ICAP News - April 2009

ICAP to Launch Multinational Nurse Capacity-Building Initiative in Africa

ICAP is launching a nurse capacity-building initiative in six countries in sub-Saharan Africa with support from the U.S. Health Resources and Services Administration.

Healthcare systems throughout Africa suffer from shortages of trained providers, including nurses. The HIV epidemic has further strained these already fragile systems by adding new responsibilities and increasing workload. As a result, some nurses have left the healthcare profession entirely, further aggravating the problem.

The ICAP Nurse Capacity Initiative will focus on enhanced nurse training and mentorship in comprehensive HIV services, and on bolstering the nursing workforce through policy advocacy and efforts to enhance nurse retention. The initiative will support nurses and nursing institutions in Ethiopia, Mozambique, Nigeria, Rwanda, South Africa, and Swaziland.

“Programs will be shaped based on locally identified needs, in collaboration with local nursing schools and associations, governments, and other stakeholders,” explained Robin Flam, MD, director of ICAP’s Clinical Unit. “A multinational network of stakeholders will also be mobilized to serve as advocates on nursing-related issues and promote sharing of best practices.”

The ICAP Nurse Capacity Initiative is a collaborative project with the Department of Nursing Sciences at the University of Fort Hare in South Africa, the Columbia University School of Nursing, and the International Council of Nursing.

Photo caption: A focus of the nurse capacity-building initiative will be enhanced nurse training and mentorshop in comprehensive HIV services.

Unique Clinic Offers HIV Services to Healthcare Workers and Civil Servants in Kenya


In Kenya, healthcare workers and civil servants living with HIV are sometimes compelled to travel long distances to obtain HIV services out of fear of revealing their status to colleagues and others in their communities. Others delay seeking such services and suffer in silence. Recognizing the special needs of these groups, ICAP and its partners recently inaugurated the first comprehensive HIV care clinic in Kenya to provide free services for healthcare workers, civil servants, and their families.

The facility, located at Mt. Kenya Hospital in Nyeri, Kenya, includes a clinic, laboratory, and pharmacy. As of March, 371 people, including 24 children, were enrolled at the site.

“This project embodies the true essence of collaboration and shared vision among the President’s Emergency Plan for AIDS Relief (PEPFAR), implementing partners, and the Kenya government,” said Mark Hawken, MD, ICAP-Kenya country director, at the April 2 launch of the clinic. “Our combined efforts to make this facility a reality will hopefully manifest itself in improved services for healthcare workers and civil servants living with HIV.”

Among those attending the clinic’s inauguration were PEPFAR Country Coordinator Buck Buckingham and officials from the Ministry of Health and U.S. Centers for Disease Control and Prevention. The event also featured the dedication of ICAP’s Central Province Field Office.

Photo Caption: Central Provincial Commissioner Jasper Rugut cuts a ceremonial ribbon marking the inauguration of the new HIV care clinic.

For more about ICAP Kenya, visit here.

Clinicians in Tanzania Strengthen Skills to Diagnose Tuberculosis Using Chest X-Rays

In Tanzania, more than half of TB patients are co-infected with HIV. To improve the diagnosis of TB and other respiratory infections in people living with HIV (PLWH), a pilot training program was recently launched in Tanzania to strengthen clinicians’ skills in interpreting chest X-rays.

In March, 60 medical officers from throughout Tanzania took part in the first training courses. The curriculum, developed by a team of radiologists, physicians, and pediatricians, featured didactic instruction and interactive exercises in interpreting X-rays.

Strengthening the capacity of clinicians to diagnose TB is part of ICAP’s larger focus on supporting the integration of TB and HIV services. This work has also included the development of standardized screening questionnaires to identify suspected cases of TB among all PLWH.

“Improved screening and diagnosis of TB is crucial to improving outcomes for PLWH receiving HIV care and treatment,” said ICAP-Tanzania Country Director Amy Cunningham. “We look forward to working with our partners in scaling up the X-ray program nationally.”

The Ministry of Health is currently reviewing the X-ray training curriculum. Although HIV service sites will be the initial focus, plans call for the program to be offered to clinicians involved in the delivery of other health services.

ICAP collaborated with The PharmAccess Foundation to develop the training program.

Photo caption: David Malugu, MD (right), an internal medicine physician at Lugalo Hospital in Dar es Salaam, receives a certificate marking his completion of the X-ray training program.

For more about ICAP Tanzania, visit here.

Tuberculosis Screening Rate Increases Markedly at Sites in South Africa Using Integrated Questionnaire

Between 2007 and 2008, the proportion of PLHW screened for tuberculosis (TB) increased from 73 to 95 percent at ICAP-supported HIV service sites in the Nelson Mandela Bay Municipality in Eastern Cape, South Africa, through the use of a TB screening questionnaire integrated into the adult clinic record. In addition, roughly half of screened patients tested positive for TB. These findings, which were reported at the Fourth South African AIDS Conference in Durban in April, demonstrate the importance of consistent screening of PLWH to identify any symptoms that might be consistent with TB.

At the sites using the integrated questionnaire, all suspected cases of TB are referred within the same facility for follow-up diagnosis and treatment, if indicated.

“Integration of the screening tool into the adult clinical record facilitates completion of this process, thus promoting high-quality monitoring and care for PLWH,” said ICAP-South Africa Country Director Tshiwela Neluheni, MD. “It also allows for improved integration of HIV and TB care and treatment services.”

Healthcare providers reported favorable responses to the use of the TB screening questionnaire. In collaboration with the Eastern Cape Department of Health, ICAP is conducting public health evaluations at two sites to evaluate the performance of the TB screening questionnaire, including determining its sensitivity and specificity.

Photo caption: Nomboniso Ngaleka (right), a nurse at ICAP-supported Empilweni Hospital in Eastern Cape, South Africa, screens a patient for TB as part of the integrated adult clinical record.

For more about ICAP South Africa, visit here.

Career Day Showcases Healthcare Sector Jobs in Swaziland

Shortages of skilled healthcare providers are a major barrier to the scale-up of HIV services in Swaziland. In an effort to generate new interest in public healthcare careers, ICAP participated in a April 3 career day at the University of Swaziland.

An estimated 500 students attended the event, which featured more than 20 organizations and companies from all sectors. In addition to distributing information about employment opportunities, ICAP staff talked to students about the acute need for Swazis to pursue careers in public healthcare. Currently, many public healthcare positions are held by non-nationals because of a lack of skilled Swazis to fill such jobs.

ICAP's participation in the career day is part of a larger strategy to strengthen the human resource capacity of Swaziland’s public healthcare system. ICAP is also supporting the Faculty of Health Science at the University to Swaziland to enhance pre-service and in-service training programs, as well as develop nurse mentor programs.

Photo caption: Ngwane Nxumalo, ICAP-Swaziland finance and administration manager, discusses employment opportunities with Univeristy of Swaziland students at the ICAP career day booth.

For more about ICAP Swaziland, visit here