Amplifying the ECHO Effect for Quality HIV Care in Nigeria

Ciheb piloted the first “telementoring” healthcare project in Nigeria in 2018 called Project ECHO^TM, an initiative developed and promoted by the Project ECHO Institute at the University of New Mexico School of Medicine.

ECHO, which stands for Extension for Community Health Outcomes, uses teleconferencing to link specialists with practitioners and create “communities of practice” in underserved areas. As stated on the organization’s website: “Project ECHO is committed to addressing the needs of the most vulnerable populations by equipping communities with the right knowledge, at the right place, at the right time.”

Facilitating Clinical Mentorship

Ciheb’s Nigerian ECHO Model^TM pilot, implemented in partnership with the Federal Ministry of Health in Nigeria and the US Centers for Disease Control and Prevention, was specifically designed to strengthen workforce capacity for high-quality HIV care and treatment and to bolster the response in meeting the nation's HIV targets.

In 2016, the Nigerian Government had revised its national guidelines for HIV treatment and care to include greater decentralization of service delivery to the primary care level in order to expand and scale up HIV program efforts. However, staff at the primary care level are frequently not physicians and have little to no experience in providing HIV/AIDS treatment.

The pilot was introduced to help fill this experience gap by providing needed clinical mentorship and create networked communities of practice across the nation. Thirty video-teleconference sessions occurred from March 2018 to September 2018 that featured case-based presentations, simulations, didactic sessions, and more.

Subject matter experts from Ciheb and the Nigerian National Antiretroviral Task Team conferred with staff from 14 HIV care and treatment facilities across 6 states in Nigeria. The sessions served as a platform to enhance and accelerate collaboration, data reporting, knowledge dissemination, and the use of patient-level data.

The pilot was well received and feedback was positive. As one participant explained, the information and advice translated to improved care:

The day about monitoring the viral load in relations to the ART drug really improved my knowledge. Formerly, I wasn’t really clear about it [viral load and ART drugs], especially there was one issue we had about a woman on ART drugs and the viral load wasn’t dropping. … It has helped me a lot on whether to change to the second line or to maybe advise her on drug adherence.

Another explained how she changed her treatment protocol for HIV in cases where there is tuberculosis coinfection:

The case I presented was a client I initiated on Tenofovir … we don’t usually do urinalysis, dipstick urinalysis, on a client who is on Tenofovir. So, we discovered that Tenofovir has a serious side effect on the nephron, as in renal toxicity so to speak. So we’re able to be informed that each client that we place on Tenofovir must have dipstick urinalysis on each clinic day, and this will help us to know if they’ve started developing problems with their kidneys. I thought because our [concentration] is more on HIV, you started HIV treatment but in the ECHO session I was made to understand that if someone is positive in both TB and HIV, you will withhold HIV treatment and enroll the patient on TB treatment for 2 weeks before the person will commence ARV treatment.

Leveraging ECHO Experience

Ciheb has continued to implement the ECHO Model^TM at sites in Nigeria since its pilot project. Recently, in December 2019, Ciheb helped extend the reach of ECHO by hosting a three-day immersion training session in Abuja. The training was facilitated by the ECHO team from the University of New Mexico and included 140 participants and trainers comprised of staff from the Government of Nigeria, CDC, USAID, as well as a host of PEPFAR implementers. Topics ranged from infrastructure to telementoring methodologies, and there were both formal presentations and robust discussion sessions.

The training will enable other implementers to use the ECHO Model^TM in Nigeria, and further support the Government of Nigeria in meeting its HIV treatment and care objectives.