The Alto Maé Reference Center (CRAM). Photo courtesy of I-TECH Mozambique.
Four decades into the HIV epidemic, more than 50,000 people per year in Mozambique continue to die from HIV-related conditions.
The Alto Maé Reference Center (CRAM) provides a specialized package of care and treatment services for patients with advanced HIV disease from the urban health network of Maputo, Mozambique. Since January 1, 2021, the International Training and Education Center for Health (I-TECH) has served as the Ministry of Health’s primary partner for managing CRAM, a role handed over by Médecins Sans Frontières (MSF), which established the clinic in 2010.
Since I-TECH started its activities at CRAM, the center has had 1,599 active patients in follow-up.
“More than 80% of patients admitted to CRAM for specialized care are referred by other health centers,” explains Dr. Florindo Mudender, Country Director for I-TECH Mozambique. “Critically ill patients are treated at CRAM until they are stable, then sent back to their facilities of origin to continue treatment. In addition to acute care, CRAM also provides individualized supportive services to patients who often present with dire psychological, social, and economic conditions.”
These supportive services proved crucial to Aisha,* a 43-year-old mother of five who had difficulty accepting her HIV status, believing that her church’s pastor had cured her disease through prayer.
Referred to CRAM five years ago with a diagnosis of Kaposi’s sarcoma, Aisha was prescribed second-line antiretroviral therapy (ART). However, after losing her job due to COVID-19, Aisha was subject to food insecurity, discrimination, social stigma, and physical, psychological, and financial abuse by her partner.
After routinely presenting a high viral load and suffering severe weight loss, Aisha’s care team at CRAM assumed she had not been taking her medication – possibly because of her religious beliefs and a lack of food. She was severely depressed, to the point of attempting suicide.
Worried about her condition, the team at CRAM enrolled Aisha in wraparound services, including behavioral psychotherapy, education in self-care and self-esteem, treatment adherence support, positive prevention, couple’s therapy and socio-family integration, group therapy with other patients with depression, and antidepressant medication.
After several months, Aisha’s last viral load test showed a result of “undetectable,” and her depressive symptoms abated to the point that she no longer uses antidepressants. Thanks in part to the support from CRAM, Aisha is now adhering to her ART, has regained her self-esteem, is working again, and eats regular meals. Her partner tested HIV-negative and has learned to support her so that she feels valued and loved. Aisha attends psychotherapeutic sessions quarterly at the CRAM to monitor her psychological and social well-being.
“[My husband] helps me a lot, so I don’t forget to take my pills, and I am very happy about that and with the improvement I made with my health,” says Aisha. “Before, we were hungry, and now, I am back to work. With the little I earn I can help with the household expenses.”
CRAM is considered a center of excellence and the main training site for AHD for Mozambique Ministry of Health clinicians and PEPFAR-funded implementing partners.
“I-TECH is currently refining a referral and counter-referral system between CRAM and Maputo City’s health centers, to ensure patient care continues after discharge,” says Dr. Mudender “The system will include a free mobile line to assist clinicians with advice from senior specialists.”
“I-TECH prides itself on working collaboratively with our international partners. We held the principle from day one that the most successful programs happen when the locus of control sits in-country,” said Marrianne Holec, Senior Program Manager at I-TECH. “We had the foundation in place with our local staff, what was missing was the organizational structure to allow the team in-country to truly lead the project. With the formation of Zim-TTECH, I’m happy to say we are there.”
Among USG funders, it’s recognized that future models for sustainable healthcare rely on local country ownership and leadership.[1] But making the transition from US-based ownership to country ownership isn’t a one-time event, added Holec, “It’s a process that takes time. We wanted to document our process so that other international organizations who are looking to pursue decolonizing global health programming can learn from our experience.”
Through 16 key informant interviews, the team gathered views on transition planning, implementation, and technical support, ethics, and success. Five themes emerged from the data collected:
Develop a vision and empower leadership for change by delegating clear roles and supporting local ownership;
Plan and strategize for transition in a manner that accounts for historical context;
Communicate with and inform stakeholders to understand transition perceptions, understand barriers to transition, and enable open communications related to risks and benefits;
Engage and mobilize staff by constructing necessary infrastructure and providing technical assistance as needed; and
Define short-term and long-term success.
“Sustainability of successful donor funded public health programs is critical if we want to maintain the important gains that have been made over the years,” says Dr. Batsi Makunike, Executive Director of Zim-TTECH. “Strong local organizations with good governance, management, and technical capacities are an important cornerstone of sustainability.
“The process of transitioning from an international to a local organization is daunting,” she continues. “We hope that this study is helpful to other organizations in their efforts to transition.”
[1] Goosby E, Von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the Bar: PEPFAR and New Paradigms for Global Health. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;60.
The initiative, conducted in partnership with the U.S. Centers for Disease Control and Prevention (CDC) and the Faculty of Medicine and Pharmacy (FMP) of the Université d’État d’Haïti, aims to contribute to the strengthening of human resources in health, increasing the number of qualified clinicians in Haiti. The year-long training comprises theoretical and practical components; this cohort’s practica took place at seven different university hospitals and other health institutions around the country.
“Haiti faces a serious problem of shortage of human resources in health, due in part to the ‘brain drain’ abroad,” says Dr. Jean Guy Honoré, Executive Director of CHARESS. “In some health facilities located in remote parts of the country, there are no physicians, and patients are seen by nurses who sometimes have limited knowledge of the management of infectious pathologies. This training aims to improve the skills of these nurses.”
This aptly fits the vision of CHARESS, which is “to be the reference center, in terms of training, research and technical assistance, allowing populations to receive quality care, with humanity,” says Dr. Honoré. Two other cohorts of nurses have already started this specialized training.
Dr. Bernard Pierre, Dean of the FMP, expressed a wish to strengthen the collaboration between the FMP and CHARESS to extend similar specialized training to doctors — in particular, general practitioners.
I-TECH and its partners have been working in Haiti since 2006, delivering training, clinical mentoring, health information systems, and other health systems strengthening interventions.
From left to right: Conrad Mitchell, Program Coordinator, I-TECH Trinidad; Belinda White, Clinical Psychologist, I-TECH Trinidad; Heather Rodney, Chairperson, NACC Secretariat; Ian Ramdahin, Permanent Secretary, NACC Secretariat; Dr. Omoye Imoisili, Senior Public Health Analyst, HRSA; Aliyah Abdul Wakil, Strategic Information, HRSA; Alana Lum Lock Cardinez, Program Advisor, I-TECH Trinidad; Misti McDowell, Program Director, I-TECH headquarters.
Recently, representatives from the International Training and Education Center for Health (I-TECH) met with health officials in Trinidad and Tobago to discuss potential areas of support for strengthening the national response to HIV and AIDS in the country.
The meeting attendees discussed strengthening advocacy for people living with HIV (PLHIV); psychosocial support for vulnerable PLHIV; and providing services at the intersection of HIV and AIDS and gender-based violence (GBV).
With support from the Health Resources and Services Administration (HRSA), I-TECH has worked in Trinidad and Tobago since 2009, collaborating with the Ministry of Health and other partners to focus on healthcare worker training and technical assistance to improve the quality of care for PLHIV.
“I’ve always been impressed with the team and activities in Trinidad and Tobago,” says Misti McDowell, I-TECH Program Director, “especially the integration of much-needed mental health services into the HIV program.”
The assessment “Strengthening Delivery and Oversight of Mental Health and Psychosocial Services for PLHIV in Trinidad and Tobago” was completed by I-TECH and shared with the National AIDS Coordinating Committee (NACC), in an effort to identify future areas of collaboration. One of the intended outcomes is the establishment of a technical working group of national stakeholders who will collaborate with I-TECH to craft a strategy for implementing all priority interventions.
“The findings of this assessment revealed that there is a tremendous need for improved mental health support specifically in the areas of assessment and treatment throughout the national HIV treatment and care sites,” says Belinda White, Clinical Psychologist with I-TECH. “One treatment and care site reported that as much as 90% of its client population experiences symptoms of mental illnesses.”
The most common mental illnesses encountered within treatment and care sites include depression, anxiety, bipolar disorder and schizophrenia; substance use disorder is also common within the PLHIV client population. A key area of interest is the integration of the Collaborative Care Model into the already existing treatment and care system, in a manner that incorporates the unique features of each site. The Collaborative Care Model is an evidence-based approach to treating common mental health conditions (e.g., depression, anxiety) in primary care settings and was developed at the University of Washington.
I-TECH also assisted the NACC with the establishment of the National HIV Helpline and will continue to provide support over the next six months, while working to transition the program fully to NACC. This includes support for the HIV Helpline Coordinator and Active Listeners, as well as training of new Active Listeners.
“We must continue fighting the stigma associated with living with HIV,” says Conrad Mitchell, Program Coordinator. “It’s important to continue to battle misinformation and to have that coupled with positive true-life experiences. The Helpline–manned by persons living with HIV together, with HIV NGO advocates and allies–provides a unique opportunity to combat misinformation though empathy and education in direct, one-on-one engagements with the public.”
A 2017 Inter-American Development Bank (IDB) National Women’s Health Survey for Trinidad and Tobago[1] showed that more than 30 percent of women in Trinidad and Tobago had reported having experienced at least one incidence of either physical or sexual partner violence. The NACC is seeking support related to GBV and the risks it poses to the health and well-being of PLHIV. Activities would focus on raising awareness and providing resources and psychosocial support for vulnerable groups.
“There is a lack of general knowledge about GBV and what it entails among the public as well as in some health care settings,” says Ms. White. “There is an opportunity to yield enormously positive results by increasing the knowledge and insight of health care workers, and people living with HIV, regarding GBV.
“My hope is that the information that is shared empowers people living with HIV to advocate for themselves if they come to the realization that they are experiencing,” she continues, “and to make contact with the local resources that are available to receive the necessary support.”
A group of DREAMS ambassadors in Zimbabwe. Photo credit: Zim-TTECH
After facing incredible obstacles, three resilient 22-year-old women from Tsholotsho District, Zimbabwe, found their lives intersecting: Sitheni, Clemencia, and Faith are DREAMS ambassadors, equipping adolescent girls and young women with skills to reduce their vulnerability to contracting HIV–and helping them to find their own strengths.
DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is a PEPFAR-funded program that aims to reduce HIV infections among adolescent girls and young women through not only prevention and treatment, but also a core curriculum that addresses HIV prevention, financial literacy, and gender-based violence (GBV). Participants can also access services such as HIV testing, family planning, pre-exposure prophylaxis (PrEP), counseling, and screening for GBV.
The International Training and Education Center for Health (I-TECH) has been supporting the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) and its ZimPAAC consortium to implement the DREAMS program since 2020. To date, nearly 20,000 girls and young women in Zimbabwe have completed the primary DREAMS curriculum, Health for Life.
Sitheni, Clemencia, and Faith were initially enrolled in the DREAMS program as beneficiaries, having turned to transactional relationships (trading sex for money or necessities) to survive poverty amid the deepening economic crisis in Zimbabwe. They now use their own experiences to give back to young women who face similar choices.
Sitheni had to abandon her life-long goal of attending university to support her parents and four siblings; carrying the burden of sole provider for her family took a toll on her. When earnings from her part-time jobs weren’t enough, she became involved in sexual relationships with older, cross-border traders—known as omalayitsha—to make extra money.
Once enrolled in the DREAMS program, she thrived within the Health for Life courses, which cover financial literacy, social asset building, condom education, and violence and HIV prevention. “I encourage young girls in my community not to depend on men, but to use their skills instead of waiting to be given money by men who will abuse them,” Sitheni says.
Training and services are often provided in a safe space such as a school or community center, where participants meet with a mentor trained to deliver the Health for Life curriculum.
“At the moment I mentor 140 adolescent girls and young women aged 15-24 in the district,” says Faith, who also dated older men for money in order to make ends meet. “It is my duty to link adolescents with the district clinical nurse to access services at health facilities and safe spaces. I also encourage women to support people living with HIV/AIDS in the community. I teach them about human rights and encourage them to utilize their talents to make a living.”
Another part of Faith’s job is enrolling and following up on beneficiaries as well as supporting community-based facilitators who teach social asset building. This includes facilitating relationships and connections within DREAMS safe spaces to share encouragement and survival skills.
These safe spaces were critical to providing hope and new options for Clemencia. “After my father passed away, there was no one to pay for my school fees,” she says. “I came to my wits’ end, and I ended up exchanging sex for livelihood. At that time, it seemed the only viable option.”
Clemencia traded sex for two-and-a-half years, placing her among those at highest risk for HIV acquisition in Zimbabwe.[1] “Luckily for me, I did not get infected with HIV,” she says. “Ever since joining DREAMS, I have become empowered, and I know how to protect myself from sexual violence.”
Thanks to what she learned in her financial literacy sessions, Clemencia has started a small business of breeding hens and selling them to community members. “I also sell clothes for extra income,” says Clemencia, who now encourages other young women to complete their financial literacy sessions so they can start their own businesses and become independent.
Faith is thrilled to be able to foster this independence, as well. “Little did I know that I could make an honest living without anyone having expectations from me,” she says. “I am now able to encourage other girls and young women to stop engaging in transactional relationships. I am able to do this because I have been mentored and I have knowledge about HIV/AIDS and violence against women.”
[1] Chiyaka T, Mushati P, Hensen B et al. Reaching young women who sell sex: Methods and results of social mapping to describe and identify young women for DREAMS impact evaluation in Zimbabwe. PLoS One. 2018 Mar 15;13(3):e0194301. doi: 10.1371/journal.pone.0194301. eCollection 2018.
The most recent racist mass shooting in Buffalo has left yet another huge hole in the fabric of our country. We honor the memory of the ten people who lost their lives in an act of white supremist terrorism and hope for the healing of not only those wounded but also those who loved the victims, the communities that will suffer for their loss, and the national and global community that bears witness. Please remember to care for yourself during this continually challenging time.
We hold in our hearts the lives, love, and humanity connected with the names that follow—as well as countless people in the Black community who continue to be re-injured by these acts of horrific violence.
The victims:
Roberta A. Drury, 32
Margus D. Morrison, 52
Andre Mackneil, 53
Aaron Salter Jr., 55
Geraldine Talley, 62
Celestine Chaney, 65
Heyward Patterson, 67
Katherine Massey, 72
Pearl Young, 77
Ruth Whitfield, 86
Zaire Goodman, 20, was released from hospital after being shot in the neck; Jennifer Warrington, 50, has also been treated; and Christopher Braden, 55, is in stable condition after being shot in the leg.
According to reports, the gunman was motivated by the so-called “Great Replacement theory,” the racist conspiracy theory that populations with white European backgrounds are being “replaced” by people of non-White, non-European descent. We must do more to combat this type of dangerous rhetoric and ongoing anti-Black violence in our communities. It is up to each of us to redress past and present injustices, find ways to meaningfully engage in work to reduce racism, and collectively contribute to safer communities and workplaces for Black people. Please see the resources below for immediate ways to take action.
Feed Buffalo (all donations will be used to serve the communities affected by the shooting): https://www.feedbuffalo.org/
Racist Terrorism in Buffalo: How the Mainstreaming of White Supremacy Puts the Nation at Risk. Thursday, May 19, 1-2 PM PT. In this presentation, anti-racist educator Tim Wise examines how overt racism has increasingly penetrated American political discourse and has contributed to terrorist violence, most recently in Buffalo, Pittsburgh, Charlottesville, El Paso and Charleston. Hosted by SpeakOut: The Institute for Democratic Education and Culture. Register here ($5-250 donation; proceeds go to Black Love Resists in the Rust).
Reading about and watching the coverage of these events can also be extremely painful. Please take care of yourselves. Please find wellness and mental health information at Mental Health America.
On April 1, the International Training and Education Center for Health (I-TECH) celebrates 20 years since its founding. It has since grown into the largest center in the Department of Global Health (DGH) and one of the largest centers at the University of Washington (UW).
“We are proud to mark this milestone,” says Dr. Pamela Collins, Executive Director of I-TECH, Professor of Psychiatry and Behavioral Sciences, and Professor of Global Health at UW. “For 20 years I-TECH has helped to save lives through its support of public health systems in the Caribbean, Europe, Africa, and Asia. Over the years, our scope has broadened, but responsive partnerships with ministries of health, collaborating NGOs, and our donors have been central to the work.”
I-TECH comprises a global network, operating in 17 countries, that fosters healthier communities around the world through equitable partnerships in research, training, and public health practice. Its work is rooted in health care training and draws on a culturally rich community that includes UW faculty, global partners, and U.S. and global staff and students. This community of people with diverse backgrounds, experiences, and opinions encourages learning from one another while working toward high quality, compassionate, and equitable health care.
“COVID-19 has reminded me, and many of us, about the critical and life-saving role of health care workers, a group that often lacks proper support,” says Ivonne X. “Chichi” Butler, Associate Director at I-TECH. “At the same time, collectively, we have come to understand the urgent need for stronger and better prepared health systems to respond to the COVID crisis.
“At I-TECH, these concerns have been at the heart of our work for the past 20 years,” she continues. “We have invested–and continue to invest–in health workers and in the systems in which they work. I am proud to be part of a center that has transformed the delivery of HIV care and treatment in so many countries and that truly puts individuals and communities at the forefront to meet their particular needs.”
I-TECH began in 2002 with its first award, the International AIDS Education & Training Center (IAETC) grant. The IAETC was administered by the Center for Health Education and Research (CHER), within the Department of Health Services (now the Department of Health Systems and Population Health). This was one of CHER’s first forays into what would become known as “global health.”
“The IAETC award was the first of its kind at UW,” says Shelly Tonge-Seymour, Associate Director of I-TECH, who has been with the center for 20 years, “the first to translate lessons from the U.S. to improve the training of health care workers and delivery of care globally.”
With the advent of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, I-TECH’s portfolio expanded rapidly, reflecting the evolution of PEPFAR from “emergency” to a longer-term investment in health systems strengthening. I-TECH became an official UW center in 2008, a year after joining UW’s new Department of Global Health at the invitation of Dr. King Holmes, then-chair of DGH. “It became clear that we had grown so large that we needed our own administrative core,” says Tonge-Seymour.
Through its work with PEPFAR, I-TECH’s efforts have contributed meaningfully to the huge advancements in HIV prevention, care, and treatment seen across the globe, with a particular emphasis on groups that have been marginalized or stigmatized.
“One of the most powerful changes in the past 20 years in the Caribbean Region has been in the attitude toward key population groups,” says Natalie Irving-Mattocks, Executive Director of the Caribbean Training and Education Center for Health (C-TECH), one of I-TECH’s independent partner organizations. “Through the Key Populations Preceptorship Program, I-TECH has contributed significantly to better health in the Caribbean region by training healthcare workers to provide nonjudgmental, high-quality, comprehensive HIV care to men who have sex with men, transgender women, and sex workers.”
“I’ve been involved with I-TECH for its entire 20 years, and the most impactful thing for me has been the contribution I-TECH has made in Zimbabwe to supporting the development of lay cadres into primary counselors,” says Abisha Jonga, Senior Program Manager at Zim-TTECH. “This program created a career path for so many, made HIV counseling services more accessible to the general population, demystified HIV testing, and shaped the individuals’ lives.”
Dr. Batsi Makunike, Executive Director of Zim-TTECH, agrees that fostering local connection has been the key to success. “I am particularly proud of the fact that I-TECH has succeeded in nurturing local organizations,” says Dr. Makunike. “Providing full support without competition–that is huge. Without I-TECH, there would be no Zim-TTECH.”
Malawi has seen its health care landscape change dramatically in the past 20 years and is now close to meeting the UNAIDS 95-95-95 targets for the elimination of HIV. Since 2008, I-TECH has partnered with the Malawi Ministry of Health’s Department for HIV and AIDS and helped to generate pioneering policy initiatives such as the 2011 adoption of Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV. Option B+ provides universal, lifelong ART for pregnant and breastfeeding women. Based on Malawi’s documented success, the World Health Organization formally adopted Option B+ as a global policy in 2013.
“We truly believe that I-TECH has significantly contributed to the prevention of thousands of infant infections and AIDS deaths among children, adolescents, and mums and dads in Malawi,” says Dr. Andreas Jahn, Senior Technical Advisor with I-TECH Malawi. “We have walked this journey with a whole generation of Malawian HIV program colleagues, and we have learned a tremendous amount from each other.”
I-TECH’s funding has grown from $500,000 for its initial award in 2002 to a cumulative total of more than $1 billion. The center currently has 26 awards, harnessing UW technical expertise in multiple technical areas from mental health to electronic health information systems to global health security and emerging health threats.
As I-TECH has adapted to changing needs, at its core remains a commitment to creating equitable partnerships and facilitating knowledge sharing throughout the I-TECH network, which includes I-TECH’s own country offices, independent partner organizations fledged from I-TECH, ministries of health, academic institutions, community groups, and others.
“When I reflect on the success of I-TECH in reaching the age of 20, two observations keep coming up for me,” says Dr. Ann Downer, co-founder and former Executive Director of I-TECH and Professor Emeritus in the Department of Global Health. “One is about the power of unity. I believe that the ability of a diverse group of individuals and teams to hold a common vision and set of values generates resilience. This unity allows I-TECH to continue operating after 20 years with integrity and grace across enormous geographic, linguistic, and cultural borders and despite regular economic and social challenges.
“The other observation is about the importance of encouraging leadership from all parts of an organization,” she continues. “This requires us to embrace the value of humility and results in our ability to listen and learn. Both are critical actions for successful work anywhere but are essential for working ethically on a global stage.”
The I-TECH story continues to unfold. From a modest grant with limited staff to a vital, resilient, and animated worldwide network of more than 1,600 dedicated personnel, I-TECH will continue to work alongside its global partners in its commitment to stronger health systems and safer, healthier communities.
“There’s so much to celebrate and a wealth of lessons to light the way forward,” says Dr. Collins. “In this era of pandemic, war, and fractured communities, our vision for health is needed now more than ever.”
Nancy Puttkammer, MPH, PhD, was recently selected to the third cohort of the Leadership Journey at WomenLift Health. The initiative, which runs from March 2022 to February 2023, is designed to support women through the challenges and opportunities of leadership positions in global health, with the ultimate goal of expanding its network of talented women leaders.
Dr. Puttkammer is Principal Investigator at the International Training and Education Center for Health (I-TECH) and Assistant Professor in the University of Washington (UW) Department of Global Health (DGH). She also serves as Program Director for the Doctor in Global Health and Leadership Practice (DrGH), and her project for the Leadership Journey will focus on augmenting the emphasis on women and leadership within the DrGH curriculum and program.
“I am thrilled to be part of the 2022 US Leadership Journey cohort—an amazing, diverse group of 30 women leaders,” says Dr. Puttkammer. “The participants come from prominent US universities, the World Bank, USAID, CDC, non-profits, and others. They each come with compelling stories, experience, and interests. Although the process has just launched, I am already grateful for the personal insights and the network I am gaining.”
As part of the Leadership Journey, each participant works on a focal project with support from senior mentors and peers. Dr. Puttkammer’s focal project will enhance the DrGH educational framework and curriculum to bring a gendered lens to leadership development, as well as develop mentorship opportunities for students to work with women leaders within and outside of UW.
“I am confident that participating in the Leadership Journey will not only enrich me,” says Dr. Puttkammer, “but will also really help me to enhance the value of the DrGH program for the next generation of global health leaders—both women and men—who join the program.”
The DrGH advances leadership development, including skills to plan evidence-based strategies and programs, catalyze resources, build partnerships across organizational boundaries, motivate teams, strengthen national policies, and manage and lead effective programs in a variety of settings. The DrGH program includes an initial year of didactic courses at UW in Seattle, followed by experiential learning rotations of 6-12 months in three different types of host organizations, such as Ministries of Health, bilateral and multilateral institutions, non-governmental organizations, and private sector companies. UW has recently extended offers of admission for the second DrGH cohort.
Tiwonge Chimpandule, I-TECH Malawi’s Strategic Information Officer, presents the results of the 2020/21 Malawi Population-based HIV Impact Assessment (MPHIA) to guest of honor Chrissy Kalamula Kantaso, Deputy Minister of Health (right). Looking on are Jeremy Neitzke, Deputy Chief of Mission, U.S. Embassy (center) and Dr. Rose Nyirenda, Director, HIV and AIDS Department in the Ministry of Health (left). Photo credit: I-TECH Malawi
On World AIDS Day, December 1, staff from the International Training and Education Center for Health (I-TECH) convened with the Ministry of Health (MOH), Columbia University’s ICAP, and other national stakeholders in Malawi to present the results of the 2020-21 Malawi Population-based HIV Impact Assessment (MPHIA). The commemoration, with the theme of “End Inequalities, End AIDS, End Pandemics,” was held at Bumba Primary School grounds in Rumphi District.
Preliminary results of the assessment, led by the MOH and ICAP, show that the national HIV testing program, supported by I-TECH, has achieved a significant increase in the awareness of status among HIV-positive adults—from 77% in 2016 to 90.9% in 2020-21.
Malawi has also made great strides toward reaching the UNAIDS 95-95-95 Fast Track targets, surpassing both the second 95 (results indicate that 98% of those who know their status are initiated on treatment) and third 95 (results indicate 97% of those on treatment are virally suppressed).
The assessment will be critical to informing future programming, says Dr. Rose Nyirenda, Director of the Ministry of Health’s HIV and AIDS Department. “The 2020-21 MPHIA has produced a wealth of information that will be critical for tailoring our services and to refine strategies for closing the remaining gaps,” says Dr. Nyirenda.
The HIV and AIDS Department also exhibited commodities (antiretroviral medications, testing kits, opportunistic infection (OI) and sexually transmitted infection (STI) medicines, condoms, voluntary medical male circumcision kits) that are procured and managed through the Supply Chain and Logistics Unit.
Correction: A previous version of this article misstated the organization that conducted the 2020-21 Malawi Population-based HIV Impact Assessment. This assessment was led by the Malawi Ministry of Health and Columbia University’s ICAP.
Brandy Rodriguez gives feedback to a clinician during the pilot training of I-TECH’s Key Population Preceptorship program in Trinidad & Tobago. Photo credit: Lauren Dunnington/I-TECH.
In honor of Transgender Awareness Week (November 13-19), the International Training and Education Center for Health (I-TECH) pays tribute to Trinidad & Tobago transgender activist and esteemed community leader Brandy Rodriguez, who passed away in late October.
Ms. Rodriguez leaves a legacy of leadership as president of the Trinidad and Tobago Transgender Coalition and a member of the Pan Caribbean Partnership against HIV and AIDS. She improved countless lives among those she supported in her many years as a peer navigator at the Family Planning Association of Trinidad and Tobago. Countless more lives were touched – and perspectives broadened – through her tenacity and compassion.
“A tireless champion for the trans community, Brandy held an open door and a willing ear to any lost children of our LGBTQ tribe,” says Conrad Mitchell, I-TECH’s Program Coordinator in Trinidad & Tobago. “Her fiery tongue and sharp wit kept us all in check, whilst her warm heart overflowed with a love that was unsurpassed. Her fearlessness was legendary both within the community and across local, regional, and international platforms. We are shaken to the core by this loss. The world is forever a little less ‘fierce’ with Brandy gone.”
The Key Populations Preceptorship program’s intensive trainings use targeted role-play scenarios to build clinicians’ capacity to provide nonjudgmental, high-quality comprehensive HIV care to communities most at risk: men who have sex with men, transgender people, and sex workers. Through this work with I-TECH, Ms. Rodriguez contributed to critical efforts to break down stigma and barriers to care experienced by marginalized communities. The first physician trained as part of the program in Trinidad & Tobago, Dr. Vedavid Manick, shared his experience with Ms. Rodriguez beautifully in a Trinidad and Tobago Newsday letter to the editor.
“More than 80% of patients admitted to CRAM for specialized care are referred by other health centers,” explains Dr. Florindo Mudender, Country Director for I-TECH Mozambique. “Critically ill patients are treated at CRAM until they are stable, then sent back to their facilities of origin to continue treatment. In addition to acute care, CRAM also provides individualized supportive services to patients who often present with dire psychological, social, and economic conditions.”
This story was first reported in 
