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Category: Linda Eckert
Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination
Post categories: Cervical Cancer COVID-19 Gabrielle O'Malley Gender/Women & Girls Jeff Lane Linda Eckert Malawi Mozambique Namibia Stefan Wiktor Uncategorized Zimbabwe
The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.
However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.
Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.
Record-breaking cervical cancer screening in Namibia
The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia's national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.
In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.
From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).
"As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities," says Dr. Laura Muzingwani, I-TECH's Cervical Cancer Lead Physician in Namibia. "Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening."
Mentoring and training continues in Mozambique via videoconferencing technology
In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® "superhub" for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.
"Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies," says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. "The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them."
In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.
While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.
Access to services increase through health communication in Malawi
Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.
To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.
I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.
In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.
Zimbabwe consortium takes measures to blunt the impact of COVID-19
I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.
By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:
Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
Procurement and distribution adequate PPE for use by health care workers at facilities.
I-TECH Team Contributes to New WHO Recommendations for Cervical Cancer Screening and Treatment
Post categories: Botswana Cervical Cancer Health Policy Health Systems Strengthening Linda Eckert Malawi Namibia
After two years of collaborative work, the World Health Organization (WHO) today launched a critical publication to aid health care workers in the march toward cervical cancer elimination: The WHO Guidelines for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention.
The guidelines contain evidence-based recommendations for cervical cancer screening and were created in the context of the WHO global strategy to accelerate the elimination of cervical cancer, as well as the need to provide screening and prevention services to all women around the globe.
Dr. Linda Eckert–University of Washington (UW) Professor of Obstetrics & Gynecology, Adjunct Professor of Global Health, and technical advisor to I-TECH's cervical cancer programs in Namibia, Malawi, and Botswana–served as one of the lead consultants coordinating the WHO guidelines.
"It has been a true privilege to join with WHO colleagues to collect and synthesize data and work with cost effectiveness modelers and our 60-member multinational Guideline Development Group, who shared their immense experience and knowledge to create these evidence-based guidelines," said Dr. Eckert. "It is so hopeful for women around the globe, and I feel inspired thinking about how many women can be spared the suffering of cervical cancer through implementation of these guidelines."
Dr. Laura Muzingwani, the lead physician for I-TECH's Cervical Cancer Prevention Program in Namibia, was also an active member of the Guideline Development Group. Her experience and expertise in cervical cancer screening and treatment in Namibia enabled her to offer valuable guidance in the crafting of these recommendations.
In addition to the UW, contributing partners in the project included McMaster University, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and Unitaid, among others.
Cervical cancer poses a serious threat to women in resource-limited settings, where an estimated 90% of all newly diagnosed cases develop.1 In women living with HIV, the progression from cervical pre-cancer to cancer is more rapid than in women without HIV.2
From 2013 to 2014, I-TECH supported cervical cancer screening and treatment in Haiti through the organization of trainings on visual inspection with acetic acid (VIA) and cryotherapy, which helped build the capacity of providers and contributed to risk reduction in cervical cancer, as well as early diagnosis and treatment.
I-TECH currently develops high-quality curricula, organizes training programs, and uses direct service delivery to strengthen and expand access to cervical cancer screening and treatment among women living with HIV; works with the Ministries of Health to update national cervical cancer screening and treatment guidelines; and strengthens routine quality assurance, supervision, mentorship, and coordination of cervical cancer providers.
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 ...
Cervical Cancer Screening and Treatment Strategy Support in Malawi
Cervical cancer is the leading cause of cancer death among women in Malawi. In response, the Ministry of Health (MOH) in Malawi developed a five-year National Cervical Cancer Control Strategy for 2016-2020. The strategy outlines comprehensive interventions, including the integration of cervical cancer screening services into HIV care. In 2019, ...
Expanding Cervical Cancer Screening in Zimbabwe
I-TECH began the expansion of cervical cancer screening for women living with HIV aged 25-49 in Zimbabwe in 2019. I-TECH initially identified a provisional list of 89 sites for the implementation of visual inspection with acetic acid and cerviography (VIAC). The team then recruited, trained, and deployed dedicated VIAC nurses ...
Expanding HIV Care and Treatment in Zimbabwe
The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:
Diagnose 95% of all persons living with HIV through integrated testing
Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained ...
1Comprehensive Cervical Cancer Control: A Guide to Essential Practice, 2nd Ed., World Health Organization.
2Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, National Institutes of Health.
I-TECH has worked for almost twenty years to support health systems strengthening and the national response to the HIV epidemic in Malawi through significant contributions to the development of a robust health care workforce that provides high-quality HIV prevention, care, and treatment services.
In Malawi, I-TECH works through the secondment of well-qualified, experienced technical advisors (TAs) in the Ministry of Health (MOH) and other institutions to provide technical assistance for development and implementation of the national strategic plan led by the Government of Malawi (GOM). I-TECH TAs play an important role in ensuring timely national HIV/TB response by supporting prevention and control across the HIV care continuum. Additionally, I-TECH TAs support and facilitate surveillance and M&E for HIV/TB programs. This assistance enables the MOH to collect and manage up-to-date data to inform evidence-based decision-making by GOM and partners.
I-TECH technical assistance to Malawi MOH also covers the implementation of national surveillance systems to improve the generation of high-quality epidemiological data. Surveillance TAs work together with their GOM counterparts to improve storage and transportation conditions for lab samples, train staff in analysis of surveillance samples, and increase the functionality of surveillance systems to generate reliable and accurate data. The principal surveillance projects I-TECH TAs support in Malawi are Birth Defects Surveillance and HIV Recent Infection Surveillance. Most recently, I-TECH TAs have been placed at Public Health Institute of Malawi (PHIM) to support GOM with its emergency response to the COVID-19 pandemic.
Departments and units supported by I-TECH TAs include the National Tuberculosis Control Programme, Department of HIV and AIDS, Supply Chain of HIV Commodities, Monitoring and Evaluation of HIV Program Diagnostics, Reproductive Health Department, PHIM, National HIV Reference Laboratory, and the National Registration Bureau. I-TECH TAs also support clinical mentoring and M&E at Lighthouse Trust, a Center of Excellence for HIV care that was established in 2001.
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 ...
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 ...
National COVID-19 Emergency Response in Malawi
In collaboration with the Malawi Ministry of Health (MOH) and Centers for the Disease Control and Prevention (CDC), I-TECH has supported the national COVID-19 response in Malawi since March 2020. Technical assistance has focused on laboratory capacity, supporting quality COVID-19 surveillance and data management, and implementing a COVID-19 population-based survey ...
HIV Recency Surveillance in Malawi
The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection ...
Using Data to Improve Health Service Delivery in Malawi
The Kuunika Project: Data for Action was a four-year program implemented by a consortium of organizations, including the International Training and Education Center for Health (I-TECH), that began in 2016 to improve healthcare service delivery through the effective use of data. Consortium activities aimed to improve data systems, data use, ...
I-TECH has worked in Namibia since 2004 to support a robust and sustainable health care system, and to address key health challenges including high HIV prevalence and a critical shortage of skilled health care workers.
Based in the capital city, Windhoek, I-TECH in Namibia has a long history of successfully supporting the Ministry of Health and Social Services (MoHSS); the Ministry of Education, Arts, and Culture; the University of Namibia; and the Ministry of Defence/Namibia Defence Force with programs to improve the prevention, care, and treatment of HIV. I-TECH's flagship work in Namibia included the training of physicians, pharmacists, nurses, and community counselors in a wide range of subjects including sexually transmitted infections, tuberculosis, and pediatrics. In 2015, the program has expanded its focus to include direct service delivery across the HIV clinical continuum including multiple prevention programs such as DREAMS, pre-exposure prophylaxis (PrEP), and voluntary medical male circumcision (VMMC).
Successes include the establishment of nurse-initiated and managed ART services, support of the use of distance learning technologies (digital video conferencing, Project ECHO) to train Namibia's dispersed health workforce, and delivery of VMMC services aimed at keeping boys and men HIV-negative. In 2017, I-TECH began implementing HIV prevention activities aimed at keeping adolescent girls and young women HIV-negative, including through the provision of PrEP.
I-TECH has also implemented a successful national survey focusing on the health and wellness of adolescents and young adults in Namibia in partnership with the Ministry of Gender Equality and Child Welfare, UNICEF, MoHSS, Namibia Statistics Agency, and the U.S Centers for Disease Control and Prevention.
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 ...
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 ...
Health and Wellness National Survey of Youth in Namibia
Since 2017, I-TECH worked closely with the Ministry of Gender Equality and Child Welfare, Ministry of Health and Social Services, UNICEF, Centers for Disease Control and Prevention, and the Namibia Statistics Agency to implement a nationally representative survey on youth experiences as well as HIV incidence and prevalence. Survey results ...
Pre-Exposure Prophylaxis for HIV Prevention in Namibia
I-TECH began supporting the implementation of pre-exposure prophylaxis (PrEP) as part of Namibia's combination HIV prevention strategy in 2017 ...
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