used during early program implementation.

Dr. Matthew Golden presents at the Index Testing Forum in Ukraine. — Dr. Matthew Golden shares his experiences in partner services implementation, scale up, and development around the world. Photo Credit: I-TECH Ukraine.

In addition to the index testing program-specific presentations, the forum also included presentations by experts who shared their valuable experiences in partner services implementation, scale-up, and development:

Matthew Golden, MD, MPH, Professor at the University of Washington (UW) Department of Medicine’s Division of Allergy and Infectious Diseases and I-TECH faculty member, reviewed the development and challenges of partner services programs around the world, as well as voiced practical recommendations for Ukrainian index testing advancement.
Nancy Puttkammer, PhD, MPH, I-TECH faculty and DIGI faculty lead, and Jason Beste, MD, MPH, I-TECH International Clinical Advisor, were on a panel discussion on the ways of overcoming key challenges in index testing implementation.

“A key part of the program is to ensure quality results,” says Shapoval, “and consistent and collaborative learning is paramount to building local capacity.”

December’s forum is just the first of planned, quarterly forums designed to further build local capacities around index testing and quality assurance.

THIS PROJECT 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.

Two-Way Texting Study Offers Innovative Model to Reduce Provider Workload while Preserving Patient Safety

Posted on November 14, 2019

This piece was first posted on the University of Washington Department of Global Health’s website.

Voluntary medical male circumcision (VMMC) safely reduces the risk of female-to-male HIV transmission by up to 60%. Few men have any post-operative VMMC complication. However, current practice in Zimbabwe and throughout most of sub-Saharan Africa requires VMMC patients to return for multiple, in-person post-operative visits. With low complication rates, and severe healthcare worker shortages, these required visits are a burden for providers and patients — threatening achievement of critical HIV prevention targets. A two-way texting model studied by University of Washington researchers in Zimbabwe offers a new way to address this barrier by reducing provider workload while also safeguarding patient safety.

“These visits can be a barrier to male circumcision uptake and expansion in countries with severe health care worker shortages, as well as negatively impacting patients who needlessly pay for transport, miss work, and wait for unnecessary reviews,” said Principal Investigator Caryl Feldacker, PhD, MPH, at the International Training and Education Center for Health (I-TECH) in the University of Washington Department of Global Health.

The study included 721 VMMC patients in two locations in urban Zimbabwe. In the study, patients communicated directly with a health care worker through interactive text messaging for the critical 13 days post-VMMC, rather than returning for required in-person visits. By giving men the option to heal safely at home, or return to care when desired or if complications arose, the method dramatically reduced in-person visits by 85%. Texting also reduced follow-up costs by about one-third while improving the quality of care.

As compared to routine in-person care, the study yielded twice the number of reported complications. “This increased identification and reporting is a positive result that is likely attributable to improved counseling and men’s engagement in care. Through texting, men were empowered to observe their healing and report potential issues promptly, before they worsened,” said Feldacker.

Currently, most text-based health care efforts blast pre-defined messages to many people simultaneously, removing patients’ ability to communicate back with health care workers. In contrast, two-way texting between providers and patients provides interactive care, and the short time frame heightened participation: in the study, 93% of men responded to texts. Both providers and clients reported confidence in the texting option, feeling safe and highly recommending it for scale.

“With the current system, Zimbabwe could perform millions of unnecessary follow-up visits over the coming five years. The workload burden for health care workers and time lost for patients who are healing without complication is a significant burden for health care workers and clients alike,” said Feldacker. “Potential gains in efficiency and reduced costs through using two-way messaging are large.”

With funding from the U.S. Centers for Disease Control and Prevention (CDC), and in partnership with the Society for Family Health, the model will soon be tested in urban South Africa. The new, field-based research will further test two-way texting in a different geographical and patient context to better inform the model for adaptation and widespread scale-up.

Feldacker added that “while our findings are grounded in studies on male circumcision, our results are largely attributable to the methods rather than to a specific disease or condition.

“With minimal adaptation,” she continued, “two-way texting could streamline other post-operative care contexts or be re-configured for other similarly acute, episodic conditions where continuity of care within a short period is critical for patients, such as short-course TB treatment, post-operative healing, post-natal care or early childhood illnesses — diarrhea, pneumonia, malaria — laying the foundation for generalizing to other diseases and contexts.”

For more on the study, see the paper pre-published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS):

Reducing provider workload while preserving patient safety: a randomized control trial using 2-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

The study was led by Caryl Feldacker, and co-investigators are Vernon Murenje (International Training and Education Center for Health (I-TECH), Harare, Zimbabwe); Mufuta Tshimanga (Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe); Scott Barnhart, Isaac Holeman, and Joseph B. Babigumira (Department of Global Health, University of Washington); Sinokuthemba Xaba (Ministry of Health and Child Care, Harare, Zimbabwe); and technology partner Medic Mobile (Nairobi, Kenya).

The Zimbabwe 2wT study was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.

I-TECH Helps to Improve Health Regulatory Systems and Training Programs in Cambodia

Ann Downer Cambodia Health Policy Health Systems Strengthening HIV Care and Treatment Human Resources for Health Jeff Lane Leadership & Management Uncategorized

Posted on October 3, 2019October 4, 2019

Pictured are mannequins used at two regional training centers for nurses, midwives, and dental nurses in Kampong Cham and Battambang, Cambodia. I-TECH has supported the procurement of new mannequins to replace those that are old or broken, as well as new teaching tools that will expand the centers’ ability to conduct simulation training. Photo credit: Ann Downer/I-TECH.

The International Training and Education Center for Health (I-TECH) is working on a project led by FHI360, and funded by the U.S. Agency for International Development (USAID), to empower health care managers and national and provincial stakeholders to improve service quality, safety, and utilization, as well as strengthen overall health systems in Cambodia.

The project’s four objectives include:

Improving policies, guidelines and standards for streamlined quality assurance.
Increasing the efficiency and effectiveness of service delivery.
Strengthening regulatory framework, implementation, and enforcement.
Supporting pre-service public health training.

Given I-TECH’s deep experience in health workforce development, supporting the environments that enable strong health systems, and working with stakeholders at all levels, the team was a natural fit for Objectives 3 and 4.

In service of this critical work, I-TECH is supporting implementation of regulations among private and public health workers, as well as helping to lay the foundation for a sustainable accreditation program for public and private health facilities. I-TECH’s team also works with national stakeholders to develop the capacity of pre-service training institutions to deliver high-quality programs aligned with current evidence and national health priorities.

“We are excited to work with our partners to strengthen these critical components of quality health services in Cambodia,” said Jeff Lane, Principal Investigator and Assistant Professor in the Department of Global Health.

“By leveraging I-TECH’s broad experience in health policy, regulation, and workforce development,” he continued, “we can help Cambodia build an accreditation program to recognize high-performing hospitals, strengthen health professional councils to regulate health practitioners, and build sustainable pre-service training institutions that deliver competency-based education to train Cambodia’s health care workers of tomorrow.”

Empowering Young Mothers in Namibia

Gabrielle O'Malley Gender/Women & Girls Namibia PrEP

Posted on September 30, 2019May 9, 2022

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.

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.”

OpenELIS Selected for Google’s Innovative Season of Docs Program

DIGI Nancy Puttkammer

Posted on August 30, 2019November 1, 2019

Google has selected OpenELIS Global, a laboratory information system stewarded by the Digital Initiatives Group at I-TECH (DIGI), as a participant in the first year of its Season of Docs, a unique program that pairs technical writers with real-world open source projects. DIGI implements OpenELIS Global in Côte d’Ivoire and Haiti and manages contributions to the software as a part of the global developer community.

“We rely on talented contributors from the global health software community to ensure that our tools have the biggest impact and are available to the widest audience possible,” explained Casey Iiams-Hauser, Senior Digital Health Specialist with DIGI and the OpenELIS Global Product Owner. “By being transparent about our challenges and triumphs, we benefit from peer-to-peer sharing to problem solve for the benefit of the whole community.”

Technical writer Areesha Tariq was paired with the OpenELIS Global project as a part of the initiative. Based in Islamabad, Pakistan, Areesha has a background in software engineering and her writing focuses predominantly on user guides. She will work to improve OpenELIS Global end-user documentation by turning the current user manual into more pragmatic and accessible job aids.

Areesha is excited to join the team, saying, “I feel great to be selected as the technical writer for OpenELIS Global. It will be a new learning experience to work in an open-source community. I hope that I will be able to complete the project and continue working with the team so that I can contribute to a global cause.”

By participating in Google’s Season of Docs initiative, DIGI will not only benefit from Areesha’s contributions, it will also have the opportunity to increase awareness of OpenELIS in the global community by having our projects posted to the initiatives website and reviewed by a large number of technical writers, open source organizations, and contributors. “We are excited to be a part of Season of Docs,” said DIGI Managing Director, Joanna Diallo. “During the application process we met a number of highly qualified technical writers and observed a lot of interest in ‘global goods’ like OpenELIS.”

The idea for DIGI’s technical documentation project grew out of a proposal to PATH’s Digital Square project, which like Google’s Season of Docs, invests in critical technology that can be accessed worldwide. DIGI’s proposal was only partially funded by Digital Square to develop practical designs and generalizable approaches to achieve interoperability among open-source, clinic-level data management systems via the OpenHIE framework. These systems include OpenELIS; OpenLMIS, a laboratory management information system; and OpenMRS, an electronic medical records (EMR) system. However, the OpenELIS documentation scope of work remained unfunded.

“Having focused our thinking already on OpenELIS documentation gaps for the Digital Square application allowed us to pull together our Season of Docs application quickly,” explained Diallo. “It was fortuitous timing – and it is inspiring to see both PATH and Google investing in open source organizations.”

New Digital Group Offers Full Range of Digital Health Services

DIGI Nancy Puttkammer

Posted on August 29, 2019November 1, 2019

In winter 2019, the International Training and Education Center for Health (I-TECH) launched a new unit: the Digital Initiatives Group at I-TECH (DIGI). The DIGI team builds upon 15 years of experience at I-TECH designing, developing, implementing, and evaluating health information systems (HIS) around the world.

The group — co-led by Dr. Nancy Puttkammer, Assistant Professor in the Department of Global Health, and Jan Flowers, Clinical Faculty and Director of Global Health Informatics in the Clinical Research Group (CRIG) — provides services to help programs scope and build technical solutions to manage program or clinical data.

“The shared faculty lead role helps the group leverage diverse resources from departments across the university,” said Joanna Diallo, DIGI Managing Director.

By promoting open-source “global goods” that are supported by implementer communities, DIGI helps partners such as Ministries of Health to be able to own and continue to develop long-term solutions.

In April, Flowers received a Digital Square award to lead an online community of practice on open-source lab information systems like OpenELIS, and Dr. Puttkammer received a Digital Square award to design and test practical and generalizable solutions for interoperability between OpenELIS and two other leading open source tools: OpenMRS and OpenLMIS.

DIGI partners with global communities to develop and enhance digital tools and provide technical assistance for effective implementation and sustainability. The team works closely with on-the-ground experts and stakeholders to guide and facilitate governance, capacity building, and continuous quality improvement using a maturity model lens.

DIGI works in the following technical areas:

Software Design & Development
Health Data Exchange Standards
Health Systems Architecture
Information Security
Evidence-Based Evaluation and Implementation
Digital Health Workforce Development

“With investment from the I-TECH center to launch DIGI, we have been able to approach the work in a new way that is flexible and responsive and promotes cross project sharing,” explained Dr. Puttkammer. “We hope this will continue to strengthen the department’s standing as a leader in digital health.”

I-TECH Shares Work at IAS 2019

HIV Care and Treatment Index Testing/Partner Notification Malawi Mozambique

Posted on July 25, 2019

Yusuf Babaye, MBA, MSc, presents his poster at IAS 2019. — *Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presenting a poster at IAS 2019.*

Representatives from the International Training and Education Center for Health (I-TECH) attended the 10th Annual International AIDS Society Conference on HIV Science (IAS 2019) in Mexico City, Mexico on 21-24 July 2019. The IAS Conference on HIV Science is a biennial conference that brings together approximately 6,000 researchers, advocates, policy makers, funders, and community leaders. It showcases advances in HIV care, prevention, and treatment; explores new directions for HIV care, prevention, treatment, and research; and features the latest in HIV research.

Yusuf Babaye, MBA, MSc, I-TECH Country Representative for Malawi, presented a poster titled, “A Cross-Sectional Study on Levels of Knowledge on Provision of Second-Line Antiretroviral Therapy in Malawi in 2016.” The poster focused on the need to build capacity for providing second-line antiretroviral therapy following first-line treatment failure.

I-TECH’s partner notification services work in Mozambique was also highlighted in an article that was included in the Journal of the International AIDS Society (JIAS) supplement published prior to IAS 2019. The supplement, “The Power of Partners: Experiences from implementing and scaling-up HIV partner notification and index testing services,” shares key lessons learned from programs implementing, evaluating, and scaling up partner notification services.

I-TECH Launches In-Service Skills Development Program for Health Workers in South Africa

Nursing/HCW Cadres South Africa Stefan Wiktor

Posted on June 10, 2019June 10, 2019

In South Africa, the International Training and Education Center for Health (I-TECH) has begun facilitating an in-service skills development training program for community health workers (CHWs) and their supervisors in their roles on the Ward-Based Primary Health Care Outreach Team (WBPHCOT). To maximize the impact of this training, I-TECH is working with two PEPFAR District Support Partners across seven of South Africa’s nine provinces to reach an estimated 20,000 CHWS, which is approximately half of the country’s CHW workforce. Training began in February 2019 and will continue through September 2019.

The WBPHCOT In-Service Skills Development Package aims to strengthen the capacity of CHWs to provide high-quality health services in the community. The program emphasizes development of core, cross-cutting service delivery skills, including communication, screening, psychosocial support, ethics, and confidentiality that enable CHWs and their supervisors, known as Outreach Team Leaders (OTLs), to effectively carry out their work.

During training, CHWs and OTLs build their skills in both classroom and on-the-job settings using group discussions, case presentations, scenario-based role play, small group activities, and interactive presentations. Priority health conditions and related clinical topics are included, and the realistic scenarios cover all components of the CHW scope of work.

I-TECH SA CHW Training App — Snapshot of the app used to capture training data.

Leveraging Technology to Improve Training
All training data collected for the skills development program will be captured via a mobile application and stored using the CommCare platform, a mobile data collection system developed by Dimagi. The app allows I-TECH access to real-time data, which can inform targeted measures to ensure that all CHWs are receiving high-quality trainings.

To tailor the program to the needs and realities of the field, I-TECH has implemented a blended tablet and paper-based data collection approach.

“There is such a large number of CHW trainees in the field that using this blended approach allows the OTLs to dedicate their time to training CHWs rather than focus on paperwork,” says Ilyse Jacobson, I-TECH South Africa Technical Director of Programs. “This flexibility allows for more in-depth and efficient training.”

Dashboard used by stakeholders and implementing partners to track the progress of the program.

Due to its role as the sole repository for all training-related data, the CommCare database will also generate reports linked to an interactive stakeholder dashboard.

“The dashboard not only brings I-TECH’s data visualization and dissemination approach into the 21st century,” says Jacobson, “it allows project stakeholders access to the data that helps with decision-making both in and outside of this program.”

The design of the Stakeholder Dashboard allows donors, implementing partners, and the National Department of Health to track current progress against training targets on a weekly basis.

I-TECH Ukraine Initiates National Discussion on Performance-based Incentives Model in HIV

Ann Downer Best Practices Implementation Science Ukraine Uncategorized

Posted on May 9, 2019May 2, 2023

Participants of the national consultation on PBI model development discuss international best practices. Photo courtesy of I-TECH Ukraine.

In response to the need to quickly revitalize efforts to reach targets in Ukraine, CDC Ukraine has asked International Training and Education Center for Health (I-TECH) to support a performance-based incentive (PBI) model.

On March 28, 2019, I-TECH facilitated a high-level stakeholder workshop centered on PBI evidence and “best practices.” Participants from the U.S. Centers for Disease Control and Prevention (CDC) in Ukraine and the Public Health Center (PHC) of the Ministry of Health of Ukraine, and I-TECH gathered to discuss options for adapting proven methodologies to Ukraine’s HIV services.

PHC launched the model in December 2018 at five pilot sites across the country. In the pilot, monetary incentives were paid to individual doctors at the facilities to double efforts toward initiating new patients on ART.

PHC plans to expand the model to all 12 priority regions in the country. On the heels of COP ’19 discussions in South Africa, CDC Ukraine is looking for additional areas of the HIV cascade to which PBI could be applied to reach the FY2020 targets set by the U.S. Office of the Global AIDS Coordinator (OGAC).

The March meeting and the preceding preparatory meetings provided catalytic opportunities for identifying additional HIV services–including index partner testing, linkage to care, and loss-to-follow-up search–that could potentially benefit from the PBI model; discussing lessons learned from other PBI global initiatives; and utilizing evidence-based practices to design well-conceived and context-driven programs.

Marianne Holec, Senior Program Manager for I-TECH Zimbabwe’s voluntary medical male circumcision program; Efison Dhodho, Results-based Financing Health Specialist from the Programs Coordination Unit of the Ministry of Health of Zimbabwe; and Charbel El Bcheraoui, PhD, Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) were keynote speakers at the event.

These working meetings resulted in meaningful exchanges between the guest speakers and Ukrainian experts about the successes (e.g., an increase in short-term achievement of targets and the opportunity to identify and target largest areas of need) and challenges (e.g., workplace friction, dissatisfaction with incentives, lack of teamwork, and reduced quality of care) of PBI implementation globally and in Ukraine to date.

Meeting participants appreciated the practical advice given by the guest speakers on designing effective, intentional, and sustainable PBI models for the longer term for HIV services. Experts advised developing a well-designed program that is adapted to local context; starting at a few sites and try different strategies to see what works best; gathering input from the providers as to what will work best; building in health competition between sites; and having a strong M&E framework.

With input from local stakeholders and international experts, I-TECH Ukraine has accepted the challenge of incorporating the key outcomes from the series of PBI meetings to structure the Ukrainian PBI model for HIV services. This narrative will include an outline of additional technical assistance required around its implementation.

THIS PROJECT 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.

MetaECHO Conference Examines New Frontiers in TeleHealth

Ann Downer Caribbean Clinical Mentoring Cote d'Ivoire eLearning/Distance Learning Malawi Namibia South Sudan Uncategorized

Posted on April 11, 2019April 29, 2019

Liz Blanton, M&E advisor at I-TECH, presents her poster at MetaECHO.

On March 13-16, Liz Blanton, Monitoring and Evaluation Advisor at the International Training and Education Center for Health (I-TECH), joined more than a thousand clinicians, funders, academic leaders, government officials, and public health experts for the MetaECHO™ conference in Albuquerque, New Mexico. The University of New Mexico’s Project ECHO® model aims to bring specialized health care and expertise to rural and underserved communities in the U.S. and worldwide.

Blanton presented a poster titled “An Evaluation of Pilot Project ECHO in the Republic of South Sudan and Implications for Implementation in Fragile States.” The evaluation, still in its early stages, will assess the feasibility and acceptability of the model, which is implemented by Columbia University’s ICAP and is the first of its kind in a fragile state.

It will also gauge the impact of the ECHO model – based on telementoring and case presentation from a panel of experts – on providers’ sense of self-efficacy and professional satisfaction, as well as assess outcomes at the facility and systems levels.

“It’s the outcomes piece that really interested people,” said Blanton, pointing out that most of the outcomes studies to date have been fairly small. “It’s something a lot of people at the conference were talking about: how effective is Project ECHO at improving health outcomes?”

In light of this year’s theme of “Infinite Possibilities,” there were also deep discussions about the evolution of the model and how it might be adapted to improve communication between providers and patients, not just among providers. “There were several ‘ECHO Talks’ – TED-style talks – that were really moving,” said Blanton. “Some of the best were by patient advocates,” who highlighted the need for patient-centered care.

A fireside chat with keynote speaker Dr. Don Berwick, President Emeritus and Senior Fellow at the Institute of Healthcare Improvement, underscored the question: how can ECHO teams best deliver what patients need?

Today, Project ECHO operates more than 220 hubs for more than 100 diseases and conditions in 31 countries. The MetaECHO community encompasses all those dedicated to reaching the collective goal of touching 1 billion lives by 2025.

Project ECHO at I-TECH

Several programs at I-TECH utilize the Project ECHO model as a mentoring tool and force multiplier:

The first I-TECH-supported ECHO program in the Caribbean was established in January 2018, with the hub site in Jamaica. In that initial year, 41 ECHO sessions were provided, with participation by nearly 300 health care workers. Topics centered on viral load suppression and also included a series on TB prevention, diagnosis, and treatment in people with HIV; tenofovir toxicity; and HIV and lymphoma. During an I-TECH assessment, it was found that the majority of complicated cases presented during ECHO sessions in the Caribbean involved patients with mental health and substance use disorders that negatively impact their ability to adhere to medication and care. Plans are under way to include a psychiatrist/mental health specialist on the ECHO expert panel, and one Wednesday per month will be focused on HIV/mental health co-morbidities. The Jamaica Ministry of Health has also requested that I-TECH include an additional 20 HIV care and treatment sites, as well as a small group of private practitioners, in the current HIV ECHO program community of practice. In service of this request, I-TECH will support the development of a second ECHO program based in Trinidad, which will be launched this month.
I-TECH is implementing ECHO to build the capacity of laboratory staff and improve the quality of lab services in Côte d’Ivoire. Sessions include up to 17 laboratories and nearly 30 participants apiece; topics have included management of non-conformities in laboratories. laboratory equipment preventive maintenance, best practices in HIV serology, and external quality assurance.
In Malawi, I-TECH supports Project ECHO in partnership with the U.S. Centers for Disease Control and Prevention (CDC), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and Lighthouse Trust. The program has more than 40 participants from five different sites, and case presentation topics have ranged from tuberculosis to HIV encephalitis to Kaposi’s sarcoma. Benefits of the program include not only increased engagement of providers to discuss difficult cases, but also an improved referral system between clinics.
ECHO is installed and supported by I-TECH at 41 sites in Namibia, and monthly participation reaches up to 400 subject matter experts and staff. Dozens of topics were discussed during the pilot period (November 2015 to September 2016) alone – the most widely attended were on HIV disclosure to children, PMTCT Option B+, and presentation of tuberculosis. In an evaluation of the Namibia pilot, nearly 80% of participants cited that access to the expertise of HIV specialists and inter-disciplinary consultation was a major area of need for them and their clinics. Ninety-three percent of the participants reported that the presentations during the pilot ECHO sessions provided them with useful, up-to-date knowledge.