KAREN PETERS, DRPH,* AND ANDREW DYKENS, MD, MPH** *UIC School of Public Health, Division of Community Health Sciences **UIC College of Medicine, Department of Family Medicine Illinois Prevention Research Center, Site Visit Presentation Chicago, Illinois May 11, 2015

Global and Territorial Health Research and Translation Network: Special Interest Project Illinois Prevention Research Center Collaborating Center

In US: Karen Peters, DrPH – Co-Principal Investigator Andrew Dykens, MD MPH – Co-Principal Investigator Tracy Irwin, MD MPH – Co-Investigator, University of Washington Tina Schuh, MPH student – Research Assistant In Senegal: Local communities, providers and health systems in Kedougou and

Sédhiou, Senegal Peace Corps Senegal Institute of Health and Development in Dakar, Senegal In Colombia: Universidad de Antioquia, National School of Public Health

Research Team and Partners

Overview of the Network

Specific Aims of the UIC Collaborating Center:

• 1. To offer recommendations for the organization, function, and evaluation of the network

• 2. To contribute to the design, implementation and interpretation of a needs assessment to identify priority research activities and communicate the findings of the needs assessment to appropriate stakeholders

• 3. To collaborate on the development of a research project agenda that can be initiated within the network and provide recommendations for additional research projects

• 4. To co-develop a plan for identifying efficacious interventions and policies related to global health research for translation into public health settings

• 5. To identify plans for creating, disseminating, and evaluating translation documents and tools

• 6. To propose and implement a pilot research project that proposes a partnership model will be used to assess the horizontal and vertical scaling of health policy originating at the local level through a community participatory approach.

Progress on Collaborating Center Aims (1-5)

• Contributions to Network research agenda development • Major contributors to the completed Scoping Study

literature review • Serve as leads on 2 ongoing cervical cancer literature

reviews • 3 UIC MPH students participating

• Potential joint conduct of CC prevalence study in rural Senegal

• Contribute ideas/provide feedback during monthly Network calls/Report to Illinois PRC and UIC campus global health efforts

Overview of the Research Project (Aim 6)

• Increasing access to primary health care services that are responsive to the local context improves health status

• The capacity of LMIC local health systems is often not adequate to support basic primary health care services

• To address this lack of capacity, health leaders often form partnerships with external agencies, governments, or universities

• The inclusion of local Peace Corps volunteers and academic personnel in a partnership model could improve capacity, by facilitating a community-centered approach that results in sustainable impact

Community-Peace Corps- Academic Partnership Model

Project Context: Senegal

• Access to cervical cancer preventive services is limited in rural Senegal - most frequent cancer among women

• Pilot test of approach since 2010 in Health Region of Kedougou (Red) • Population 143,000 • 23 health posts, 3 health

centers, 1 regional hospital

• Health Region of Sédhiou (Blue) • Population 145,579 • 40 health posts, 1 Type 2

health center, no regional hospital

Partnership Project Components (Kedougou)

• Developed regional-level cervical cancer prevention clinical guidelines outlining a service accessible to an estimated 10,000 women

• Implemented EngenderHealth-developed Client Oriented Provider Efficient (COPE®) cervical cancer quality improvement process

• Trained 60 health workers in VIA through a training of trainers approach

• Trained one physician in cryotherapy for pre-cancer treatment

• Conducted only CC prevalence study in Senegal outside of Dakar

Goals of the Project

• To assess the horizontal and vertical scaling of health policy originating at the local level through a community participatory approach

• To test the feasibility of scaling a community-Peace Corps-academic partnership approach to health services implementation research in Senegal (with potential for adaptation in Colombia)

UIC GTHRN Collaborating Center Project Research Aims

• AIM 1: Assess the impact of horizontally-scaled community-developed health services policy promoting access to cervical cancer prevention services at three primary health care posts in each region of Kedougou, Senegal and Sédhiou, Senegal compared to three matched control posts in each region;

• AIM 2: Assess the feasibility of this community-Peace Corps-academic partnership approach to implement community health services policy as applied in Kedougou, Senegal and scale health policy horizontally to a neighboring region of Sédhiou, Senegal.

• AIM 3: Recommend a Senegal national-level cervical cancer prevention services policy approach for implementation in decentralized regions where this policy does not currently exist by conducting an analysis of the existing Kedougou policy and its horizontal scale to the region of Sédhiou, Senegal.

• AIM 4: Explore, plan and implement, if feasible, a policy development capacity building approach focused on chronic disease prevention efforts in local communities in the Colombian Amazon.

Progress Made on Objectives

• AIM 1: Assess the impact of horizontally-scaled community-developed health services policy promoting access to cervical cancer prevention services at three primary health care posts in each region of Kedougou, Senegal and Sédhiou, Senegal compared to three matched control posts in each region

• Intervention and control sites in Kedougou region identified

• Intervention and control sites in Sédhiou region in process of being identified

• Regional CCP policy for Kedougou drafted collaboratively and being circulated

Progress Made on Objectives

• AIM 2: Assess the feasibility of the community-Peace Corps- academic partnership approach to implement community health services policy as applied in Kedougou, Senegal and scale health policy horizontally to a neighboring region of Sédhiou, Senegal

• Assessments of Partnership and Service process in Kedougou ongoing through multiple methods including skype discussions and service level impact data review provided by regional officials

• Working on Partnership development activities in Sédhiou through the Regional Ministry of Health official

Progress Made on Objectives

• AIM 3: Recommend a Senegal national-level cervical cancer prevention services policy approach for implementation in decentralized regions where this policy does not currently exist by conducting an analysis of the existing Kedougou policy and its horizontal scale to the region of Sédhiou, Senegal

• Collection of existing policy in Kedougou, Sédhiou and Senegal currently being collected by PCVs, partners and MOH officials

• Review of literature on CCP policy in Senegal and elsewhere being conducted

• Discussion of policy implementation taking place during quarterly CAB meetings and similar discussions planned for during Regional meeting in the Fall

• Establishing CABs in Sédhiou

Progress Made on Objectives

• AIM 4: Explore, plan and implement, if feasible, a policy development capacity building approach focused on chronic disease prevention efforts in local communities in the Colombian Amazon

• Initial discussion with Universidad de Antioquia representatives to take place May 19-29, 2015

• Finalizing arrangements for Fulbright Visiting Scholar from U de A to study at UIC beginning in August

Changes to Workplan/Budget

• May need to adjust field work timelines by 1 field site visit • Ebola, IRB, Language translation

• No changes to budget at this time

Success Stories

• 2 internal UIC grants leveraged: GH Seed & Nuveen • Initial introduction of project/instruments • Initiated plans for next site visit in Fall 2015 • 3 MPH students recruited as Literature Review

abstractors, 1 is a PCMI • Will be trained on PRISMA

• 1st Annual Rochester Symposium on Global Health • 2 presentations, 1 poster

Global Health Symposium

Lessons Learned

• Timelines and milestones are critically important but flexibility in implementation process is needed, especially in global health context

• "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

• You cannot take anything for granted and you must make the most of and celebrate what you have

Special Acknowledgement

• Miriama Toure, Coordinatrice SR du district Sanitaire de Saraya

• Midwife of the Saraya District, Senegal • 1979 - 2015

Pour vous, qu’est-ce que cela signifie de vivre? To you, what does it mean to live? Pour moi vivre est un état de plénitude, c’est être en paix c’est s’investir pour les autres donc pour soi même. To live is to be in a state of wholeness, whereby giving yourself to others, you find peace within yourself.

Acknowledgments

• This work is conducted by the Illinois Prevention Research Center, funded by cooperative agreement No. U48-DP005010 from the Centers for Disease Control and Prevention, and administered by the Institute for Health Research and Policy at the University of Illinois at Chicago.

Acknowledgments

• The content of this presentation is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention, or the State of Illinois.

• Learn more at http://go.uic.edu/IllinoisPRC