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Expanding Two-Way Texting for Voluntary Medical Male Circumcision Clients in South Africa

I-TECH, in close partnership with voluntary medical male circumcision (VMMC) implementing partner, the Aurum Institute and technology partner, Medic, is conducting a five-year study funded by the National Institutes of Health to further evidence on the efficiency, safety, and scalability of two-way text-based (2wT) follow-up for VMMC services.

An example of the 2wT tab display options.
An example of the 2wT tab display options. Image Credit: © 2022 Marongwe et al. via PLoS Digital Health, Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe.

2wT is SMS-based telehealth, providing direct patient to provider communication that improves the quality of post-operative VMMC care. A daily educational message is sent to each participant, requesting a response to report potential complications. 2wT allows the nurse to triage men to care when needed or desired while supporting most men to heal independently at home. 2wT-based follow-up dramatically reduces unnecessary post-operative visits, saving patient and provider costs, while improving patient care quality through swift identification and referral for potential adverse events. In South Africa, the 2wT intervention benefits were similar across routine VMMC programs in both rural and urban settings.

This 2wT intervention in South Africa builds on the I-TECH work previously done in Zimbabwe, which found that “2wT reduced client visits by 85%, increased AE identification, and reduced costs.”

Transitioning OpenELIS Training and Implementation to Local Professionals in Côte d’Ivoire

For nearly a decade I-TECH has worked in Côte d’Ivoire in collaboration with the US Centers for Disease Control and Prevention to develop and implement an electronic laboratory information system (LIS) in key laboratories. In order to respond to evolving data needs and ensure timely access to quality laboratory data, an electronic LIS requires ongoing development and continuous user training and technical support.

Previously, from 2015-2017 I-TECH worked closely with the Ivorian Ministry of Health and Public Hygiene (MSHP)’s Directorate of Informatics and Sanitary Information (DIIS) to identify, develop and reinforce the capacity of local professionals to lead and conduct LIS training, deployment, and maintenance activities in anticipation of national roll-out of the LIS at 96 general hospital laboratories. As part of this effort, and in collaboration with the DIIS, I-TECH trained users and deployed LIS at 13 national and regional level laboratories. Between 2013 and 2015, the total number of local professionals competent in LIS deployment increased to 24 local LIS support providers, while the number of in-country LIS trainers increased to 27. Within ten months, local IT providers and trainers trained over 75 health care workers to use an LIS and implemented an LIS at 36 laboratories. During supervision visits to 26 laboratories, within 4 to 6 months post-installation, 25 out of 26 (96%) of laboratories were actively using the LIS.

More recently, Côte d’Ivoire International Training and Education for Health (I-TECH CIV), I-TECH’s local partner in Côte d’Ivoire, has started working directly with CDC and DIIS and continued to engage I-TECH computer developers and deployment strategists to continue the progress with LIS.

I-TECH continues to make considerable progress with code base development for OpenELIS. For more information, visit the OpenELIS Global website.

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 by the two reference labs and all ten regional flu clinics and creates real-time, easy-to-read data dashboards. These dashboards are used by the MOHW staff and public health officials to track national COVID-19 cases numbers and trace ongoing and potential outbreaks of COVID-19 and other infectious diseases.

DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.

Implementing a National Laboratory Information System in Mauritius

Since 2020, the Digital Initiative Group at I-TECH (DIGI)  has worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to deploy a national laboratory information management system (LIMS) using the OpenELIS platform. The LIMS connects the national reference laboratory to regional laboratories and flu clinics around the country to quickly process COVID-19 tests, as well as send results notifications to patients via text message or email.

The OpenELIS system, while implemented to support COVID-19 surveillance, was also designed to be able to support most routine lab workflows, including HIV viral load testing and other other infectious diseases (e.g., HIV, Ebola, Zika, Chikungunya), which ensures MOHW can quickly trace, respond to, and manage cases.

DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.

Optimizing the COVID-19 Testing Process at the Airport in Mauritius

As a measure to help stop the spread of COVID-19, the Government of Mauritius began requiring that all arriving passengers submit to COVID-19 health screenings upon arrival in Mauritius. To rapidly process the influx of tests and quickly notify passengers of their results, the Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to digitize the COVID-19 screening declaration form for all passengers arriving to the Mauritius International Airport and supported MOHW in opening a COVID-19 reference laboratory at the airport to rapidly process the tests and send notifications of COVID-19 tests passengers.

The airport laboratory is connected to the National Reference Laboratory via OpenELIS, which allows all the data captured on the digital form, such as passenger information and COVID-19 screenings/test results, to assist public health officials from all over Mauritius to carry out surveillance and contact tracing efforts.

Since opening in December 2020, the airport reference laboratory has returned over 250,000 tests and continues to process thousands of tests to passengers and citizens of Mauritius daily.

Using Project ECHO in Malawi

The Extension for Community Healthcare Outcomes (ECHO) Project® was developed by the University of New Mexico to improve care for underserved populations using a hub-and-spoke approach of knowledge-sharing by video-conferencing technology. The Lighthouse ECHO project provides a platform for sharing critical, timely, and life-saving information and data with health care workers (HCWs) located in different locations and facilitates peer-to-peer interactions among local, regional, and international experts using real-time, video-conferencing technology.

Lighthouse, a long-standing I-TECH implementing partner, is a World Health Organization-recognized clinic for integrated HIV prevention, treatment, and care in Malawi, serving approximately 60,000 antiretroviral therapy patients across the country. Lighthouse is an established HIV education site and has been involved in capacity building in pre- and in-service trainings for staff from the Ministry of Health as well as non-governmental organizations and implementing partners for many years.

Since April 2020, Lighthouse’s Project ECHO has conducted 67 sessions and has served 4,150 participants on COVID-19, HIV, and tuberculosis topics.

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 antiretroviral therapy before or during pregnancy.

Since 2016, the International Training and Education Center for Health, in collaboration with the Centers for Disease Control and Prevention, has supported the implementation of an active hospital-based birth surveillance system at four high-volume facilities in Malawi. To date, a total of 165,608 of births have been assessed. A subset of women are also enrolled in an ongoing nested case control study to assess associations between external birth defects and maternal exposures such as prior health conditions, medications, and environmental and lifestyle factors.

Anticipated use of these data include:

  • Establish a baseline prevalence of external birth defects in Malawi
  • Evaluate the impact of introducing new drugs for the management of HIV (e.g., dolutegravir) on the prevalence of external birth defects
  • Advocate for investment in programs and interventions to reduce the occurrence of birth defects and adverse pregnancy outcomes.

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 implements the Quality Improvement (QI) Solutions for Sustained 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 Program, 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. Focused on 80 priority sites throughout the country, QISSEC works 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.

Assisted HIV Partner Notification/Index Testing in Ukraine

Since 2019, I-TECH has provided increased technical assistance for 39 state healthcare facilities in eleven high HIV burden regions of Ukraine to advance assisted partner notification/services and index testing as a sustainable strategy for HIV case finding.

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