Research/Innovation https://www.pih.org/ en Research: Investment in Nurses and Midwives Improves Health Care Outcomes in Rural Liberia https://www.pih.org/article/research-investment-nurses-and-midwives-improves-health-care-outcomes-rural-liberia <span class="field-wrapper">Research: Investment in Nurses and Midwives Improves Health Care Outcomes in Rural Liberia</span> <span class="field-wrapper"><span lang="" about="/user/4512" typeof="schema:Person" property="schema:name" datatype="">jdelzo</span></span> <span class="field-wrapper">Wed, 06/08/2022 - 09:00</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Published paper highlights importance of advanced training for nurses and midwives<b> </b></p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.webp?itok=PBvYd_t_ 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.webp?itok=yh66ZWaL 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.webp?itok=JjS2jzTf 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.webp?itok=Wol2ZkVA 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.webp?itok=W5477G5P 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.jpg?itok=PBvYd_t_ 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.jpg?itok=yh66ZWaL 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.jpg?itok=JjS2jzTf 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.jpg?itok=Wol2ZkVA 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.jpg?itok=W5477G5P 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2022-06/289551_liberia_0821_daniel_maweu_jamoo_001.jpg?itok=PBvYd_t_" alt="Daniel Maweu trains nurses " typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Daniel Maweu, nurse-midwife and reproductive health care educator, trains nurses how to use a cardiac monitor. Photo by Jason Amoo / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Nurses and midwives are vital to health care systems. This is especially true in regions with health workforce shortages, such as southeast Liberia. On a daily basis, nurses and midwives help meet patients’ everyday needs and fill in during emergency situations. Simultaneously, they train nursing students.</p> <p>To improve patient care and nurse training, strategic interventions must be carried out. In a new paper—<a href="https://annalsofglobalhealth.org/articles/10.5334/aogh.3251/">published in </a><i><a href="https://annalsofglobalhealth.org/articles/10.5334/aogh.3251/">Annals of Global Health</a> </i>in October 2021—Partners In Health (PIH) leaders and Tubman University partners call for sustained investment in education and training.</p> <p>“Nurses and midwives are the first and sometimes the only health care workers patients meet in Liberia,” says Daniel Maweu, nurse-midwife for PIH Liberia and lead author of the paper. “Due to a shortage in the number of doctors in Liberia, nurses and midwives are expected to perform lifesaving tasks which ordinarily would be the preserve of doctors.”</p> <p>Since 2015, PIH has worked with Tubman University faculty to prepare nurses and midwives in Liberia for the workforce<b> </b>through effective teaching methods, capacity building, and the promotion of nursing.</p> <p>There is a deep gap in Liberia’s health delivery system and rural regions of the country bear the brunt of the problems, according to Maweu and Lydia Johnson, health science instructor at Tubman University and co-author of the paper. Maweu noted that the gap impacts educational interventions, which are key to equipping nursing students to deliver high-quality care.</p> <p>In the paper and through various research projects, Maweu and Johnson investigated hard-hit areas of the health system in rural Liberia to identify optimal interventions, such as training nurses.</p> <p>There’s not a single teaching method that is effective on its own, they say, but rather a combination of theoretical sessions, practical sessions, and group work. More specifically, reviewing case studies, practicing procedures through simulation training, and clinical training with real patients equips nurses with essential skills.</p> <blockquote> <p>“When the capacity of nurses is built in rural Liberia, the positive impact of global health will be felt throughout the country,” says Johnson.</p> </blockquote> <p>Nurse training is constantly evolving due to diseases like Ebola and COVID-19 and advances in technology and research. That makes continuous professional development and curriculum review all the more important. Another strategy for nurse education adopted by the Liberian Board of Nurses and Midwives is the Online Continuous Professional Development Program, which provides hundreds of free short courses for nurses and midwives.</p> <p>“Investing in nurses and midwives has an undisputed potential to contribute to the sustainability of the health workforce, develop resilience of the health system and provide quality universal health access for all,” says Maweu, who hopes to expand the <a href="https://www.pih.org/article/qa-addressing-nursing-shortage-through-education-research-liberia">Nursing Center of Excellence</a> in rural Liberia.</p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/nursing" hreflang="en">Nursing</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/nursing" hreflang="en">Nursing</a></div> <div class="field-item"><a href="/research" hreflang="en">Research</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Wed, 08 Jun 2022 13:00:00 +0000 jdelzo 8276 at https://www.pih.org Research: Household Coverage by Health Workers Increases Access To Care, Treatment  https://www.pih.org/article/research-household-coverage-health-workers-increases-access-care-treatment <span class="field-wrapper">Research: Household Coverage by Health Workers Increases Access To Care, Treatment </span> <span class="field-wrapper"><span lang="" about="/user/4559" typeof="schema:Person" property="schema:name" datatype="">rzimmerman</span></span> <span class="field-wrapper">Thu, 03/31/2022 - 11:45</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Study shows Malawi’s “household model” also helps reduce stigma, prevent hospitalization&nbsp;</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2022-03/Copy%20of%20IMG_7714.webp?itok=e3wwXCeM 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2022-03/Copy%20of%20IMG_7714.webp?itok=SMEmYkZx 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2022-03/Copy%20of%20IMG_7714.webp?itok=v-A7p_fM 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2022-03/Copy%20of%20IMG_7714.webp?itok=bbnj-H4_ 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2022-03/Copy%20of%20IMG_7714.webp?itok=OmT2KJfG 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2022-03/Copy%20of%20IMG_7714.JPG?itok=e3wwXCeM 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2022-03/Copy%20of%20IMG_7714.JPG?itok=SMEmYkZx 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2022-03/Copy%20of%20IMG_7714.JPG?itok=v-A7p_fM 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2022-03/Copy%20of%20IMG_7714.JPG?itok=bbnj-H4_ 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2022-03/Copy%20of%20IMG_7714.JPG?itok=OmT2KJfG 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2022-03/Copy%20of%20IMG_7714.JPG?itok=e3wwXCeM" alt="Community health worker Catherine Benito visits a household in Neno District, Malawi." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Community Health Worker Catherine Benito visits a household in Neno District, Malawi, in March 2022.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photos by Benson Phiri / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p paraeid="{d169e5cb-5b63-4de4-81d8-2769d2365d06}{128}" paraid="109869217">For Catherine Benito, a <a href="https://www.pih.org/programs/community-health-workers">community health worker</a> (CHW) in Neno District, Malawi, <a href="https://www.pih.org/article/cyclone-rips-through-malawi">Cyclone Ana</a> may have ripped out an entire wall of her home in January, but it didn’t stop her regular visits to 26 households nearby. </p> <p paraeid="{d169e5cb-5b63-4de4-81d8-2769d2365d06}{192}" paraid="4">Benito, a divorced mother of four children, has been a community health worker for six years, making the rounds by foot through Neno, an impoverished, rural area with about 140,000 residents, still incomplete tarmac roads and scarce electricity. She visits each household once or twice a month, she said, speaking in Chichewa translated into English. If someone in the home is sick—with HIV or diabetes, or if she hears of pregnancy complications or a child appears malnourished—she visits more often.  </p> <p paraeid="{d169e5cb-5b63-4de4-81d8-2769d2365d06}{238}" paraid="6">This so-called “household model,” in which CHWs tend to everyone living in the house whether they are ill with a specific disease or not, represents an evolving approach to care and was designed in partnership with communities. From Benito’s perspective, it’s effective. “Now people don’t wait until they are very sick to go to the hospital,” she said. “We can identify the disease faster…and refer people to where they can access treatment.   </p> <h2 paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{21}" paraid="8"><strong>Everyone Under One Roof</strong></h2> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{21}" paraid="8">A <a href="https://gh.bmj.com/content/6/9/e006535.full" rel="noreferrer noopener" target="_blank">study</a> published in BMJ Global Health in September 2021 found various benefits from this “household model” compared to an earlier approach in which CHWs were assigned to visit individual patients already diagnosed with a specific illness. Under the new model, many more residents enrolled in health care, the study found, and fewer dropped out of the system. </p> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{40}" paraid="10">But even before the research study concluded, it became clear that accompanying all members of the households made sense, said Dr. Chiyembekezo Kachimanga, chief medical officer of Partners In Health <a href="https://www.pih.org/country/malawi">Malawi</a>, or Abwenzi Pa Za Umoyo (APZU), as PIH is known locally. </p> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{100}" paraid="13">Now, each of Neno District’s 1,228 CHWs visit and monitor households, offering check-ins and medical and social support as needed to everyone under one roof.   </p> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{128}" paraid="16">“I think the biggest takeaway is that every house—whether they have an illness or not—has a community health worker,” said Kachimanga. “Most programs are geared to specific conditions, so if you’re not sick, you’re not visited. Here, the work of the CHW is not narrow, it’s broad, they are monitoring eight disease conditions, and they do other things. If they see that people require other medical intervention, the CHW can help.” </p> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{150}" paraid="18">The flexibility to address what’s needed is built into the household model, clinicians said. For instance, during the recent cyclone, about one-fourth of CHWs reported some losses, and about 179 of them received food packages, household items, or other support. “Otherwise for the rest, work is continuing as normal,” said Kachimanga. A number of CHWs also worked at the camps for displaced people set up in the district, offering referrals for psychosocial support, medical supplies, food, and other basics.  </p> <h2 paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{176}" paraid="19"><strong>CHWs as Core of Primary Care </strong></h2> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{190}" paraid="20">As part of the study, CHWs are assigned to visit 20 to 40 households each month, focusing on a set of priority conditions, including HIV, TB, pediatric malnutrition, maternal and child health, and non-communicable diseases. Additionally, pregnant women were enrolled in primary care programs and any symptomatic individuals were accompanied—literally walked— to the nearest health facility to help them navigate screening, care, and treatment. Certain patients, like those with HIV and other chronic conditions were seen more frequently. </p> <p paraeid="{3eee5cf9-b024-4915-81c9-7e5f381f5846}{220}" paraid="1683582411">The study had significant findings for patients with chronic disease, such as <a href="https://www.pih.org/programs/hiv-aids">HIV</a> or a <a href="https://www.pih.org/programs/cancer-chronic-diseases">non-communicable disease</a> (NCD) such as diabetes or asthma. The household model approach reduced the monthly “default” rate – when patients are lost to care – by approximately 20%. This amounts to about 1,200 additional patients being retained in care and treatment every year and has great potential for impact because this program continues to rapidly grow in Neno and currently cares for more than 15,000 patients with HIV and/or an NCD.   </p> <p paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{9}" paraid="24">Dr. Emily Wroe, the study’s lead author, and now a PIH senior advisor on COVID-19 response, said the research led to several important findings. First, she said, under the household model, CHWs helped more women get antenatal care early in pregnancy. This connected women throughout pregnancy to routine care, such as checkups and accessing vitamins, and, when complications arose, enabled swift action since the women were already linked to a health care system. </p> <h2 paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{17}" paraid="25"><strong>Greater Prevention, Faster Access to Treatment </strong></h2> <p lang="EN-US" paraeid="{4114fbdc-7862-45e5-b360-df908a4da1eb}{30}" paraid="26" xml:lang="EN-US" xml:lang="EN-US">Second, Wroe said, people with chronic conditions such as diabetes or asthma, remained supervised and supported by CHWs. “This means they have routine access to treatment, monitoring, and counseling,” she said. “Keeping people with chronic conditions under care prevents diseases from getting worse and keeps patients out of the hospital.”  </p> <p paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{31}" paraid="27">This type of research, a stepped-wedge randomized controlled trial, is a big deal for understanding the impact of the CHWs and the household model. But the team was confident it would work and had an earlier success story in mind when formulating the new study: a program providing ongoing CHW support to patients with HIV in Neno led to high treatment and retention rates. Indeed, as of late 2021 in the Neno district, 94% of people living with HIV (ages 15-49) were enrolled in life-saving antiretroviral treatment; in 90% of these patients the virus was undetectable.   </p> <p paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{87}" paraid="30">The recent study was fashioned to achieve that level of impact for all other conditions: household support means identifying problems early, whether it’s adherence to medication regimens, dealing with side effects, or missing medical appointments.  </p> <p paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{101}" paraid="32">“It really proved what we suspected,” added Wroe. She said her “favorite” finding is that the biggest benefits from the CHWs were for diseases where the primary care system was strong: “This taught us that CHWs are synergistic with strong primary care — they don’t replace primary care but boy can they amplify it.”  CHWs are not “cheap alternatives” for strong primary care systems, Wroe said, they are embedded in the system. “That really came out in our results…if you build a CHW system without strong primary care you can support people, but if there’s no microscope to check for TB, the impact will be limited.” </p> <figure role="group"> <img alt="Cyclone Ana destroyed homes across Malawi, including CHW Catherine Benito's house. " data-entity-type="file" data-entity-uuid="4eeedb17-411a-4a4e-90bb-12fffb6171fe" src="/sites/default/files/inline-images/6.JPG" width="800" height="533" loading="lazy" /> <figcaption>Cyclone Ana destroyed homes across southern Malawi, including CHW Catherine Benito's house.</figcaption> </figure> <h2 paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{111}" paraid="1256664829"><strong>Feeling Better </strong></h2> <p lang="EN-US" paraeid="{4114fbdc-7862-45e5-b360-df908a4da1eb}{126}" paraid="40" xml:lang="EN-US" xml:lang="EN-US">For Benito, the CHW, there can be a few bumps in the system. Sometimes, she says, if no one  is sick in the household, families can be reluctant to open their homes to her. “But we are able to continue to visit,” she said, “and it helps the community.” </p> <p paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{141}" paraid="42">Recently, a woman in one of Benito’s households was complaining of weakness and fatigue. Benito urged a medical appointment, but doctors found nothing and sent the woman home. Still, she told Benito, she continued to feel unwell and began suffering from numbness on one side of her body that ran down her leg. Once again, Benito arranged for a hospital visit. This time the woman was diagnosed with high blood pressure and put on medication. “Now,” Benito said, “she is starting to feel better.” </p> <p paraeid="{88bea052-cca9-4a94-862d-2ee71ec71151}{141}" paraid="42"><a class="btn btn-light btn-orange donate" href="https://www.pih.org/country/malawi">More on Malawi</a></p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/social-support" hreflang="en">Social Support</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Thu, 31 Mar 2022 15:45:59 +0000 rzimmerman 8228 at https://www.pih.org Q&A: Malaria Vaccine ‘Is a Powerful Tool’ to Save Lives https://www.pih.org/article/qa-malaria-vaccine-powerful-tool-save-lives <span class="field-wrapper">Q&amp;A: Malaria Vaccine ‘Is a Powerful Tool’ to Save Lives</span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Fri, 11/12/2021 - 15:20</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>PIH expert shares insights on first-ever malaria vaccine</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.webp?itok=AEMdZq2V 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.webp?itok=cyWUtCyW 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.webp?itok=eWczHiST 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.webp?itok=tlOEP5Dz 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.webp?itok=ayRFOjwy 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.JPG?itok=AEMdZq2V 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.JPG?itok=cyWUtCyW 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.JPG?itok=eWczHiST 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.JPG?itok=tlOEP5Dz 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.JPG?itok=ayRFOjwy 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-11/malawi_0918_lisungwipatient_zdeclerck_115.JPG?itok=AEMdZq2V" alt="Chisomo Tigone, 7 months, is held by his mother, Flora Tigone, while undergoing treatment for severe malaria in Lisungwi, Malawi." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Chisomo Tigone, 7 months, is held by his mother, Flora Tigone, while undergoing treatment for severe malaria in Lisungwi, Malawi.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Zack DeClerck / PIH.</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>A vaccine can change the course of global health—and not just amid COVID-19.</p> <p>After 100 years of research and clinical trials, the first-ever malaria vaccine was approved by the World Health Organization on October 7, a historic moment that marked a turning point in the longstanding fight to end one of the world’s deadliest diseases.</p> <p>Malaria<a href="https://www.nytimes.com/2021/10/06/health/malaria-vaccine-who.html"> </a><a href="https://www.nytimes.com/2021/10/06/health/malaria-vaccine-who.html">kills</a> about 500,000 people each year, with children in Africa accounting for around half of those deaths. The disease is highly prevalent in Rwanda, Liberia, Sierra Leone, and Malawi—countries where Partners In Health works and where community health workers can do little more than hand out bed nets as a preventative measure.</p> <p>Even as the vaccine ushers in a new era for millions of people worldwide, questions remain about its cost and accessibility, especially for those who need it most.</p> <p>To explore these questions and others, PIH sat down with our Africa Regional Policy and Partnerships Advisor Dr. Evrard Nahimana for his insights on this scientific breakthrough and how it could change the course of global health.</p> <p><strong>A vaccine for malaria has been a long time coming—100 years, to be exact. How does this historic moment resonate with you, on a professional and personal level?</strong></p> <p>Malaria is a disease I have grown up with. I had a couple episodes of malaria during my childhood and during my clinical years. I also cared for many patients with severe malaria, particularly children under 5 and pregnant women. Some of them unfortunately died from the disease. The burden of malaria goes beyond the number of patients affected and/or deaths related. Malaria has a huge negative impact on a family’s finances and a country’s economy. </p> <p>Clinical trials on the malaria vaccine started decades ago. I had the opportunity to meet researchers directly involved in the trials in Kenya and Tanzania. And so hearing about this scientific milestone in my lifetime is so exciting. A vaccine is and could be a powerful tool in the fight against malaria.</p> <p>However, the fight is far from over. Malaria is a “poverty disease” and so, only relying on drug/vaccine/commodities-based interventions to control and eliminate the disease is a big mistake. Its elimination should go hand-in-hand with poverty reduction strategies, including improving housing and building strong and equitable health systems.</p> <p><strong>The story of this vaccine is quite different from others; it was developed in Africa, by African scientists, which is major. Can we talk about the development of this vaccine—what makes it unique and what lessons can we learn from it?</strong></p> <p>Over the past century, clinical trials in infectious diseases have been led by researchers and agencies from the western countries. However, the research and development of malaria vaccines present a different scenario. African scientists have been closely involved and leading clinical trials for the malaria vaccine, including the one that led to RTS,S (the new malaria vaccine), which was recently approved by the World Health Organization. Although the process involved a collaboration with a British drug manufacturer, with funding from the United States and United Kingdom, scientists born, raised, and trained in Africa led the clinical trial that occurred in Ghana, Malawi, and Kenya.</p> <p>This means a lot for the scientific community across Africa. For the scientists involved in the trial, it is about fighting a disease that is killing them, their families, and communities they live in. But most importantly, when it comes to scale, you are not relying on data from studies conducted elsewhere on other populations by other researchers. This is also a message of hope for other scientists from Africa involved in similar trials—their work may lead to even more efficacious drugs and vaccines.</p> <figure role="group"> <img alt="rearch" data-entity-type="file" data-entity-uuid="f0714639-59df-430d-a503-43b018505264" src="/sites/default/files/inline-images/malawi_0918_lisungwiresearch_zdeclerck_159.JPG" width="938" height="624" loading="lazy" /> <figcaption>Lab scientist Allan Chimpeni prepares TB samples at Lisungwi Community Hospital in Malawi. The lab's biggest workload is malaria at 50-70 tests a day, and will rise to 120-150 tests a day in rainy months of Nov – Jan. Photo by Zack DeClerck / PIH.</figcaption> </figure> <p><strong>The vaccine has modest efficacy—30% among children under five—and requires a complex regimen of doses—4 shots. What do you make of this, from a clinical perspective?</strong></p> <p>It is true that the vaccine has a modest efficacy of 30%. However, the evidence from a recent study shows that the vaccine RTS,S combined with other existing methods (use of antimalarial drugs and bed nets) could reduce under 5 mortality and hospitalization up to 70%. Also, 30% of efficacy might seem modest, but applying that to the millions of children affected by malaria every day could save so many lives.</p> <p>Across most African countries, vaccination coverage among children was high (around 90%) before COVID-19. Countries like Rwanda achieved 98% coverage for the overall complete basic childhood vaccination among children aged 12–23 months. Even for countries with low coverage, the issue is less hesitancy but more related to accessibility due to structural barriers. I am confident that adding a malaria vaccine into routine immunizations for children will be met with a lot of enthusiasm and the uptake will be high. Producing the vaccine at a large scale and making it available to the people who need it most will be the critical next steps.</p> <p><strong>Now that the vaccine has been approved, what would it take to make it free and accessible to the world’s population, especially those who need it most?</strong></p> <p>Developing a lifesaving product (vaccine or drug) is one important step; ensuring large production, fair distribution, and administration to everyone, particularly those who need it most, is challenging—but possible. Recent history has taught us, through so many examples (HIV, Ebola, COVID-19), that without global collaboration to fund the production, distribution, and administration of vaccines, we could be waiting years and even decades before those vaccines, already approved, are available to those who need them most. It would be a tragic, global, moral failure if that happens again with the malaria vaccine.</p> <p>The COVID-19 Vaccines Global Access (COVAX) facility was established as a mechanism to support low- and middle-income countries in accessing vaccines doses for their populations. We need a similar mechanism for the malaria vaccine. And the right time to do it was yesterday! A study shows that countries with moderate to high malaria transmission will need about 110 million doses per year by 2030. I don’t know how much this will cost, but it is nothing compared to the lives of children we can save. This is a call for governments, multilateral agencies, donors, philanthropists, and the entire global health community to work together to mobilize resources for universal access to malaria vaccines. Again, it should be clear that a vaccine is not a magic bullet to control malaria. Vaccination should be integrated into broader strategies for health system strengthening and economic and human development.</p> <figure role="group"> <img alt="Chisomo Tigone, 7 months, sits with parents Flora and Thomas Tigone during his treatment for severe malaria. " data-entity-type="file" data-entity-uuid="b4a3e15a-5fbb-429c-b393-f5085235e600" src="/sites/default/files/inline-images/malawi_0918_lisungwibaby_zdeclerck_127.JPG" width="938" height="624" loading="lazy" /> <figcaption>Chisomo Tigone, 7 months, sits with parents Flora and Thomas Tigone during his treatment for severe malaria. Photo by Zack DeClerck / PIH.</figcaption> </figure> <p><strong>What does this vaccine mean for the sites where PIH works and where malaria has long been prevalent?</strong></p> <p>Malaria kills half a million people every year and the majority of them (more than 90%) live across the African continent. Access to malaria vaccines will help save lives and prevent the hospitalization of millions of people. It is good news for people living in malaria endemic areas, including countries supported by PIH.</p> <p>Countries with weak health systems will struggle to distribute and administer the vaccine once it is available, and its impact on malaria control will be very limited. Improving supply chain systems will be essential for effective vaccine distribution. With PIH’s efforts over the past two decades to build a robust, resilient health system through our <a href="https://www.pih.org/article/pihs-five-ss-essential-elements-strong-health-systems">5S model</a> (staff, stuff, space, systems, and social support), the sites we support are well-positioned to embark into the effective distribution of the malaria vaccine, and PIH will continue to support governments with that.</p> <p><strong>Any insights on what the vaccine could mean for the Global Fund—the international partnership between governments, civil society, and the private sector to fight malaria, HIV and TB? Do you think the Fund will be used to buy vaccines? Will it be as needed as before if this vaccine proves to be revolutionary?</strong></p> <p>The Global Fund has been essential in the fight against malaria, TB, and HIV. In some countries, the Fund contributed to building a horizontal health system. It has been supporting the procurement of commodities, including malaria drugs. It is not clear what the Fund’s strategy will be toward procuring malaria vaccines and facilitating distribution and administration. But that’s what we hope to see.</p> <p><strong>The WHO endorsement of this vaccine is a huge win in the long-running fight against malaria, but that fight is far from over. What do you think is the next chapter in the global push to end malaria? What must the global health community do now?</strong></p> <p>Malaria is a good example of a “poverty disease.” Over the past decades, most of the strategies to control it have been focusing on commodities (bed nets, drugs, etc.) which are effective but limited in the long-run.</p> <p>Shifting our methodology by embedding these existing tools and new ones into a broader development agenda, including proper housing and improving health systems, will help to eliminate the disease. And resource mobilization for mass production of the vaccine—including building capacity within developing countries to manufacture the vaccines for themselves—should happen as soon as possible.</p> </div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Fri, 12 Nov 2021 20:20:49 +0000 apollard 8098 at https://www.pih.org Research: Improving Breast Cancer Outcomes for Patients in Haiti https://www.pih.org/article/research-improving-breast-cancer-outcomes-patients-haiti <span class="field-wrapper">Research: Improving Breast Cancer Outcomes for Patients in Haiti</span> <span class="field-wrapper"><span lang="" about="/user/4512" typeof="schema:Person" property="schema:name" datatype="">jdelzo</span></span> <span class="field-wrapper">Thu, 10/28/2021 - 09:50</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p><meta charset="UTF-8" />Earlier detection, diagnosis, and treatment can save lives&nbsp;</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.webp?itok=bW5jPq7X 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.webp?itok=DdlXq1eD 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.webp?itok=n3mE0-Xm 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.webp?itok=Y2m4un7r 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.webp?itok=B4VXnCDJ 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.JPG?itok=bW5jPq7X 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.JPG?itok=DdlXq1eD 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.JPG?itok=n3mE0-Xm 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.JPG?itok=Y2m4un7r 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.JPG?itok=B4VXnCDJ 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-10/Haiti_0118_Oncology-OE_CAvila_002-2.JPG?itok=bW5jPq7X" alt="two clinicians meet with a patient with breast cancer" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Dr. Joarly Lormil, an internal medicine and oncology physician, and Dr. Erwine Dina Jeune, an OBGYN medical resident, meet with a 35-year-old patient with breast cancer in 2018. Photo by Cecille Joan Avila / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>In Haiti, breast cancer is the most common form of the disease among women, as it is worldwide. But there’s a key difference: a higher percentage of women will die from breast cancer in the Caribbean nation than most other countries.</p> <p>While many factors may contribute to this, including that Haitian patients are often diagnosed at later stages, there is limited research detailing how these factors play a role in Haiti. To gain a better understanding of the situation and to assess care delivered at Hôpital Universitaire de Mirebalais (HUM), researchers from Zanmi Lasante—Partners In Health’s sister organization in Haiti—alongside co-collaborators from several institutions in the United States, conducted a comprehensive assessment.</p> <p>Their findings, which were <a href="https://theoncologist.onlinelibrary.wiley.com/doi/10.1634/theoncologist.2019-0951">published</a> last year in <i>The Oncologist</i>, include many important takeaways, with the most encouraging being that basic breast cancer treatment can lead to better outcomes in Haiti, especially when patients are diagnosed and treated early.</p> <blockquote> <p>“We wanted to highlight the fact that we can treat cancer in Haiti. It’s feasible but you need the right resources,” says Dr. Ruth Damuse, clinical care coordinator in HUM’s oncology department and co-author of the study.</p> </blockquote> <p>Their research is the first published assessment of cancer care at HUM since the program (which began in Cange in 2011) moved to the hospital in 2013, the same year the 350-bed, world-class teaching facility opened its doors. HUM has the country’s only public oncology center capable of diagnosing and caring for patients and offering both therapeutic and surgical treatments.</p> <p>As the oncology department at HUM becomes more widely known, patients—80% of whom have breast cancer—have come from all around the country for care.</p> <h4><b>A Closer Look</b></h4> <p>The study included data from 341 female patients with nonmetastatic breast cancer who started treatment at HUM from 2012-2016. Damuse and her colleagues measured “event-free survival” in patients, meaning how much time elapsed before the patient had either a recurrence of cancer, a new tumor, disease progression, or death from any cause. They also reviewed the type of care provided by HUM, taking into consideration what treatments were administered, the time it took for patients to receive that treatment, and the treatment’s duration.</p> <p>Of those patients, 81.5% received curative surgery, or removal of the breast where a tumor was found. (Breast-conserving surgery is not performed in Haiti at this time since it requires patients to receive radiation therapy, which is not available in the country.) Pre- and post-surgical therapies such as chemotherapy were provided to shrink the tumor, and some patients also received further chemotherapy and hormonal therapy after surgery. During the follow-up period, 28 patients died, 77 had disease recurrence, and 10 experienced progression of the disease.</p> <p>Of the patients that had up to 3 years of follow up, over 60% were alive and free of disease.</p> <p>Most patients tended to have more advanced disease at the time of diagnosis—a rate that was even higher than previous studies conducted across Haiti had indicated. The authors believe one reason was the lack of nationwide breast cancer early detection programs. And many of the patients appeared to get breast cancer at an earlier age than patients in the U.S., which previous studies have also found.</p> <p>Lead author Dr. Temidayo Fadelu, PIH’s oncology advisor, says an explanation is illusive and needs further research. “You have an overall younger population, and then you have the possibility that the biology of cancer might be different in a population of African descent. Overlaying that is likely referral bias.”</p> <p>In other words, he wonders: “Is it possible that older patients are having cancer but not making their way to our facility?”</p> <p>The study helped researchers pinpoint several important obstacles to care that will be useful in identifying areas of improvement. For example, researchers found that many patients experience delays when they go to other facilities. When patients wait until their disease has advanced, it becomes more difficult to treat their cancer and more likely that they will have a negative outcome.</p> <p>Damuse said that patients are oftentimes resistant to seeking care for several reasons: stigma related to breast cancer, fear that a mastectomy will make them less feminine, or because they believe breast cancer is a death sentence. In some cases, patients are skeptical of modern treatments. And in rural areas, she says, people tend to be unfamiliar with hair loss associated with chemotherapy or have never heard of a breast being removed to save a patient’s life.</p> <p>Diagnosis is also challenging. For most of the study period, there was very limited access to pathology services and patient samples had to be sent to the U.S. for a diagnosis. In Haiti, clinicians evaluate the extent of the cancer using a chest x-ray and ultrasounds, but other tests common in higher-income  countries such as CT scans, nuclear studies, MRI, and PET scan machines are not readily available.</p> <figure role="group"> <img alt="Marana Toussiant standing outside" data-entity-type="file" data-entity-uuid="314c4a7f-1340-49fc-bb25-85a8209bffac" src="/sites/default/files/inline-images/Haiti_0118_Oncology-MT_CAvila_038.JPG" width="800" height="533" loading="lazy" /> <figcaption>Marana Toussiant was treated for breast cancer by Dr. Ruth Damuse at HUM where she underwent a mastectomy and eight months of chemotherapy. She often talks about her experience. "People think that if you get cancer, you will die," Toussiant said in 2018. Yet she points to her own case and simply tells them "that’s not true." Photo by Cecille Joan Avila / PIH</figcaption> </figure> <h4><b>Implementing Changes at HUM </b></h4> <p>Since conducting the study, the team has worked hard to improve the scheduling system and follow up with patients, with the goal of making sure patients continue treatment.</p> <p>Dr. Joarly Lormil, oncology care coordinator at HUM, has seen thousands of patients in his practice. He estimates that, at the moment, about 150 patients are actively receiving chemotherapy at HUM. Lormil treats patients with all kinds of cancers, but the majority are patients with breast cancer. He has seen firsthand how harmful it can be when patients delay treatment.</p> <p>Lormil recalls seeing a patient in her early 30s who was diagnosed with breast cancer and was a candidate for surgery. However, she was newly married and reluctant to have her breast removed. Nearly a year later, “we finally convinced her to receive the care,” he says. But then the earthquake struck, further delaying her surgery. Two more months passed. Finally she had the surgery and is doing well now, but is at higher risk for further complications and recurrence of her disease.</p> <p>As the oncology team continues to increase its capacity to care for and treat patients in Haiti, increasing its staff and eventually bringing in new technology and treatments will improve patient outcomes, but all this comes at a significant cost.</p> <p>Nonetheless, Lormil is optimistic: “Most men and women with breast cancer can get cancer care, including palliative care.”</p> <p>Take the recent example of a nurse working in HUM’s maternal health unit, who discovered she had breast cancer. When she first got treatment, she felt ill from chemotherapy, but is doing better now. She is free from cancer, says Lormil, adding that the nurse has been sharing her experience with her co-workers and patients.</p> <blockquote> <p>“She is the embodiment that, if you receive care early,” he says, “you can be free of cancer.”</p> </blockquote> <h4><b>Moving Forward</b></h4> <p>The research team identified gaps and areas for improvement, such as increasing the percentage of patients who receive surgery, the proportion of patients who get estrogen receptor testing, and the use of chemotherapies before and after surgery. The team also hopes to reduce the number of patients who fail to follow up and decrease system delays for patients.</p> <p>As a result of the study, HUM staff are now working with local partners on initiatives to teach women how to perform self-breast exams. Clinicians are also providing information and support to patients with the goal of overcoming stigma around cancer care. Further studies are recommended to better understand why there are high rates of breast cancer in Haiti, and why Haitian women seem to get breast cancer at a younger age.</p> <p>The study’s findings have already helped raise the standard of care for breast cancer patients at HUM. For example, the hospital now has a full-time surgeon integrated in the oncology team and dedicated to providing expedited access to surgery.</p> <p>Damuse says the study has given the team confidence and proven the success of HUM’s oncological care model, which can serve as a blueprint for cancer care across Haiti and other developing countries.</p> <p>“The study,” she says, “shows that we can improve cancer care in Haiti going forward.”</p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/cancer-chronic-diseases" hreflang="en">Cancer &amp; Chronic Diseases</a></div> <div class="field-item"><a href="/programs/research" hreflang="en">Research</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/cancer" hreflang="en">Cancer</a></div> <div class="field-item"><a href="/taxonomy/term/768" hreflang="en">Haiti</a></div> <div class="field-item"><a href="/research" hreflang="en">Research</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Thu, 28 Oct 2021 13:50:25 +0000 jdelzo 8067 at https://www.pih.org Research: Innovative Program Saves At-Risk Newborns In Rwanda https://www.pih.org/article/research-innovative-program-saves-risk-newborns-rwanda <span class="field-wrapper">Research: Innovative Program Saves At-Risk Newborns In Rwanda</span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Wed, 10/13/2021 - 14:49</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>All Babies Count reduced neonatal deaths by 35% in rural districts</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.webp?itok=eETDMvjl 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.webp?itok=eA0HAh0w 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.webp?itok=kXrXyTR6 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.webp?itok=zt_kXpdh 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.webp?itok=lvtLAoaN 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.JPG?itok=eETDMvjl 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.JPG?itok=eA0HAh0w 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.JPG?itok=kXrXyTR6 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.JPG?itok=zt_kXpdh 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.JPG?itok=lvtLAoaN 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-10/rwanda-0621-butaro-newbornnicu-zdeclerck-14.JPG?itok=eETDMvjl" alt="Nyirabizeyimana Fortunée and her daughter, Gwizimpano Nshizirungu Annick, rest in the kangaroo care ward at Butaro District Hospital in May 2021." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Nyirabizeyimana Fortunée and her daughter, Gwizimpano Nshizirungu Annick, rest in the kangaroo care ward at Butaro District Hospital in May 2021.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Zack DeClerck / Partners In Health.</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>In Rwanda, “impinja ntizigapfe” captures a mother’s prayer—that no baby ever dies. The phrase is part of a folk song in Kinyarwanda, one of the country’s four official languages. And it inspired an innovative program intent on saving newborns’ lives.</p> <p>The program, All Babies Count, was launched by Inshuti Mu Buzima, <a href="https://www.pih.org/country/rwanda">as Partners In Health is known locally</a>, and the Rwandan Ministry of Health in 2013, focused on reducing newborn deaths in Kayonza and Kirehe, two rural districts where neonatal mortality was high.</p> <p>The results were striking: in just 18 months, the program reduced neonatal mortality by 35%. Among high-risk preterm and low-birth weight newborns, that drop was even greater—49%.</p> <p>Since then, PIH staff have been determined to understand what made All Babies Count so successful—curiosity that led to new research <a href="https://www.ghspjournal.org/content/8/3/000.2.full#ack-1">published</a> last year in Global Health: Science and Practice.</p> <p>The study examines how All Babies Count reduced neonatal mortality and what those findings could mean for efforts to save newborns’ lives throughout Rwanda and worldwide, especially in rural contexts.</p> <p>“What All Babies Count did is to provide knowledge and skills,” says Dr. Erick Baganizi, director of maternal, newborn, child and adolescent health at Inshuti Mu Buzima and co-author of the study. “It has had a huge impact on premature babies.”</p> <h4>‘These Achievements Are Possible’</h4> <p>Over the past two decades, Rwanda has made remarkable progress toward reducing child mortality. But neonatal mortality has not seen the same level of progress and has remained alarmingly high in rural areas such as Kayonza and Kirehe, where 30 out every 1,000 newborns <a href="https://data.worldbank.org/indicator/SH.DYN.NMRT?locations=US">died</a> in 2013, compared to the nationwide ratio in Rwanda of 19.5 and United States’ 4.</p> <p>Since its inception in 2013, All Babies Count aimed to change that. Launched by Inshuti Mu Buzima and the Rwandan Ministry of Health as an 18-month pilot, the program had one mission: end preventable neonatal deaths by equipping hospitals with resources, training, and national protocols for neonatal care.</p> <p>Caring for newborns with health complications is costly and challenging for any hospital, but especially for those in rural communities where access to resources, staff, and expertise is limited. Having the right medical equipment can mean the difference between life or death for a baby born prematurely, or with other complications—a reality that clinicians routinely saw in Kayonza and Kirehe districts.</p> <p>To address this critical gap, All Babies Count helped hospitals and clinics in these districts procure lifesaving medical equipment, such as delivery tables, incubators, suction machines and infant scales, improving their capacity for neonatal care and providing safe, clean infrastructure for both mothers and babies.</p> <p>The program also invested in training and mentoring clinicians, offering “learning collaborative” sessions for health professionals to meet and share best practices and partnering with the Ministry of Health to develop national protocols for neonatal care and strategies to onboard clinicians—strategies that could be as simple as hanging a flyer on the wall of a clinic, or as complex as implementing mandatory trainings.</p> <p>“Having the entire country on the same message for neonatal care really played a big role,” says Merab Nyishime, a neonatal nurse specialist who managed All Babies Count from 2013 to 2017.</p> <p>That unified message saved lives.</p> <p>After the 18-month pilot, neonatal mortality in Kayonza and Kirehe dropped from 30.1 to 19.6 deaths per 1,000 live births. Overall, 139 nurses and midwives were trained in essential newborn care, and more than 150 health workers were trained in the management of pre-eclampsia and eclampsia—both potentially life-threatening conditions for expectant mothers and, by relation, their newborns. Every hospital in the program received a full-time nurse or midwife mentor to provide specialized training.</p> <p>All Babies Count was so effective that it was expanded to seven hospitals and 69 health centers across Rwanda from 2016 to 2019 and its elements—such as trainings, data sharing, quality improvement projects, and the learning collaborative—were integrated into Rwanda’s national strategy for neonatal care, which continues to this day. And it has served as a model for health workers elsewhere—<a href="https://www.pih.org/country/liberia">PIH Liberia</a> is applying elements of the program to its own maternal and neonatal care.</p> <p>“This type of project helps in spreading knowledge and also increases the confidence of people who see the project working,” says Baganizi. “It’s a good way to show that this is doable, even if you are in a low-resource setting. These are the achievements that are possible.”</p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/research" hreflang="en">Research</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/child-health" hreflang="en">Child Health</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Wed, 13 Oct 2021 18:49:58 +0000 apollard 8054 at https://www.pih.org Register Now: Global Health and Social Medicine in Latin America https://www.pih.org/article/register-now-global-health-and-social-medicine-latin-america <span class="field-wrapper">Register Now: Global Health and Social Medicine in Latin America</span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Tue, 09/28/2021 - 16:18</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>PIH conference will convene health experts from across the region</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-09/mexico-0921-cespatient-prodriguez.webp?itok=AdO5mvzq 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-09/mexico-0921-cespatient-prodriguez.webp?itok=pq3-lKen 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-09/mexico-0921-cespatient-prodriguez.webp?itok=b3VkiRLy 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-09/mexico-0921-cespatient-prodriguez.webp?itok=N662gfGG 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-09/mexico-0921-cespatient-prodriguez.webp?itok=fTDltEKv 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-09/mexico-0921-cespatient-prodriguez.JPG?itok=AdO5mvzq 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-09/mexico-0921-cespatient-prodriguez.JPG?itok=pq3-lKen 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-09/mexico-0921-cespatient-prodriguez.JPG?itok=b3VkiRLy 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-09/mexico-0921-cespatient-prodriguez.JPG?itok=N662gfGG 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-09/mexico-0921-cespatient-prodriguez.JPG?itok=fTDltEKv 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-09/mexico-0921-cespatient-prodriguez.JPG?itok=AdO5mvzq" alt="A patient receives care from a health worker with Compañeros En Salud." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Compañeros En Salud has provided medical care and social support in the Sierra Madre region of Chiapas for more than a decade.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Paola Rodriguez / Partners In Health.</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>On October 5 and 6, Compañeros En Salud, as Partners In Health is known in Mexico, will bring together an array of health experts—from midwives to epidemiologists—for a conference on global health and social medicine in Latin America.</p> <p>The conference, which will be held virtually and in Spanish, will convene experts from across Latin America to discuss a range of topics, including: the impact of COVID-19 on HIV care; the role of primary care services in guaranteeing reproductive autonomy; integrating mental health into primary care; and the history, trends, and future of community health in Latin America.</p> <p>Additionally, the conference will explore Compañeros En Salud’s <a href="https://www.pih.org/country/mexico">decade of work</a> in the Sierra Madre region of Chiapas, examining how Compañeros has delivered care and resources for rural, impoverished communities and how that work can serve as a model for health services in rural communities across Latin America.</p> <p>Conference organizers hope the event will connect health professionals throughout Latin America and spark engaging conversations, bringing the region one step closer to achieving the United Nations' goal of achieving universal health coverage by 2030.</p> <p>Speakers will include Dr. Eliette Valladares Cardoza of the World Health Organization, Dr. María del Rocío Sáenz of the University of Costa Rica and Costa Rica’s former Minister of Health, Elsa Santos of the United Nations Population Fund, Laura Sánchez of the National Institute of Epidemiology in Argentina, and Dr. Jimena Maza of Compañeros En Salud.</p> </div> </div> </div> <div class="field-wrapper field field-node--field-paragraphs-content field-name-field-paragraphs-content field-type-entity-reference-revisions field-label-hidden"> <div class="field-items"> <div class="field-item"> <div class="paragraph cta darktext" style="background-color: #f3f2f0;"> <div class="header__intro container"> <h2 class="center">To learn more &amp; register</h2> <p class="center"> <a class="bttn btn-orange btn-large action-light" href="http://www.cescongreso.com/">Click here </a></p> </div> </div> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/research" hreflang="en">Research</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> <div class="field-wrapper field field-node--field-do-not-show-in-pih-news field-name-field-do-not-show-in-pih-news field-type-boolean field-label-above"> <div class="field-label">Do not show in PIH News</div> <div class="field-items"> <div class="field-item">Off</div> </div> </div> Tue, 28 Sep 2021 20:18:50 +0000 apollard 8031 at https://www.pih.org 5 Unique Elements Driving Partners In Health's Work https://www.pih.org/article/5-unique-elements-driving-partners-healths-work <span class="field-wrapper">5 Unique Elements Driving Partners In Health&#039;s Work</span> <span class="field-wrapper"><span lang="" about="/user/290" typeof="schema:Person" property="schema:name" datatype="">lfriday</span></span> <span class="field-wrapper">Tue, 06/08/2021 - 12:22</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>The social justice and global health nonprofit’s mission is both medical and moral</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.webp?itok=d0sbM3Ay 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.webp?itok=L8BY9qkX 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.webp?itok=69AQZogd 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.webp?itok=sbANOpO4 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.webp?itok=uNnuPE3F 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.jpg?itok=d0sbM3Ay 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.jpg?itok=L8BY9qkX 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.jpg?itok=69AQZogd 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.jpg?itok=sbANOpO4 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.jpg?itok=uNnuPE3F 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-06/NTK%20about%20PIH%20Blogpost-31_resized.jpg?itok=d0sbM3Ay" alt="5 unique aspects of Partners In Health" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">As part of all our global work, PIH values accompaniment, partnership, equity, research and advocacy, and &quot;the Five S&#039;s&quot;: staff, stuff, space, systems, and social support.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Graphic by Maggie Zhang / Partners In Health</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p class="headerintro-para">Partners In Health is not an average NGO. PIH <a href="https://www.pih.org/our-founders">founders</a><a> </a>established the organization more than 30 years ago based on a simple, yet radical, idea: Health care is a human right. We believe everyone deserves the right to live a healthy life, regardless of income, geography, or identity.</p> <p>At PIH, our <a href="https://www.pih.org/our-mission">mission</a> is to provide a “preferential option for the poor” in health care, meaning that those most in need are first to receive care and support. In partnership with local and national governments, we bring the benefits of modern medical science to some of the most marginalized communities around the world, while also integrating local, culturally relevant, and traditional forms of care. From Haiti to Rwanda, our global teams do whatever it takes to make our patients well—just as we would do if a member of our own families or we ourselves were ill.</p> <p>None of this work is simple--but none of it is impossible. And all of it is essential. Here are five elements that make PIH unique:</p> <h2>1. Accompaniment</h2> <p>Accompaniment means being there, together, for as long as it takes. We accompany first and foremost our patients, whom we often refer to as “our bosses.” We believe that any meaningful social progress is only born out of true solidarity and partnership, and so our style of accompaniment is rooted in shared experiences and meant to support whomever needs assistance, for as long as they need it.</p> <p>At PIH, accompaniment has no time limit. Only by keeping an open commitment to collaboration can we aspire to solve problems caused by centuries of oppression—due to colonialism, the slave trade, and systemic racism—and find the hope needed to overcome seemingly insurmountable hurdles.</p> <p>When PIH began working in Haiti in the early 1980s, among the first employees hired were accompagnateurs, or community health workers (CHWs) in Haitian Creole. These accompagnateurs put our accompaniment model into action.  Recruited from their communities, they are intimately aware of the challenges their neighbors, friends, and family members face on a daily basis--first-hand experience that helps them connect patients to local clinics and form the bridge often missing to quality health care.</p> <p>Their work reflects how we accompany all our partners—from leaders of global health organizations and ministers of health, to lab technicians and local clinicians—focused on our overarching goal of achieving a universal right to health care.</p> <figure role="group"> <img alt="TB doctor in Peru shakes hands with a patient" data-entity-type="file" data-entity-uuid="25b5c344-faf2-4ef5-b109-1f8d491c20a0" src="/sites/default/files/inline-images/Peru_1217_SESTB_WRodriguez%20_26.JPG" width="799" height="533" loading="lazy" /> <figcaption>Tuberculosis patient Randy Robles (right) shakes hands with Dr. Epifanio Sánchez in Carabayllo, a district in which PIH works north of Lima, Peru. Elizabeth Vargas, a member of the care team, watches on. Photo by William Castro Rodriguez / Partners In Health</figcaption> </figure> <h2>2. Partnership</h2> <p>Since the beginning, PIH leaders knew that real advancement toward a universal right to health would only be possible through strong partnerships. Our goal is not to expand across the globe, but to partner with governments and organizations who invite us to the work. Together, we prove what is possible in resource-poor settings, among the most marginalized communities, and offer it up as a model for replication. Then, we dare the world to look the other way.</p> <p>We partner with national governments, local districts, the private and public sectors, civil societies, as well as some of the world’s most prestigious academic institutions, such as Harvard Medical School and Brigham &amp; Women’s Hospital. These partnerships, of public officials and clinicians, scholars and scientists, advocates and community members, are what drive all our work, everywhere.</p> <h2>3. Equity</h2> <p>PIH is a social justice and global health nonprofit, with both elements  intertwined. We see social justice as the continuous push to create a more fair and equitable society, one in which everyone has the right and opportunity to live a life filled with dignity and purpose.</p> <p>Our social justice work is focused on creating a new universal standard of health care and is anchored in a preferential option for the poor.  We refuse to accept the global health norm, where all that is imagined for those with the least resources or power are the cheapest options. This is a failure of imagination.</p> <p>We reject that paradigm and propose a different model of care—one rooted in equity. At the clinics and hospitals that we support, care is driven by patients’ needs. And often, that care isn’t solely medical; it includes resources for food, shelter, employment, and transportation to and from health facilities. The entire package of medical care and social support is necessary to care for patients, fix broken health systems, and right historic wrongs. </p> <figure role="group"> <img alt="a PIH mental health coordinator speaks with a patient in rural Rwanda" data-entity-type="file" data-entity-uuid="e08e1882-e2d1-40ec-831c-2f8b56c47cb7" src="/sites/default/files/inline-images/Rwanda_0215_RusasaHC_CAvila_059.JPG" width="800" height="533" loading="lazy" /> <figcaption>Beatha Nyirandagijimana, a mental health research evaluation coordinator with PIH in Rwanda, talks with Sylvestre, a patient, and his mother at Rusasa Health Center. Photo by Cecille Joan Avila / Partners In Health</figcaption> </figure> <h2>4. Research + Advocacy</h2> <p>PIH has decades of experience in global health care and deep academic and research partnerships in the United States.</p> <p>Some of the most brilliant scientific minds in global health work within our ranks. Fordecades, PIH has partnered with world-renowned institutions, such as Harvard University, to deliver groundbreaking research. Our work has informed hundreds of peer-reviewed, scientific papers that in turn form the base of our global advocacy and inspire lasting change.</p> <h3>Some concrete examples:</h3> <ul> <li>In the 1990s, our community-based treatment of multidrug-resistant tuberculosis (MDR-TB) in Peru proved so effective that the World Health Organization (WHO) revised its global treatment recommendations.</li> <li>Years later, our HIV Equity Initiative helped deliver antiretroviral therapy to patients in Haiti, eventually saving hundreds of lives. Our initiative was so successful that it inspired the Global Fund, PEPFAR, and the WHO to fund the fight against HIV in rich and poor countries, alike.</li> <li>In 2012, our cholera vaccination campaign in Haiti set a precedent for outbreak response and inspired the WHO to create a global stockpile of the oral vaccine, which has since been used to control and prevent outbreaks in Yemen and Sierra Leone.</li> </ul> <p>Ultimately, we measure ourselves not only by how many people we have served directly, and how well, but also by how many people we have served indirectly, through our efforts to change minds, laws, and policies.</p> <h2>5. “The Five S’s”</h2> <p>Around the world, PIH builds up local health systems alongside its partners, strengthening these systems to respond to disasters and meet the daily needs of patients and their families.</p> <p>We believe all strong health systems must have five essential elements, which we call “the Five S’s.”</p> <h3>PIH's Five S's</h3> <ul> <li>Staff: Well-trained, qualified staff in sufficient numbers to respond to the need</li> <li>Stuff: Proper and ample medication and supplies</li> <li>Space: Safe, appropriate spaces with reliable electricity and clean water</li> <li>Systems: Universally shared best practices for care delivery and administration</li> <li>Social support: Essential resources to ensure effective care, such as food, transportation, housing, and education</li> </ul> <p><a class="btn btn-light btn-orange donate" href="https://secure.pih.org/a/sign-up">JOIN US</a></p> </div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/human-rights-and-justice" hreflang="en">Human Rights and Justice</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> Tue, 08 Jun 2021 16:22:45 +0000 lfriday 7940 at https://www.pih.org Research: In Rural Mexico, Building Trust Is Key To COVID-19 Response https://www.pih.org/article/research-rural-mexico-building-trust-key-covid-19-response <span class="field-wrapper">Research: In Rural Mexico, Building Trust Is Key To COVID-19 Response </span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Thu, 04/29/2021 - 15:42</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>In <em>The Lancet Global Health</em>: Community health workers key to contact tracing</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-04/mexico_0620_covidresponseces_prodriguez.webp?itok=Ekn7GNyg 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-04/mexico_0620_covidresponseces_prodriguez.webp?itok=Fi51GmKI 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-04/mexico_0620_covidresponseces_prodriguez.webp?itok=APWspwZ4 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-04/mexico_0620_covidresponseces_prodriguez.webp?itok=mytJyP1C 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-04/mexico_0620_covidresponseces_prodriguez.webp?itok=91uK-8bm 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-04/mexico_0620_covidresponseces_prodriguez.JPG?itok=Ekn7GNyg 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-04/mexico_0620_covidresponseces_prodriguez.JPG?itok=Fi51GmKI 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-04/mexico_0620_covidresponseces_prodriguez.JPG?itok=APWspwZ4 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-04/mexico_0620_covidresponseces_prodriguez.JPG?itok=mytJyP1C 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-04/mexico_0620_covidresponseces_prodriguez.JPG?itok=91uK-8bm 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-04/mexico_0620_covidresponseces_prodriguez.JPG?itok=Ekn7GNyg" alt="A doctor teaches a nurse how to wear a face mask as part of a larger training on how to manage triage areas in Chiapas, Mexico." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Dr. Doris Altuzar teaches a nurse how to properly wear a face mask as part of a larger training on how to manage triage areas in the community clinic of Honduras, one of the communities in Chiapas, Mexico where PIH works. </div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Paola Rodriguez / Partners In Health.</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>In much of the world, contact tracers pick up the phone. But in places like Chiapas, Mexico, they knock on doors.</p> <p>That’s because phone and internet service are hard to come by in Mexico’s southernmost state, where more than 75% of the population lives in poverty. That makes contact tracing a complex and challenging process—but not impossible.</p> <p>In fact, new research <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00112-1/fulltext">published</a> in The Lancet Global Health and presented in the Consortium of Universities for Global Health's 12th Annual Global Health Conference as a poster in March shows how Partners In Health supported hundreds of people in Chiapas with contact tracing, medical care, and essential resources over the past year, mounting an effective COVID-19 response despite structural barriers.</p> <p>The research demonstrates the value of PIH’s approach worldwide: building long-term relationships with local communities and strengthening health systems, before disaster strikes, so that patients receive the care they need, when they need it most.</p> <p>“We, through the community members, have built a contact tracing force,” says Zeus Aranda, a research coordinator at Compañeros En Salud, as PIH is known locally, and co-author of the Lancet Global Health abstract. “At the end of the day, the people who know the community best…are the community members.”</p> <h4>Responding In Rural Chiapas</h4> <p>When the pandemic struck Chiapas in March of last year, the case count was low at first, hovering in the single digits. But then the surge came. Between March 2020 and January 2021, the state of 5.2 million recorded 8,745 positive cases and 1,259 deaths from the virus.</p> <p>Even as case counts soared, critical resources—such as COVID-19 tests and oxygen concentrators—were in short supply. And in Chiapas’ rural communities in the Sierra Madre region, where Compañeros En Salud works, disinformation spread, along with the disease.</p> <p>Despite these challenges, Compañeros En Salud was able to <a href="https://www.pih.org/article/rural-mexico-clinicians-deliver-lifesaving-care-amid-fast-moving-pandemic">mount an effective response</a> in the communities where it works, detecting and supporting 287 suspected cases and 1,111 of their contacts through its contact tracing program and providing groceries and hygiene products for 650 households.</p> <p>But that success didn’t happen overnight.</p> <p>In the Lancet Global Health research, authors Dr. Ariwame Jiménez, Dr. Bruno Vargas, and Zeus Aranda describe Compañeros En Salud’s COVID-19 response in rural Chiapas—and how its impact could reach far beyond the Sierra Madre.</p> <p>“It’s such great news that this abstract is being shared in a journal that has such a large impact,” says Laura Martinez, who supported the research as Compañeros En Salud’s contact tracing coordinator. “What was undertaken here in Chiapas is something that a lot of communities with similar characteristics can reproduce and adapt to their contexts.”</p> <h4>‘Contact Tracing Is Possible’</h4> <p>Compañeros En Salud has been working in Chiapas since 2011, and its decade of work building relationships and operating programs there <a href="https://www.pih.org/article/fighting-growing-covid-19-pandemic-mexico">made it a trusted partner</a> in the Ministry of Health’s COVID-19 response. But it had never run a contact tracing program before.</p> <p>To accomplish that, it enlisted members of one of its longest-running programs.</p> <p>“Community health workers have been the bridge between the clinic and the community for years,” says Jiménez, who coordinates Compañeros En Salud’s community health program and served as a first-year doctor in the community clinic in Soledad.</p> <figure role="group"> <img alt="Dr. Ariwame Jiménez meets with a patient at a clinic in Soledad in 2017." data-entity-type="file" data-entity-uuid="662d7374-9c50-4df0-a04b-e0fc44c1f9b7" src="/sites/default/files/inline-images/mexico_1117_soledad_cavila_013.JPG" width="938" height="624" loading="lazy" /> <figcaption>Compañeros En Salud has been working in Chiapas' rural Sierra Madre communities for nearly a decade. Dr. Ariwame Jiménez meets with a patient at a clinic in Soledad in 2017. Photo by Cecile Joan Avila / Partners In Health.</figcaption> </figure> <p>A cornerstone of public health programs worldwide, community health workers are local residents who are recruited, trained, and then dispatched throughout their communities to provide a range of basic health information and services, medications, and social support.</p> <p>Compañeros En Salud’s community health workers have been knocking on doors in Chiapas’ Sierra Madre communities for nearly a decade, checking in on patients and becoming familiar faces in areas where paved roads and nearby clinics are few and far between.</p> <p>That track record of building trust with the community made them a natural fit for the contact tracing program. Each community that accepted support was assigned one or two community health workers for contact tracing efforts. These community health workers followed a careful set of protocols. First, a check in with the local clinic for a list of suspected cases in their area. Then, door-knocking to follow up with the cases and their contacts. Finally, collecting and entering the data in a centralized database.</p> <p>As COVID-19 intensified in the region, these trusted residents <a href="https://www.pih.org/article/rural-mexico-pih-community-health-workers-accompany-covid-19-patients">became a lifeline</a> and, for the researchers, proof of an important concept.</p> <p>“Contact tracing is possible, no matter how hard the context is or the conditions in that specific area,” says Jiménez.</p> <p>It wasn’t always seamless.</p> <p>In the early days of the pandemic, Compañeros En Salud’s workforce of community health workers halved, plummeting from 84 to 43 people. Two communities declined to participate in the contact tracing program due to skepticism and misinformation about the pandemic. And many community health workers have only basic literacy skills, complicating data collection.</p> <p>But the program moved forward, undaunted.</p> <p>As the pandemic became less novel and more detailed health guidance was released, the vast majority of community health workers returned to work, eventually bringing the staff to 80. Jiménez and her team, along with the infection control and prevention team, met with the communities that declined contact tracing to discuss other ways to provide support. And community health workers without literacy skills found other ways to record their data, often with the help of their supervisors or facility staff.</p> <p>The pandemic is far from over, and Compañeros En Salud continues to battle the virus in Chiapas. But for the researchers, the Lancet Global Health abstract shows that an effective pandemic response is possible, even in the most rural and under-resourced settings. And it taps into another resource that has, at times, felt scarce: hope.</p> <p>“What was done is possible in similar contexts around the world. So many communities are very similar to where we work,” says Martinez. “It’s really motivating and inspiring.</p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/community-health-workers" hreflang="en">Community Health Workers</a></div> <div class="field-item"><a href="/programs/research" hreflang="en">Research</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/covid" hreflang="en">Covid-19</a></div> <div class="field-item"><a href="/research" hreflang="en">Research</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> Thu, 29 Apr 2021 19:42:01 +0000 apollard 7897 at https://www.pih.org Telehealth Apps Connect Patients With Care In Peru https://www.pih.org/article/telehealth-apps-connect-patients-care-peru <span class="field-wrapper">Telehealth Apps Connect Patients With Care In Peru</span> <span class="field-wrapper"><span lang="" about="/user/3201" typeof="schema:Person" property="schema:name" datatype="">apollard</span></span> <span class="field-wrapper">Wed, 04/14/2021 - 15:58</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Chatbots improve access to variety of care amid COVID-19</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.webp?itok=wi_5stR9 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.webp?itok=obaNctSJ 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.webp?itok=2iiEXNfy 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.webp?itok=FErioIHK 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.webp?itok=Q8CPrbYS 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.JPG?itok=wi_5stR9 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.JPG?itok=obaNctSJ 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.JPG?itok=2iiEXNfy 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.JPG?itok=FErioIHK 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.JPG?itok=Q8CPrbYS 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2021-04/peru-0121-casita-chatbot-mother-peru-msoldevilla-007.JPG?itok=wi_5stR9" alt="A mother holds her child and looks at an app on her cell phone." typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">In Peru, Socios En Salud is using telehealth apps to connect patients with care.</div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photo by Melissa Estefany Toledo Soldevilla / Partners In Health.</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p>As a young mother faced with parenting during a pandemic, Sol Prieto worried about her 9-month-old and whether he was hitting all the milestones in child development. They spent all day at their house in Carabayllo, Peru. She wondered if it was coming at a cost.</p> <p>“Since I became a mother, I have always been very interested in and concerned about the well-being of my little one,” she says.</p> <p>Fortunately for Prieto, the 26-year-old mother was not left to face these challenges alone. Support came from an unlikely place: a telehealth app.</p> <p>The app is called CASITA, and it’s one of seven telehealth apps developed by Socios En Salud, <a href="https://www.pih.org/country/peru">as Partners In Health is known in Peru</a>. These apps vary in focus, but all have a common goal: to help patients connect with care during the pandemic.</p> <h4>Quality Care, At Home</h4> <p>Socios En Salud has worked in Carabayllo, an impoverished community 20 miles north of the capital of Lima, since 1994, when it responded to <a href="https://www.pih.org/article/melquiades-huauya-ore-mdr-tb-patient-survivor-movie-star-and-advocate">a deadly outbreak of multidrug-resistant tuberculosis</a>. Then and over the decades since, SES has partnered with Peru’s Ministry of Health to deliver medical care and social support, strengthening Carabayllo’s health system.</p> <p>When COVID-19 struck, Socios En Salud was ready to respond with testing, contact tracing, and resources for those in quarantine, drawing from its deep experience fighting TB. It also adapted its clinical programs to keep patients safe, shifting to a virtual format whenever possible—a shift that called for technological innovation.</p> <p>That’s where telehealth came in. As cases mounted and virtual programming became a necessity, Socios En Salud developed seven mobile apps, corresponding with ongoing clinical programs. All of the apps connect patients with a chatbot—and, eventually, care—from the comfort and safety of their homes.</p> <blockquote> <p>“Chatbots are an alternative to provide tele-advice and tele-monitoring in health and to connect people at risk of a health problem with health professionals,” says Karen Ramos, director of Socios En Salud’s community health program. “Chatbots allow us to accompany and follow-up at a distance and allow the participant to have an alternative response to their health problem.”</p> </blockquote> <p>Some of the apps focus on <a href="https://www.pih.org/article/amid-covid-19-delivering-mental-health-care-thousands-peru">mental health</a>, such as Bienestár, which offers a free screening and connects patients with a network of specialized psychologists. KUSKA follows a similar model, but in Quechua, an Indigenous language that can be a barrier to quality care for Peru’s historically marginalized Quechua communities.</p> <p>Other apps focus on <a href="https://www.pih.org/article/peru-care-chronic-diseases-continues-amid-covid-19">chronic diseases</a>. Soy Qhalikay helps identify people at risk for Type 2 diabetes or hypertension and alerts a nursing and nutrition team for follow-up. Chatea con tu Nutri connects patients with health professionals to improve their diet and physical activity.</p> <p>Still other apps focus on maternal and child health. ALMA enables women at risk for breast cancer to access a <a href="https://www.pih.org/article/delivering-breast-cancer-care-peru">free preventative mammography</a>. And GESTamor helps identify women who may be pregnant and refers them to a health facility for prenatal care and monitoring.</p> <h4>A Patient-Centered Approach</h4> <p>For Prieto, it was an app called CASITA that made all the difference. Connected to Socios En Salud’s <a href="https://www.pih.org/article/peru-pih-offers-virtual-sessions-child-development-amid-covid-19">CASITA program</a>, the app offers a free screening, educational resources, and, if needed, enrollment in the program, which identifies infants at risk for developmental delays and provides training and support for their caregivers.</p> <p>Prieto first heard about CASITA from her neighbor, whose family is enrolled. After speaking with a Socios En Salud community health worker, she decided to give the app a try. As she spent her days at home with her son, she wanted to know whether he was showing any signs of developmental delays.</p> <p>When she logged on, the chatbot asked a series of general questions about her and her child. Then, it shared information about the stages of child development, including pictures, and asked more targeted questions about her child’s behaviors.</p> <p>As she answered the questions and saw the pictures of children—pictures that resembled her son—she felt a sense of relief.</p> <p>“Through the CASITA chatbot app, I was able to rule out signs of delay or risk in his child development,” she says.</p> <figure role="group"> <img alt="Sol Prieto and her son in their home. Photo by Melissa Estefany Toledo Soldevilla / Partners In Health." data-entity-type="file" data-entity-uuid="14cb25b3-77f0-4afe-8268-465cf24e765f" src="/sites/default/files/inline-images/peru-0121-casita-chatbot-motherchild-peru-msoldevilla-003.JPG" width="938" height="624" loading="lazy" /> <figcaption>Sol Prieto and her son in their home. Photo by Melissa Estefany Toledo Soldevilla / Partners In Health.</figcaption> </figure> <p>Over the past several months, Socios En Salud’s telehealth apps have helped hundreds of people like Prieto access education, resources, and support—including those previously unserved. The Bienestár app, for example, has helped identify more than 111,540 people in need of mental health support—enabling Socios En Salud to connect them with psychologists and specialized care.</p> <p>The process has had its challenges. Most of Socios En Salud’s community health workers are women over 50 years old who may not have had technological savvy—at least, before the pandemic.</p> <p>“They have had to learn and adapt to the use of chatbots, messaging, and video calls through WhatsApp and other applications,” says Ramos. “This pandemic has allowed them to explore their abilities and know that, regardless of their age, they can continue to learn new things that strengthen their abilities.”</p> <p>As a young mother, learning new things has been a constant for Prieto. But she knows she’s not alone.</p> <p>Just the other day, she watched her son try to sit up on his own—another sign of progress, one that she recognized from the CASITA app.</p> <p>“I feel much calmer now,” she says. “I want to create a healthy space for the development of my youngest son. I always keep an eye on him, so that he can be healthy and happy."</p> </div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> Wed, 14 Apr 2021 19:58:59 +0000 apollard 7829 at https://www.pih.org Research: Integrated Care Improving Outcomes for Patients in Rural Malawi https://www.pih.org/article/research-integrated-care-improving-outcomes-patients-rural-malawi <span class="field-wrapper">Research: Integrated Care Improving Outcomes for Patients in Rural Malawi </span> <span class="field-wrapper"><span lang="" about="/user/366" typeof="schema:Person" property="schema:name" datatype="">mlawrence</span></span> <span class="field-wrapper">Wed, 12/23/2020 - 09:11</span> <div class="field-wrapper field field-node--field-large-intro-text field-name-field-large-intro-text field-type-text-long field-label-hidden"> <div class="field-items"> <div class="field-item"><p>Integrating care for HIV and non-communicable diseases such as hypertension, diabetes, and mental illness&nbsp;is making treatment more accessible and effective in Neno District&nbsp;</p> </div> </div> </div> <div class="field-wrapper field field-node--field-photo field-name-field-photo field-type-image field-label-hidden"> <div class="field-items"> <div class="field-item"> <picture> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.webp?itok=ciYVEmMW 1x" media="all and (min-width: 1200px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_large/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.webp?itok=PF8YaUfB 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.webp?itok=bAfnUAbC 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.webp?itok=ET3wRORa 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/webp"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.webp?itok=xX5g2RCl 1x" type="image/webp"/> <source srcset="/sites/default/files/styles/article_xlarge/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.jpg?itok=ciYVEmMW 1x" media="all and (min-width: 1200px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_large/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.jpg?itok=PF8YaUfB 1x" media="all and (min-width: 900px) and (max-width: 1199px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_xmedium/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.jpg?itok=bAfnUAbC 1x" media="all and (min-width: 640px) and (max-width: 899px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_medium/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.jpg?itok=ET3wRORa 1x" media="all and (min-width: 450px) and (max-width: 639px)" type="image/jpeg"/> <source srcset="/sites/default/files/styles/article_mobile/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.jpg?itok=xX5g2RCl 1x" type="image/jpeg"/> <img src="/sites/default/files/styles/article_xlarge/public/2020-12/Malawi-1220-IC3-waitingarea-FunnyKamanga-1200-crop.jpg?itok=ciYVEmMW" alt="People chat in the waiting area of the new integrated care building in Neno, Malawi" typeof="foaf:Image" /> </picture> </div> </div> </div> <div class="field-wrapper field field-node--field-caption field-name-field-caption field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">A new building that&#039;s dedicated to integrated care opened earlier this year next to Neno District Hospital and has significantly improved space and services for patients with HIV and non-communicable diseases. A new study shows PIH&#039;s integrated care model is making treatment more accessible and effective for patients. </div> </div> </div> <div class="field-wrapper field field-node--field-photo-credit field-name-field-photo-credit field-type-string-long field-label-hidden"> <div class="field-items"> <div class="field-item">Photos by Funny Kamanga / PIH</div> </div> </div> <div class="field-wrapper body field field-node--body field-name-body field-type-text-with-summary field-label-hidden"> <div class="field-items"> <div class="field-item"><p><span><span>Bringing patients for hypertension, diabetes and other non-communicable diseases under one roof for treatment that’s intertwined with HIV care is significantly improving outcomes in rural Malawi, a new study shows.  </span></span></p> <p><span><span>Partners In Health and Malawi’s Ministry of Health launched their Integrated Chronic Care Clinic, or IC3, in 2015 in Neno District. The IC3 model integrates <strong><a href="https://www.pih.org/programs/hiv-aids">HIV </a></strong>care with treatment for non-communicable diseases, or <strong><a href="https://www.pih.org/programs/cancer-chronic-diseases">NCDs</a></strong>, which can also include asthma, epilepsy, mental illness, and more. </span></span></p> <p><span><span>PIH has worked in <strong><a href="https://www.pih.org/country/malawi">Malawi </a></strong>since 2007, is known locally as Abwenzi Pa Za Umoyo, and supports 12 health centers and two hospitals across Neno District. Dr. George Talama, the team’s primary health care clinical manager, said building integrated care on the foundation of a successful HIV program was a natural progression.   </span></span></p> <p><span><span>“We thought, if we could leverage from our HIV platform, we could expand access to care for NCDs,” he said. “Since NCD care was being delivered only at (PIH-supported) Neno District Hospital and Lisungwi Community Hospital, while HIV care was being provided at all 14 health facilities and with better outcomes, we hypothesized that introducing NCD care to this already existing HIV care platform would increase access to NCD care and improve outcomes.” </span></span></p> <p><span><span>And providing care to clients diagnosed with both HIV and an NCD—on the same day, at the same clinic—would ease burdens on NCD care and make it easier to access, Talama added. </span></span></p> <figure role="group"> <img alt="Clinician Bright Mailosi talks with a patient in Neno, Malawi " data-entity-type="file" data-entity-uuid="f8c9a65d-d880-4db0-ae6e-89638bd864a0" src="/sites/default/files/inline-images/Malawi-1220-IC3-PatientCare-FunnyKamanga%20800.jpg" width="800" height="533" loading="lazy" /> <figcaption>Bright Mailosi, clinical officer for Abwenzi Pa Za Umoyo, talks with a patient in Neno District. Mailosi said providing  integrated care for patients is creating new opportunities to share information about non-communicable diseases.</figcaption> </figure> <p><span><span><strong><a href="https://bmjopen.bmj.com/content/10/10/e036836">The study </a></strong>was published in October in the journal <em>BMJ Open </em>and features several PIH co-authors. It shows that PIH’s integrated clinics are improving the accessibility of NCD care by allowing patients to have all of their chronic conditions treated on the same day at their nearest health facility. The model also makes better, more efficient use of staff time and clinical space. </span></span></p> <h2><span><span>Impacts of Integrated Care</span></span></h2> <p><span><span>Over the study’s three-year period, from 2015-17, integrated clinics at 14 primary care facilities enrolled a total of 6,233 new patients, nearly half of whom presented with one or more chronic NCD. After just a year, retention in treatment stood at 85% of patients with HIV, and 72% of patients with an NCD. Those numbers compare to retention rates as low as 25% found in other studies from similar settings.  </span></span></p> <p><span><span>IC3 patients in Neno not only were staying in regular treatment; they also were getting better. </span></span></p> <p><span><span>Most clinical measurements—such as blood pressure, asthma severity, blood sugar, or number of seizures per month, for patients with epilepsy—showed statistically significant improvement over the course the study. One year after enrolling in IC3 care, more than half of hypertension patients had controlled blood pressure, and patients with epilepsy were reporting fewer seizures overall—with more than 40% regularly reporting no seizures since their previous visit. </span></span></p> <p><span><span>Meanwhile, HIV patients continued to show excellent outcomes with continued high-quality care, despite the addition of NCD clients to the clinic. </span></span></p> <p><span><span>Hypertension, asthma and epilepsy were the most common diagnoses for patients in the study. </span></span></p> <p><span><span>While the concept of integrating HIV and NCD care is not new, the IC3 model is having an outsized impact in Neno. Earlier this year, PIH opened a brand-new, expanded IC3 building adjacent to Neno District Hospital, to better serve growing numbers of patients. </span></span></p> <p><span><span>The need is stark. NCDs are a leading cause of death and disability globally, and especially in underserved areas like Neno, where accessing care can be difficult and materials needed to diagnose and treat hypertension, diabetes, and more, can be scarce. </span></span></p> <p><span><span>“Before IC3, I was the only one providing NCD care at Neno District Hospital,” said Bright Mailosi, a clinical officer with Abwenzi Pa Za Umoyo. There were many challenges at that time, he added, citing staff shortages, an unreliable supply chain and a high rate of default, or patients leaving treatment. </span></span></p> <figure role="group"> <img alt="The new integrated care building next to Neno District Hospital is providing much more space for patients and services " data-entity-type="file" data-entity-uuid="ae0d8d59-7c39-49ce-b8b0-3000171aa10f" src="/sites/default/files/inline-images/Malawi-1220-IC3-BuildingMug-FunnyKamanga%20800-crop.jpg" width="800" height="424" loading="lazy" /> <figcaption>The new integrated care building next to Neno District Hospital opened earlier this year and is providing vastly improved space for patients and services.</figcaption> </figure> <p><span><span>With the launch of IC3, Mailosi was trained to administer antiretroviral therapy and provide HIV care. At the same time, the HIV team learned about NCDs, including how to diagnose different conditions and counsel patients.      </span></span></p> <p><span><span>Mailosi said patients aren’t always as informed about NCDs as they are about HIV.</span></span></p> <blockquote> <p><span><span>“People hear HIV, and they know what that means,” Mailosi said. “For so long, it was a death sentence. But with NCDs, they may not take it so seriously. So you have to take more time to explain the diagnosis, and the medication, and why it’s important that they take it every day.”   </span></span></p> </blockquote> <p><span><span>As IC3 continues to scale up in Neno and across Malawi, maintaining supplies of medications will be a critical consideration, as will the increased workload for health center staff. </span></span></p> <p><span><span>“There are districts that are already overloaded with clients in need of care for HIV,” Talama said. “For those providers to take on NCD clients as well—that could be quite a lot.” </span></span></p> <p><span><span>Nonetheless, Talama said the IC3 has been a huge success so far, and the study indicates the model can serve as a blueprint for integrated HIV and NCD care across Malawi and beyond. </span></span></p> <p><span><span>Before IC3, Talama noted, there was only one facility in Neno providing care for NCDs. </span></span></p> <p><span><span>“Now all 14 (PIH-supported) health facilities are able to provide NCD care,” he said. “Everyone can see the benefits.”</span></span></p> </div> </div> </div> <div class="field-wrapper field field-node--field-programs field-name-field-programs field-type-entity-reference field-label-above"> <div class="field-label">Programs</div> <div class="field-items"> <div class="field-item"><a href="/programs/hiv-aids" hreflang="en">HIV/AIDS</a></div> <div class="field-item"><a href="/programs/cancer-chronic-diseases" hreflang="en">Cancer &amp; Chronic Diseases</a></div> <div class="field-item"><a href="/programs/mental-health" hreflang="en">Mental Health</a></div> <div class="field-item"><a href="/programs/research" hreflang="en">Research</a></div> </div> </div> <div class="field-wrapper field field-node--field-taxonomy-tags field-name-field-taxonomy-tags field-type-entity-reference field-label-above"> <div class="field-label">Related Categories</div> <div class="field-items"> <div class="field-item"><a href="/build-systems" hreflang="en">Build Systems</a></div> <div class="field-item"><a href="/hiv-aids" hreflang="en">HIV/AIDS</a></div> <div class="field-item"><a href="/infrastructure-improvements" hreflang="en">Infrastructure Improvements</a></div> <div class="field-item"><a href="/malawi" hreflang="en">Malawi</a></div> <div class="field-item"><a href="/ncd" hreflang="en">NCD</a></div> <div class="field-item"><a href="/research" hreflang="en">Research</a></div> <div class="field-item"><a href="/tag/article-0" hreflang="en">Research/Innovation</a></div> </div> </div> Wed, 23 Dec 2020 14:11:44 +0000 mlawrence 7732 at https://www.pih.org