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 - [email protected] • Mireille Kalou – [email protected] • Ritu Pati - [email protected]
http://echo.unm.edu
• Laura Tison -
• Learn more about Project ECHO at
Sanjeev Arora, MD Director, Project ECHO