project echo and vl scale-up - aidsfree...project echo® and viral load scale-up author rituparna...

Rituparna Pati, MD, MPH

HIV Care and Treatment Branch Division of Global HIV & TB

U.S. Centers for Disease Control

March 22, 2017

Project ECHO® and VL Scale-Up

Introduction

Project ECHO® [Extension for Community Healthcare Outcomes] is a model of distance learning and mentorship developed at the University of New Mexico to improve access to care for complex health problems for underserved populations. Elements of the model include: • Hub-and-spoke networks • Videoconferencing • Didactics and case-based learning • Chronic disease management

Background

Essentials for ECHO Replication: Leadership and support of stakeholders Internet infrastructure and connectivity Implementing partners whose scope of work includes clinical mentorship Partnership with Project ECHO® UNM

ZOOM Videoconferencing

Background

Project ECHO® is an intervention that can help support PEPFAR’s goal of HIV epidemic control: • Provides accessible and cost-efficient clinical mentorship and continuing

professional education • Fosters the development of peer networks and communities of practice

that increase provider satisfaction • Trains healthcare workers while they remain at their posts, reducing costs

related to travel and limiting time away from seeing patients • Offers the opportunity to address operational and program priorities,

including laboratory support and supply chain management

First HIV ECHO in Africa

Namibia, Nov 2015

Namibia MOHSS HIV ECHO Hub and Spokes

1 Hub with 10 spoke sites 10 additional sites have joined 36 weekly ECHO sessions Average of 72 participants per week More than 1600 training hours Topics included: Approach to patients failing ART HIV Disclosure to Children ART Toxicities HIV-HBV Co-infection Interpretation of HIV VL Results Skin manifestations of HIV

HIV Rapid Testing ECHO Sites in Tanzania and Uganda

Uganda

Potential for Project ECHO to support Global VL Scale-up

Foster collaboration and shared learning amongst VL scale-up countries Optimize program outcomes by creating a global community of learning and practice among PEPFAR countries

Address cross-cutting issues of processes and systems to promote efficiency

Case presentations from countries Describe a VL implementation challenge and seek help from the group

of countries and subject matter experts Mentorship from experts in Quality Improvement, Health Systems, Clinical Operations Outcomes include a list of Next Steps and Recommendations

Project ECHO as a Tool for Country VL Scale-up (1)

Management of VL Failure Case presentations from providers and/or adherence counselors who seek help with managing patients with non-suppressed VL Mentorship from master adherence counselors and HIV clinical experts

Guidance on switching ART regimens Outcomes are measures of clinical improvement in patients that were discussed in case presentations, with the goal of durable viral load suppression

Project ECHO as a Tool for Country VL Scale-up (2)

• VL Quality Improvement (QI) • Case presentations from multidisciplinary team members from different facilities within

a region or country that are working together to optimize the capacity, efficiency and quality of routine VL monitoring, e.g.

• Participants include clinical managers, lab techs, phlebotomists, data clerks, providers • Mentorship from subject matter experts of QI, implementation science, HIV care and

treatment, laboratory science, supply chain, monitoring and evaluation • Outcomes include metrics that evaluate work processes and systematic improvements in

routine VL monitoring

• Standardizing practices through SOPs • Reducing number of rejected VL samples

• Enforcing the completion of VL requisition forms • Decreasing turnaround time for return of results

• Training lab staff on quality and safety principles • Improving follow-up of patients with high VL

Thank You

Please feel free to contact a member of the ECHO working group at CDC HQ:

• Carla Johnson - jju5@cdc.gov • Mireille Kalou – chn7@cdc.gov • Ritu Pati - rpa7@cdc.gov

wup7@cdc.gov

http://echo.unm.edu

• Laura Tison -

• Learn more about Project ECHO at

Sanjeev Arora, MD Director, Project ECHO