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Photo: A facilitator from the Ministry of Health delivered a training presentation on good clinical practice. 

We have often heard the phrase “Where did the year go?” or “Time flies,” and oh man, does it! I cannot believe it has been a year and a half since I moved to Abidjan, but the memories of my very first meeting on September 27, 2016 with the Côte d’Ivoire Population-based HIV Impact Assessment (CIPHIA) technical working group are still vivid. I remember meeting representatives from the Ministry of Health and Public Hygiene (MSHP), National AIDS Programme (PNLS), ICAP, Institute Pasteur Côte d’Ivoire (IPCI), the National Institute of Statistics (INS), and other NGO institutions in the room. I was quite intimidated, but after introducing myself as the fellow who came to support the research project, I received the warmest welcome and hospitality, which made me feel happy and excited to be part of the group.

Now fast-forward to June 29, 2017, and allow me to give you a snapshot of the Ministry of Health and Public Hygiene’s official launch of CIPHIA, a survey that aimed to build the country’s capacity for a more rapid and efficient response to HIV.

PHIA in Côte d’Ivoire- What is it?

If you are wondering what CIPHIA really is, you no longer have to wonder. Côte d’Ivoire, a country with a high HIV prevalence rate (3.7%) in West Africa, is in the midst of implementing a population-based HIV impact assessment also known as PHIA, a multi-country initiative funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention (CDC). In Côte d’Ivoire, the survey was implemented under the leadership of the MSHP in partnership with ICAP at Columbia University and CDC. CIPHIA is a national survey designed to provide essential HIV data on adult and pediatric prevalence, incidence, CD4 count, ARV transmitted resistance, key population estimates, and viral load suppression to help describe trends of the epidemic and measure response progress. Findings from CIPHIA will be used to assess the impact of the national HIV prevention, care, and treatment services.

Capacity Building using CIPHIA

Human Capacity Development

Me debriefing with a team during a field monitoring visit.

Over the span of this fast-paced year and a half, I was involved in most, if not all, aspects of the survey planning and implementation activities, from the development of the protocol and tools, to trainings and eventually data collection. For me, one of the key planning activities to the implementation of the survey was the cascade of trainings, which lasted for about six months, and aimed to strengthen resource capacity of both survey personnel and selected members of the technical working groups who worked as facilitators and supervisors. During the training period, we received visits from experienced PHIA representatives from CDC, ICAP, and Westat, who trained about 40 facilitators, including myself. With technical assistance from these experts, we in return trained more than 200 data collectors (interviewers and phlebotomists) and lab technicians on survey procedures and protocol. During the trainings, we covered topics such as recruitment and enrollment of participants procedures, utilizing tablets to administer questionnaires using Open Data Kit, GPS navigation software for locating households, sample collection using rapid HIV test algorithm, PIMA testing, HIV pre- & post-test counseling, linkage to care procedures, and other ethical considerations.

In addition to being designated as one of the key persons to answer protocol-related questions, I was also in charge of developing evaluations, which I called “celebration of knowledge.”  The evaluations provided immediate feedback to participants and facilitators on how well the knowledge and skills presented were internalized and understood. When developing the evaluations, I made certain to include key points from each topic covered during the training not only to assess participants’ overall understanding of survey objectives and procedures, but to also help facilitators put a greater emphasis on topics where participants performed poorly.

Once trainings ended, data collection began almost immediately. I was part of the national multidisciplinary supervisory group that conducted supportive site visits to provide additional coaching to field teams. From my experience, the combination of trainings and supervised field visits provided facilitators and survey staff practical and transferrable skills they could apply right away to make tangible contributions, which led to real and long-lasting impact for Côte d’Ivoire.

Laboratory Capacity

Besides training survey personnel, laboratory capacity was also enhanced in-country. During CIPHIA, evaluators from the laboratory technical working group conducted a detailed evaluation of 33 national laboratories to assess their operational capacities. Based on the labs’ operational capacity as well as their proximity of the lab to enumeration areas of households, 14 laboratories known as satellite labs were selected to receive and perform additional tests on CIPHIA field samples. During the evaluation, evaluators observed and identified specific renovation demands for each lab.

I visited these laboratories after renovation work was done to confirm their readiness to conduct CIPHIA activities. To date, the majority of the requested needs were met, and these lab facilities also benefited from receiving laboratory supplies and equipment including freezers, refrigerators, centrifuges, generators, split air conditioners, reagents, desktop computer, tables, and cabinets.

One of the satellite labs before renovation work to the left and renovation to the right.

As the PHI/CDC Global HIV Surveillance Fellow who worked closely on the CIPHIA survey, capacity building in human resource was one of the essential contributors to a successful CIPHIA implementation. For Côte d’Ivoire, capacity building will continue with data analysis and validation, as well as development and dissemination of the survey report.

On a personal note, CIPHIA remains a remarkable experience to date. I would like to sincerely thank the Public Health Institute and CDC for giving me the opportunity, and my CDC mentors (Dr. Judith Hedje, Dr. Stephane Bodika, and Dr. Roger Lobognon), whose ideas, suggestions, and continuous guidance and support has enriched my experience. I also would like to acknowledge and thank the CIPHIA team, especially Dr. Hermann Brou, the CIPHIA Project Director, whose leadership, enthusiasm, and meticulous work since day one has inspired me. I am honored to have contributed and been part of such a vital research project. I am grateful for everything I have learned through this process.


Written by Ornella Leukou Nzoutchoum
Ornella is a PHI/CDC Global Health Surveillance Fellow for CDC Côte d’Ivoire.