Author: Anne Fox

I-TECH Network Minimizes Disruptions in Treatment Access for PLHIV During COVID-19

By Chelsea Elkins

Members of a Community Adherence Refill Group in Zimbabwe

In a time of increased barriers, disruptions, and restrictions due to the COVID-19 pandemic, the International Training and Education Center for Health (I-TECH) and its network partners have implemented new approaches and adapted existing programs to support continued access to antiretroviral therapy (ART).

As a result of the pandemic, many organizations and health systems have had to shift to offering virtual care, which allows ART initiation and other HIV services to persist while minimizing patients’ risk of exposure to COVID-19. However, not all patients have access to the technology that makes virtual services possible, and additional approaches are needed to support ART treatment access during this time.

“Globally, the pandemic has generated innovative responses from communities and health systems that are striving to keep people connected to care,” says Dr. Pamela Collins, I-TECH Executive Director. “One challenge is to recognize how (or when) some adaptations increase disparities in access. We’ve learned that the right combinations of technological and no-tech solutions can also be innovative if they help provide the care that’s needed.”

One way I-TECH has helped to provide innovative care during the pandemic is by centering solutions within the affected communities themselves. A few of the community-oriented approaches that the I-TECH network has implemented include decentralized ART centers, community outreach, home delivery, community adherence refill groups (CARGs), and multi-month dispensing (MMD) of antiretroviral (ARV) medication.

Decentralized ART Refill Sites and Community Outreach

Decentralized refill sites have been an essential strategy during lockdown restrictions for I-TECH’s network partners because they allow ART to be distributed at more convenient locations, minimizing travel and treatment interruptions. Some programs have also started providing mobile outreach to improve ART access during the pandemic, at times even providing doorstep delivery to those who are unable to go to a clinic or refill center.

I-TECH’s network partner in India, the UW International Training & Education Centre for Health Private Limited (I-TECH India) launched the ARTMitra helpline in Mumbai, an outreach effort designed to map the location of unreachable PLHIV and aid in planning decentralized ART refill sites. SMS messages were delivered to 13,103 PLHIV who had missed appointments during the pandemic, resulting in the identification of 42 decentralized ART refill centers in Mumbai in 2020. A similar helpline was launched in five districts of the state of Mizoram in partnership with the State AIDS Control Society. In total, I-TECH India, in close coordination with government partners in the PEPFAR states in Northeast India and in Mumbai, has ensured uninterrupted ART delivery through 145 decentralized ART refill sites.

Through outreach efforts, clients were notified about how they could access medication, and which decentralized ART refill site they should visit. Additionally, ART home delivery was provided to 255 PLHIV living in Mumbai who were unable to pick up their medication.

Thank you for calling and informing me about the availability of medicine at the nearby ART Centre, as I had no idea whom to contact and how to collect medicine.

—an ARTMitra client in Mumbai

I-TECH network partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) has also utilized community outreach to support PLHIV during the pandemic. Zim-TTECH has supported the Zimbabwe Partnership to Accelerate AIDS Control (ZimPAAC) consortium—along with PEPFAR partners and in close collaboration with national efforts—to provide mobile HIV care, including prevention services and integrated services at ART events. In the Harare District, 8,257 clients were supplied ART during outreach events from 28 March through 17 July 2021.

Community Adherence Refill Groups and Multi-Month ART Dispensing

Through CARGs, a community of PLHIV access treatment more easily by sending a representative to receive ARVs for the entire group. The I-TECH network implements CARGs in a number of countries, using the person-centered approach to simplify HIV care and reduce the need for in-person services. This approach is often used in tandem with MMD, allowing a group to access multiple months of medication at a time.

While ARVs have traditionally been prescribed monthly, MMD allows patients to pick up medication for 2 to 6 months and reduces traditional barriers, such as access to transportation and taking time off work, as well as barriers specific to COVID-19, such as lockdown restrictions and limited capacity of health care facilities. I-TECH and its network partners have scaled up MMD in many programs during the COVID-19 pandemic, effectively minimizing the number of in-person visits and encouraging ART adherence.

In response to COVID-19, the Ministry of Health and Social Services (MoHSS) in Namibia introduced a new MMD policy in April 2020 for eligible ART patients, making more people eligible for this service than ever before. In addition to policy support, I-TECH Namibia is engaged in technical support to the national HIV/AIDS program through clinical mentors who work in more than half of Namibia’s health districts. This national engagement has contributed to a rapid increase in the number of eligible ART patients who now receive between 2 to 6 months’ supply of ARVs at a time.

‘’As the number of ART patients on MMD increased, waiting areas in Namibia’s health facilities have rapidly decongested, enhancing COVID-19 infection prevention and control measures,” says Dr. Norbert Forster, I-TECH Namibia’s Country Director. “At the same time, our HIV clinicians now have more time to focus their care on patient engagement and on enhancing viral load suppression and other interventions.”

I-TECH’S WORK IN INDIA IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER U91HA06801, THE INTERNATIONAL AIDS EDUCATION AND TRAINING CENTER (IAETC). THE CONTENT OF THIS POST IS THE AUTHOR’S AND SHOULD NOT BE CONSTRUED AS THE OFFICIAL POSITION OR POLICY OF, NOR SHOULD ANY ENDORSEMENTS BE INFERRED BY HRSA, HHS OR THE U.S. GOVERNMENT.

Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination

The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.

However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.

Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.

Record-breaking cervical cancer screening in Namibia

The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia’s national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.

In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.

From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).

“As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Lead Physician in Namibia. “Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening.”

Mentoring and training continues in Mozambique via videoconferencing technology

In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® “superhub” for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.

“Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies,” says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. “The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them.”

In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.

While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.

Access to services increase through health communication in Malawi

Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.

To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.

I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.

In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.

Zimbabwe consortium takes measures to blunt the impact of COVID-19

I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.

By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:

  • Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
  • Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
  • Procurement and distribution adequate PPE for use by health care workers at facilities.

We Asked Women Leaders in the I-TECH Network: What Inspired Your Career?

The International Training and Education Center for Health (I-TECH) has a broad network of talented faculty and staff across the globe. We are particularly lucky to benefit from the knowledge, passion, and dedication of many women within our network leadership — both in our country offices and independent partner offices. We recently had the chance to ask just a few of the women leaders in our network, “What drew you to a career in public health?” The answers were as varied as they were inspiring.

Nadine Abiola, PhD, MS
Country Director, I-TECH Côte d’Ivoire

I am French native, with strong Cameroonian roots. I came from a Christian Presbyterian family. My father was the first medical pediatrician of Cameroon, and my mother was a nurse. I grew up with a culture and education of compassion, acceptance, and resilience. My parents were always trying to provide, with very little, a maximum of education and treatment for all.

My life as a toddler existed inside several outbreaks that affected children (cholera, kwashiorkor, meningitis, rubeola, polio). Observing my father treating more than 60 babies and children per day, with a great faith in God, undeniably inspired my career in public health.

Naturally, I chose to be pharmacist and medical biologist. I like the challenges–being on the front lines in Haiti, DR Congo, Tunisia, or Côte d’Ivoire in the battle against AIDS or Ebola is my passion.

Pamela Collins, MD, MPH
I-TECH Executive Director

When I entered medical school, I was drawn to psychiatry. I was also intrigued by the possibilities of preventive medicine and the challenge of problems that could not be solved in a doctor’s office.

Although I did not really know what the field of public health entailed, I was fascinated by the broad concept of culture and how culture, as well as social and political context, could support health or curtail help-seeking; how societies could systematically deny quality health care or adequate income and education to some groups—all of which affected health and wellbeing. I liked the idea that responses to these problems could benefit an entire population.

By the time I was a resident, I’d had some important experiences that confirmed my desire to study public health. In one example I sat with a group of South African nurses who were discussing how they might approach HIV prevention with their patients. They described cultural differences as tremendous barriers. They talked about how the threat of conflict with a spouse, or loss of a relationship, could influence health behavior and thus risk of disease. I listened to them, and I began to appreciate the complexity that public health must embrace in order to achieve its aims. That conversation led me to a public health research career with a central focus on HIV and mental health.

Natalie Irving-Mattocks, MBA
Executive Director, Caribbean Training and Education Center for Health (C-TECH)

About 17 years ago, a close relative of mine died of AIDS at the age of 24. She was a commercial sex worker in her community. After she was diagnosed with HIV, the health care workers in the community disclosed her status to her family members, and it quickly spread in the community that she was HIV positive. She continued to hide her status, which prevented her from accessing care and taking her medication. Her health deteriorated rapidly, and she later died of AIDS. I was very hurt by the way she was treated by her own family members as well as members in the community. Her story inspired me to start looking for opportunities to help the sick, particularly those with HIV.

I applied for my first job in public health, HIV prevention, care, and treatment in 2006. My plan has always been to support those who are most vulnerable, as well as those who have suffered because of stigma and discrimination. What drives me every day is my passion to see those women, children, men who have sex with men, as well as other members of the key population groups receive comprehensive, equitable, and quality health care. No one should be left behind because of their gender, sexual orientation, profession, or social status.

Anna Shapoval, MIR, MPA
Country Representative, I-TECH Ukraine

Back in 1996, I was in my second year at the School of International Affairs in Kyiv. I found myself surrounded by predominantly business-minded/profit-focused classmates. I majored in social policy studies and, soon, realized that I want to devote my life to something more meaningful than money-making.

That year, I volunteered for the Harm Reduction Program at Soros Foundation and, eventually, got hired. The program supported initial few harm reduction sites in country, where no antiretroviral therapy (ART) was available, and people with HIV were dying daily.

Back then, my life-long passion for social justice and public health started along with my professional career. This passion drives me to date.

 

I-TECH Team Contributes to New WHO Recommendations for Cervical Cancer Screening and Treatment

After two years of collaborative work, the World Health Organization (WHO) today launched a critical publication to aid health care workers in the march toward cervical cancer elimination: The WHO Guidelines for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention.

The guidelines contain evidence-based recommendations for cervical cancer screening and were created in the context of the WHO global strategy to accelerate the elimination of cervical cancer, as well as the need to provide screening and prevention services to all women around the globe.

Dr. Linda Eckert–University of Washington (UW) Professor of Obstetrics & Gynecology, Adjunct Professor of Global Health, and technical advisor to I-TECH’s cervical cancer programs in Namibia, Malawi, and Botswana–served as one of the lead consultants coordinating the WHO guidelines.

“It has been a true privilege to join with WHO colleagues to collect and synthesize data and work with cost effectiveness modelers and our 60-member multinational Guideline Development Group, who shared their immense experience and knowledge to create these evidence-based guidelines,” said Dr. Eckert. “It is so hopeful for women around the globe, and I feel inspired thinking about how many women can be spared the suffering of cervical cancer through implementation of these guidelines.”

Dr. Laura Muzingwani, the lead physician for I-TECH’s Cervical Cancer Prevention Program in Namibia, was also an active member of the Guideline Development Group. Her experience and expertise in cervical cancer screening and treatment in Namibia enabled her to offer valuable guidance in the crafting of these recommendations.

In addition to the UW, contributing partners in the project included McMaster University, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID), and Unitaid, among others.

I-TECH Develops COVID-19 Vaccine Registry in Botswana

In March, the Botswana Ministry of Health and Wellness (MoHW), launched an online self-registration platform to allow eligible citizens to register for COVID-19 vaccination. The registration portal was developed by the International Training and Education Center for Health (I-TECH), in conjunction with the MoHW and the National COVID-19 Task Force. Since the launch, more than 60,000 people have registered for vaccination through the platform, and more than 45,000 people have received their first dose of the COVID-19 vaccine.

Screenshot of the COVID-19 registration portal

I-TECH assisted the MoHW to develop the following modules for the platform:

  • A DHIS2 tracker module tracks vaccinated clients for a follow-up dose. I-TECH trained MoHW health informatics and M&E officers to provide remote and on-site support to frontline health care workers across the country on application use. An interactive and intuitive dashboard shows vaccination trends across age and gender bands, geographical area and clinics/health facilities. The tracker module sends automated SMS reminders to clients regarding vaccination date, location, and time. Clients also receive a post-vaccination acknowledgment message.
  • An adverse events tracking module records any adverse events (AEs) due to COVID-19 vaccines. The module also automates reports on AEs and the correlation between AEs and any underlying conditions as disclosed by the clients.
  • A stock management module tracks the vaccine stock at facility, district, and national levels. This module is particularly helpful in projecting the vaccine demands at the clinics and vaccine availability against the vaccination bookings. The MoHW team closely monitors daily opening and closing stocks, to ensure optimal supply. Automated data checks and validations are built in to alert the facility management of any misappropriations in the vaccine stocks.

Available reports within the COVID-19 registration portal

Currently, I-TECH is working on a scheduling application that will be integrated into the portal for online booking of vaccination appointments. This will considerably reduce the number of “walk-in clients,” increase efficiency, and assist frontline workers in managing the workload at vaccination sites.

I-TECH will continue supporting this initiative until the end of the current funding cycle, while simultaneously capacitating the MoHW to take over the day-to-day management and maintenance of the portal.

This online, DHIS2-based platform is available here.

I-TECH’s work in Botswana is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the authors’ and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.

I-TECH’s Work Supports WHO’s First-Ever Strategy to Eliminate Cervical Cancer

The International Training and Education Center for Health (I-TECH) is proud to support today’s launch of the World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer. I-TECH has supported interventions for education, testing, and treatment of cervical cancer since 2014.

In Namibia, I-TECH currently supports screening and treatment at 31 health facilities and 11 outreach sites in seven regions. As of August 2020, the program had performed more than 14,000 screenings and 1,700 treatment procedures for HIV-positive women.

The Namibia team has also launched a campaign to raise awareness of the importance of screening for and treatment of cervical pre-cancer in women aged 20–49. The campaign has been crucial during the COVID-19 pandemic, as patients may be less likely to visit their health care provider for preventive care, including cervical cancer screening and treatment.

I-TECH’s network partner in Botswana, the Botswana Training and Education Center for Health (B-TECH), will soon begin work on a national cervical cancer and treatment program, focused on women living with HIV. Activities will include providing quality routine cervical cancer screening and treatment for all eligible women living with HIV at high-volume ART sites in 12 districts, as well as raising awareness among this population.

B-TECH — in conjunction with I-TECH, University of Botswana, and the National Cervical Cancer Prevention Program (NCCPP) — will align national screening and treatment guidelines with WHO standards to ensure sustainability. B-TECH will also work closely with National Laboratories to increase capacity for quality cervical cancer screening services.

Dr. Linda Eckert, UW Professor of Obstetrics & Gynecology as well as Global Health, is lead coordinator for updating WHO recommendations on cervical cancer screening and treatment and serves as technical advisor to I-TECH in this work in Namibia and Botswana. She notes that the time has come for the WHO strategy.

“The WHO’s Cervical Cancer Elimination Strategy will literally save millions of women’s lives around the globe,” says Dr. Eckert. “Each year, over 300,000 women die of cervical cancer, and the number of deaths is projected to increase by over 20% in the next decade.

“Almost all cervical cancer can be prevented—making these deaths even more tragic,” she continues. “This is the first time WHO has launched a cancer elimination strategy, calling on the global community who care for women to say ‘enough’ to cervical cancer, ‘enough’ to these preventable deaths.”

I-TECH Announces Launch of Independent Local Organizations B-TECH and C-TECH

The B-TECH team implements innovative, high-yield testing approaches to increase HIV case identification and yield.

On October 1, the International Training and Education Center for Health (I-TECH) celebrated the launch of the local and independent Botswana Training and Education Center for Health (B-TECH) and Caribbean Training and Education Center for Health (C-TECH).

For more than 17 years, these teams have worked within the regional Botswana and Caribbean offices of I-TECH to respond to the health needs of individuals and communities infected and affected by HIV. B-TECH and C-TECH, as locally registered non-governmental organizations, will continue to build on those years of experience implementing innovative, locally driven HIV prevention, care, and treatment programs, as well as expand their work to tackle other pressing health issues within the Batswana and Caribbean communities.

As part of the I-TECH network, B-TECH and C-TECH are able to access the academic depth and regulatory structures of UW and, together with local and regional clinical and programmatic expertise, scale up best practices and strengthen health systems. As local entities, B-TECH and C-TECH will also be able to take advantage of expanded partnership opportunities.

The C-TECH team also has broad experience with clinical mentoring at HIV treatment sites.

Both teams have supported pioneering work in their regions to provide comprehensive, patient-centered care for the most vulnerable populations. The C-TECH team has implemented a groundbreaking preceptorship program to improve provider communication with key populations affected by HIV in Jamaica and Trinidad and Tobago. It has also implemented a successful telementoring program through a Project ECHO®-based platform and model, reaching 465 providers. The program connects groups of providers to form communities of practice throughout the region to facilitate clinical updates, case consultations, and strengthened practice in HIV treatment and care and, recently, COVID-19.

“We look forward to remaining within the I-TECH family,” said Natalie Irving-Mattocks, Executive Director of C-TECH. “But our team is equipped and ready to move into this next chapter, deepening our local relationships, expanding our reach throughout the Caribbean, and building on our commitment to support access to high quality health care for the region’s most vulnerable.”

For its part, the B-TECH team has made an enormous impact on the health systems of Botswana, enabling the policy environment for HIV clinical case management; developing and implementing an interoperable, standards-based health information system; and enhancing the capacity of the health workforce at all levels. The team has also implemented innovative, high-yield testing approaches to increase HIV case identification. Targeted HIV testing strategies include partner testing services; HIV self-testing; testing among presumptive tuberculosis cases; and the expansion of afterhours and weekend testing to target men.

“We are excited to begin this new endeavor to promote innovative, locally driven, and effective programs to respond to the HIV epidemic in Botswana,” said Dr. Odirile Bakae, Executive Director of B-TECH. “With a high level of technical assistance from I-TECH, combined with B-TECH’s boots-on-the-ground approach, we are a winning team. We look forward to a fruitful partnership with both I-TECH/UW and the Government of Botswana.”

I-TECH has worked closely with UW Global Operations Support over the past decade to inform the internal procedures and structures necessary for international office registrations. This work has promoted operational effectiveness by enabling a safe, compliant, and legal environment for conducting international work. I-TECH’s close work with Global Operations Support has also helped to create the administrative and policy structures necessary to enable the successful launch of B-TECH and C-TECH.

Over the past two years, three other I-TECH offices – in Haiti, India, and Zimbabwe – have launched local organizations, signaling I-TECH’s bedrock commitment to transition, sustainability, and country ownership.

“These new organizations reflect our shared goals of serving communities, building capacity, and supporting expert leadership across the I-TECH network,” said Dr. Pamela Collins, I-TECH Executive Director. “We look forward to continued strong collaboration that saves lives.”

Read more about the B-TECH and C-TECH leadership teams below.

Dr. Odirile Bakae, Executive Director, B-TECH

Dr. Bakae is a physician with over 15 years of clinical experience in providing services to people living with HIV, as well as a deep understanding of structuring health programs to optimize client outcomes. He has several years of experience practicing medicine in public health settings in Botswana, including the management of the Infectious Disease Control Centers (IDCC), specializing in ART failure clients, complicated TB and HIV cases, and cervical cancer patients.

In addition to his role as B-TECH Executive Director, Dr. Bakae is the Principal Investigator for the CDC funded Cervical Cancer (GH20-2009) and Strategic Information Services (GH20-2007) awards.

He joined I-TECH Botswana in 2015 and led one of the most successful HIV testing programs in the country, focusing on a client-centered approach. Under his leadership, the country program performed exceptionally well, in terms of quality of service delivery and in meeting donor targets and expectations.

Thulaganyo Kauta, Deputy Executive Director, B-TECH

Ms. Kauta is a seasoned operations management professional with over 20 years of experience across a wide range of industries. She joined I-TECH Botswana in April 2009 and, as the Deputy Executive Director for B-TECH, she oversees operations, finance, and human resources, and is responsible for design and implementation of internal controls and compliance oversight at all levels of the organization.

In her management role, Ms. Kauta provides planning and coordination of efficient and effective support services to enable delivery of quality work to B-TECH clients and stakeholders. A key function of her role is to identify solutions to address operational challenges within B-TECH as well as ensure the implementation and adherence to the organization’s operational systems, policies and procedures.

Natalie Irving-Mattocks, Executive Director, C-TECH

Ms. Irving-Mattocks is a public health program director with extensive experience in managing projects focusing on health systems strengthening. She is also a business development practitioner with 13 years of experience in the field of social development. Her expertise includes financial management, budget management, project proposal writing, program design/development, planning, implementation and monitoring, strategic planning, and institutional development.

To her role as C-TECH Executive Director, Ms. Irving-Mattocks also brings deep experience and a proven track record in mobilizing and managing grants from international funding agencies such as United States Department of Human Services Health Resources and Services Administration (HRSA), PANCAP Global Fund, United States Agency for International Development (USAID), Clinton Foundation and National Institutes of Health (NIH).

Dr. Clive Anderson, Board Chair and Technical Advisor, C-TECH

Dr. Anderson has 30 years of experience as a primary care physician, specializing in HIV and STI care and prevention, as well as dermatology. He comes to his role as Board Chair and Technical Advisor after serving as Country Director of I-TECH Jamaica for the past three years.

He remains Technical Advisor to I-TECH Jamaica, where his experience also includes extensive experience as Technical Lead of the Caribbean Quality Improvement Collaborative (CareQIC), Lead HIV Project ECHO® Facilitator and Mentor, and clinical mentor at HIV treatment sites throughout Jamaica.

Dr. Anderson is currently a Clinical Assistant Professor in the Department of Global Health, University of Washington.

I-TECH Says Goodbye to Longtime Executive Director Ann Downer

Dr. Ann Downer speaks at the I-TECH annual meeting in 2010.

On June 30, 2020, Dr. Ann Downer will retire from her post as the Executive Director of the International Training and Education Center for Health (I-TECH) at the University of Washington (UW).

Downer has had a 31-year career at UW; she founded I-TECH 18 years ago with a talented team of global health professionals at UW, along with her friend and colleague Dr. Michael Reyes, at the University of California, San Francisco. In that time, she has been the center’s trusted leader; a principal investigator for several awards; and a pioneering educator, mentor, and friend.

As is fitting for a hero’s journey, hers started on a boat.

After dropping out of University of California, Berkeley, as an undergraduate in the early ’70s, one semester shy of completing her degree, she worked as one of the only female commercial fisher-“men” in the Pacific Northwest for the lion’s share of her 20s.

Downer fishes in Neah Bay on the Makah Reservation in Washington, across the border from British Columbia.

“Mistake or not, [leaving UC Berkeley] set me on a path that school wasn’t setting for me at the time,” says Downer. “My experience fishing made me resilient, taught me how to work hard, and, above all, made me think about my future since I knew I couldn’t fish forever.”

But in order to finish school, she needed to set a new direction. On the advice of a female sailing instructor, she volunteered at Planned Parenthood Whatcom County in Bellingham, where she quickly secured a paying job.

“This one action — asking someone for advice — set my entire career in motion,” says Downer. “She prompted me to seek a new direction.

“And it was during my time as an education coordinator for Planned Parenthood that I gained the core skills that would serve me for the rest of my career,” she continues. “Teaching and instructional design, health education and curriculum development, comfort with discussing issues related to sexual health, and being in front of groups of people. Those years also solidified one of my core values — that people should have choice in regard to their own bodies.”

Downer finished her undergraduate degree while working at Planned Parenthood and then applied to the UW in Seattle. She went on to get a master’s degree in Health Education and Health Promotion at UW from a department (Kinesiology) that was later eliminated as duplicative with School of Public Health programs.

She again worked full-time during graduate school, exercising her entrepreneurial muscles helping to start a nonprofit program on prevention of child sexual abuse (the successful Committee for Children program has since expanded its work with parents and teachers to provide training on development of empathy and conflict resolution skills).

Downer and her team designed many of the first AIDS prevention campaigns in the state.

Following graduation and a year doing consulting work for clients such as the Washington State Office of the Superintendent of Public Instruction, Downer became the education coordinator in the mid-’80s for the first HIV/AIDS program at Public Health-Seattle and King County, where she and her team designed many of the first AIDS prevention campaigns in the state.

“I had learned by then that I really enjoyed working at the edge of emerging social issues,” she says.

Downer joined the UW faculty in the Department of Health Services in 1989. As a practice-focused educator working among researchers — and as a master’s-trained faculty member working closely with physicians, nurses, and PhDs — she had ample opportunity to call on the work ethic and tenacity she’d forged in the commercial fishing industry years earlier.

She eventually took the advice of her department chair, Dr. Bill Dowling, to continue her education. So, once again, she returned to school and worked full time while earning an advanced degree in educational leadership at Seattle University.

“The program wasn’t what I expected,” says Downer. “I thought it would concentrate on topics related to educational administration, like finance and law, but, while those topics were included in the curriculum, it was really a degree program focused on values-based leadership.

“I didn’t know it then,” she says, “but this was exactly what I needed in order to stay at UW and flourish.”

Values-based leadership became the foundation of two centers that Downer led at UW: the Center for Health Education and Research (CHER) and, later, I-TECH.

“I discovered that I could bring people together who shared certain values —  respect for others, belief in the power of education, maintaining an attitude of hope, the desire to integrate practice and research,” she says. “These were the core values that guided us at CHER and carried over to I-TECH.”

CHER’s programs were initially focused on domestic public health challenges but began to expand in the direction of global health, so Downer approached Dr. Stephen Gloyd, who led the International Health Program (IHP).

“With Steve’s help and encouragement, we aligned more closely with IHP and began to grow our global portfolio of projects” says Downer. “As new projects were funded, the metamorphosis into what would become I-TECH was rapid, but our values and principles always remained the same.”

Downer and mentor Dr. King Holmes, Chair Emeritus of the UW Department of Global Health, in 2017.

I-TECH was formally founded in 2002 and moved from Health Services into the newly created Department of Global Health (DGH) in 2007, at the invitation of Dr. King Holmes, the founding chair of DGH. Holmes was closely involved in I-TECH from its inception and has been instrumental in its success; he remains a mentor to Downer and I-TECH to this day.

Since 2002, I-TECH’s cumulative funding at UW totals nearly $1 billion. I-TECH currently has an international staff of 2,000, with 13 offices in low- and middle-income countries, several of which have now transitioned to become independent, local organizations.

I-TECH implements programs in more than 30 different technical areas that support strengthening of health care systems, including workforce development; HIV prevention, treatment, and care; laboratory systems strengthening; voluntary medical male circumcision; health information systems; health regulation and policy; and leadership and management.

Downer was recognized by UW in 2015 as the recipient of the “Distinguished Contributions to Lifelong Learning” award, in part because of her growing interest in promoting e-learning at UW. Downer’s pioneering 12-week online course, Leadership and Management in Health, had graduated 25,242 participants as of March 2020, with an 87% completion rate. More recently, partnering again with the DGH e-Learning Program (eDGH) on a second 12-week professional development course, Project Management in Health, graduated 6,197 participants in its first two offerings, with a completion rate of 88%.

“My work with eDGH has brought me back to my roots in education,” says Downer, “designing educational products that include content and voices from diverse cultural traditions and perspectives. This is critical learning for those working in public health systems throughout the world — and especially important for improving the leadership and management skills of people working in those systems.”

I-TECH staff past and present, as well as assorted friends and family, gather virtually to toast Ann’s career and retirement.

Though officially retiring on June 30, Downer, as an emeritus professor in DGH, will continue to work for a small amount of time from July through December 2020 in order to finish one global health project under way in Cambodia and two online courses before turning them over to others.

At the same time, Downer does plan to be a retired person and reports that she’ll be busy in her garden, as always, and returning to her early roots as she again takes up sailing. Her adventure began — and now continues, it would appear — on the vast waters of our beautiful Pacific Northwest.

Downer is truly excited to see I-TECH move into the next phase of its organizational life under the leadership of Dr. Pamela Collins, Professor of Psychiatry and Behavioral Health, Professor of Global Health, and Director of the Global Mental Health Program.

“We all welcome you, Pamela!” says Downer. “I believe with all my heart that you are the right person at the right time for I-TECH. You inherit one of the most competent, resilient, and ethical groups of people you will ever work with — and a vision, mission and set of operating principles that I know are consistent with your own.

“I-TECH has been one of the loves of my life,” she continues, “and I wish you the same sense of fulfillment and pride I have had working with this incredible team of people — past and present — at this incredible university of ours.”

I-TECH Welcomes Pamela Collins as Executive Director

Dr. Pamela Collins, I-TECH’s new Executive Director

The International Training and Education Center for Health (I-TECH) is pleased and proud to welcome Dr. Pamela Collins as our new Executive Director, starting July 1, 2020.

A psychiatrist and mixed-methods researcher, Collins joined the University of Washington (UW) in 2018 as Director of the Global Mental Health Program, within the Department of Global Health (DGH) and the Department of Psychiatry and Behavioral Sciences. She also serves as Director of Faculty Development at DGH and as Principal Investigator of EQUIP Nairobi, a pilot implementation of Trauma-Focused Cognitive Behavioral Therapy (CBT) in Nairobi, Kenya.

Prior to arriving at the UW, Collins spent eight years at the National Institute of Mental Health, where she was Director of the Office for Research on Disparities & Global Mental Health and the Office of Rural Mental Health Research.

Collins was awarded an MD from Cornell University and an MPH from Columbia University, where she was a faculty member for 13 years. There, her research focused on the intersections of HIV prevention, care, and treatment and the mental health needs of women of color in the U.S., as well as diverse groups in Latin America and Sub-Saharan Africa. At Columbia, Collins was also the founding Director of the Global Health Track and Co-Director of the Initiative for Maximizing Student Diversity at the Mailman School of Public Health.

“I am humbled and thrilled by the opportunity to join and lead the I-TECH community,” says Collins, “as it applies its depth of experience and readiness for opportunity to a rapidly changing global health landscape.”

We Stand in Solidarity

During the “Doctors for Justice” march on June 6, 2020, health care workers and others marched from Harborview Hospital to Seattle City Hall to protest police brutality.

Communities in the United States and globally continue to respond to the tragic murders of George Floyd and Breonna Taylor at the hands of police officers, as well as the death of Ahmaud Arbery, who was murdered by two White men, one of whom was a former police officer. We acknowledge the pain experienced by Black people and other communities of color. We acknowledge racism, police violence, and anti-Blackness as pervasive and systemic problems – and as barriers to the health and well-being of Black people and other communities of color. Racism and police violence are public health emergencies in the U.S., and we stand with Black communities in the fight against these public health and human rights violations.

Police violence against persons with black and brown skin is not new in the U.S. The United States were founded on racial violence – first through the mass destruction of indigenous communities and then again when the first ship bearing enslaved, captive Africans arrived in 1619. For hundreds of years enslaved people were bought and sold in the U.S. and, though slavery was officially abolished in 1865, the legacy of slavery lives on through the systemic racism, mass incarceration, and injustice that continue to impact our communities of color to this day.

I-TECH staffers and their families attend the “Doctors for Justice” march, which began outside of I-TECH headquarters.

I-TECH will continue to examine policies and procedures that foster safe workplaces for our colleagues of color, especially our Black colleagues; continuously examine and challenge our own biases; and strive to be purposely anti-racist in our actions. I-TECH remains committed to creating an environment where equity, diversity, and inclusion are core values and integral to our workplace and communities. We will hold ourselves accountable when those core values are not upheld.

Our thoughts are with Black members of the community, particularly the families of Mr. Floyd, Ms. Taylor, and Mr. Arbery and all of the other Black families who have lost loved ones to acts of racist violence. We will honor these individuals through our commitment to examining and reducing structural racism in our work.

If you would like to see how UW Health Sciences leadership have responded to these tragedies, read their message here.