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CDC HQ, University of California San Francisco, Global Programs, and Namibia Ministry of Health and Social Services Trainers in Swakopmund, Namibia; May 2019

In September 2018, I began my fellowship as a PHI/CDC Global Health Surveillance Fellow on the Clinical Surveillance and Epidemiology Team (CSET), in the Epidemiology and Surveillance Branch (ESB) in the Division of Global HIV and TB (DGHT). Before this fellowship, I had worked in various surveillance positions at a State Department of Health and state-funded needle exchange/harm reduction center but had limited international public health experience.

Working at CDC headquarters (HQ) in Atlanta has been both an immensely educational and rewarding experience and has further solidified my interest and passion in working in global health disease surveillance.

I started my fellowship at an exciting time when our team was tasked with helping oversee the expansion of a new surveillance system focused on HIV recency status: TRACE (see below). Immediately I was able to assist with TRACE activities at both the broader headquarters level and provide frequent, hands on technical assistance in Namibia, one of the countries implementing during the 2019 fiscal year. I feel this dual perspective allowed me to see how planning occurs at various levels as well as how activities come to reality in the field working with the local Ministry of Health and implementing partners. At the headquarters level, I participate in and contribute to discussions around standardizing data capture and management platforms, data visualization and use, and the public health response. In Namibia, my time was spent both at the CDC country office as well as out in the field helping conduct trainings or site visits.

TRACE – What is it?

HIV recency surveillance, also known as TRACE, Tracking with Recency Assays to Control the Epidemic, is a PEPFAR priority under public health surveillance and response. With the development of rapid tests that can determine if someone was recently (<12 months) or long-term (>12 months) infected in as little as 20 minutes, countries can identify in real time geographic areas and populations experiencing recent infections and potentially ongoing transmission. Existing clinical workflows can be leveraged by integrating this test as a concurrent or serial test in a country’s national testing algorithm. Data resulting from this surveillance system can be used for targeted prevention and public health activities.For more information visit www.trace-recency.org

TRACE in Namibia

Map Courtesy of CDC Center for Global Health

Namibia has a population of roughly 2.4 million with a HIV prevalence of 12.4% among persons aged 15 – 49 years in 2017 (CDC Namibia). As the country nears epidemic control there is a need to refine surveillance and prevention strategies, including implementing recency surveillance, to identify populations experiencing ongoing transmission and close the remaining gaps.

The first few months of my fellowship, I worked on drafting a protocol for TRACE that required ongoing coordination and concurrence across not just multiple agencies, but various branches across DGHT at CDC HQ. Once approved by scientific and ethical offices, preparations went underway for a national training of trainers (ToT) in May 2019 where CDC-Namibia, University of California San Francisco, and CDC-HQ staff trained around 30 national and regional leadership on the rapid test for recent infection, standard operating procedures (SOPs), and electronic data entry using a tablet. These trainees became “master trainers” where they were equipped with the knowledge and skills to help train additional staff in the districts implementing TRACE.

Since then, the project has been on an accelerated timeline and there have been five additional step-down trainings with approximately 100 additional persons trained. These trainings were led by these master trainers with the support of CDC Namibia and HQ. Immediately after these trainings, participating sites were “activated” once they had all the necessary supplies and trained staff began to test consenting patients with the HIV recency test. Currently the focus is on conducting site visits to identity any gaps or needs by study staff and planning for national scale up.

CDC Namibia and CDC HQ staff at the Namibia TRACE Training of Trainers in Swakopmund, Nambia; May 2019

I move into the second year of my fellowship looking forward to expanding my portfolio to provide technical assistance to additional countries, take on new activities, and scale up existing projects. I also am working on several manuscripts that I hope to have published by the end of 2019.

Overall, I am so thankful for this fellowship experience as it has allowed me to expand my knowledge on disease surveillance, gain a global perspective, and build relationships with people around the world.

Joshua Holmes, MPH, PHI/CDC Global Health Surveillance Fellow;  Epidemiology and Surveillance Branch, Atlanta, Georgia. Joshua is a current Fellow and the Recipient of the PHI/CDC Global Health Fellowship 2019 Outstanding Leadership Award.

To learn more about CDC in Namibia, visit their website here. To join the PHI/CDC Global Health Fellowship mailing list, click here.