Category Archives: Ukraine

HIV Care and Treatment in Ukraine

Since 2018, I-TECH has supported the Ukraine Ministry of Health (MOH), through the MOH Public Health Center, in introducing and adopting WHO-recommended safe and effective antiretroviral therapy (ART) regimens.

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Assisted HIV Partner Notification/Index Testing in Ukraine

Since 2019, I-TECH has provided increased technical assistance for 39 state healthcare facilities in eleven high HIV burden regions of Ukraine to advance assisted partner notification/services and index testing as a sustainable strategy for HIV case finding.

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HIV Pre-Exposure Prophylaxis (PrEP) in Ukraine

The Government of Ukraine prioritized pre-exposure prophylaxis (PrEP) as part of combination prevention for HIV in 2019.1 Since 2020, I-TECH has focused its programmatic efforts in Ukraine on improving PrEP services uptake and strengthening PrEP delivery at selected stat healthcare facilities.

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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 Ukraine Hosts First Index Testing Forum Following Launch of National Index Testing Program

Attendees brainstorm at the Index Testing Forum in Ukraine.

A group of forum attendees meet to brainstorm and discuss the index testing program. Photo credit: I-TECH Ukraine.

On December 18, 2019, I-TECH Ukraine facilitated its first forum on index testing, a key strategy used to identify and support HIV-positive individuals. Service providers, as well as representatives from the US Centers for Disease Control and Prevention (CDC) and the Public Health Center (PHC) of the Ministry of Health (MOH) of Ukraine, attended the forum and participated in discussions detailing the best ways to implement and adapt proven index testing methodologies in Ukraine.

I-TECH Ukraine rolled out its national program in October 2019, after shifting its programmatic focus to provide index testing development and quality assurance. The program was launched at 39 antiretroviral therapy (ART) clinics in 11 PEPFAR priority regions across the country.

The recent forum included a review of early program performance; identification of best practices that can be scaled up to improve index testing and partner notification performance; and solutions to key challenges that index testing providers are currently facing in Ukraine.

“The index testing strategy gives us all high hopes that we can reach out to the most affected groups of people living with HIV and identify many individuals in need of care much earlier than it happens currently in Ukraine,“ says Anna Shapoval, I-TECH Ukraine Country Representative. “As always, I-TECH is proud to build this new programming not just on the vast evidence and globally acknowledged best practices but also on the mountain of successful experiences in other countries where index testing programs have been initiated and implemented by I-TECH in previous years.”

To strengthen the programmatic response, the forum included a number of speakers and index testing subject matter experts. Dr. Serhii Riabokon, an infectious disease doctor in the PHC’s department of the coordination of treatment programs on HIV, viral hepatitis, and sexually transmitted infections, presented the current legal framework and the state of index testing program implementation in Ukraine. I-TECH’s program and evaluation teams also gave a brief overview of the program including the design as well as the successes and challenges to date. Four well-performing regional sites were also able to share the best practices they used during early program implementation.

Dr. Matthew Golden presents at the Index Testing Forum in Ukraine.

Dr. Matthew Golden shares his experiences in partner services implementation, scale up, and development around the world. Photo Credit: I-TECH Ukraine.

In addition to the index testing program-specific presentations, the forum also included presentations by experts who shared their valuable experiences in partner services implementation, scale-up, and development:

  • Matthew Golden, MD, MPH, Professor at the University of Washington (UW) Department of Medicine’s Division of Allergy and Infectious Diseases and I-TECH faculty member, reviewed the development and challenges of partner services programs around the world, as well as voiced practical recommendations for Ukrainian index testing advancement.
  • Nancy Puttkammer, PhD, MPH, I-TECH faculty and DIGI faculty lead, and Jason Beste, MD, MPH, I-TECH International Clinical Advisor, were on a panel discussion on the ways of overcoming key challenges in index testing implementation.

“A key part of the program is to ensure quality results,” says Shapoval, “and consistent and collaborative learning is paramount to building local capacity.”

December’s forum is just the first of planned, quarterly forums designed to further build local capacities around index testing and quality assurance.

THIS PROJECT 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.

I-TECH Ukraine Initiates National Discussion on Performance-based Incentives Model in HIV

Participants of the national consultation on PBI model development discuss international best practices. Photo courtesy of I-TECH Ukraine.

In response to the need to quickly revitalize efforts to reach targets in Ukraine, CDC Ukraine has asked International Training and Education Center for Health (I-TECH) to support a performance-based incentive (PBI) model.

On March 28, 2019, I-TECH facilitated a high-level stakeholder workshop centered on PBI evidence and “best practices.” Participants from the U.S. Centers for Disease Control and Prevention (CDC) in Ukraine and the Public Health Center (PHC) of the Ministry of Health of Ukraine, and I-TECH gathered to discuss options for adapting proven methodologies to Ukraine’s HIV services.

PHC launched the model in December 2018 at five pilot sites across the country. In the pilot, monetary incentives were paid to individual doctors at the facilities to double efforts toward initiating new patients on ART.

PHC plans to expand the model to all 12 priority regions in the country. On the heels of COP ’19 discussions in South Africa, CDC Ukraine is looking for additional areas of the HIV cascade to which PBI could be applied to reach the FY2020 targets set by the U.S. Office of the Global AIDS Coordinator (OGAC).

The March meeting and the preceding preparatory meetings provided catalytic opportunities for identifying additional HIV services–including index partner testing, linkage to care, and loss-to-follow-up search–that could potentially benefit from the PBI model; discussing lessons learned from other PBI global initiatives; and utilizing evidence-based practices to design well-conceived and context-driven programs.

Marianne Holec, Senior Program Manager for I-TECH Zimbabwe’s voluntary medical male circumcision program; Efison Dhodho, Results-based Financing Health Specialist from the Programs Coordination Unit of the Ministry of Health of Zimbabwe; and Charbel El Bcheraoui, PhD, Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) were keynote speakers at the event.

These working meetings resulted in meaningful exchanges between the guest speakers and Ukrainian experts about the successes (e.g., an increase in short-term achievement of targets and the opportunity to identify and target largest areas of need) and challenges (e.g., workplace friction, dissatisfaction with incentives, lack of teamwork, and reduced quality of care) of PBI implementation globally and in Ukraine to date.

Meeting participants appreciated the practical advice given by the guest speakers on designing effective, intentional, and sustainable PBI models for the longer term for HIV services. Experts advised developing a well-designed program that is adapted to local context; starting at a few sites and try different strategies to see what works best; gathering input from the providers as to what will work best; building in health competition between sites; and having a strong M&E framework.

With input from local stakeholders and international experts, I-TECH Ukraine has accepted the challenge of incorporating the key outcomes from the series of PBI meetings to structure the Ukrainian PBI model for HIV services. This narrative will include an outline of additional technical assistance required around its implementation.

THIS PROJECT 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.

I-TECH Ukraine Trains Faculty in Innovative Teaching Methods and Principles

Training participants and facilitators. Photo source: I-TECH Ukraine.

The International Training and Education Center for Health (I-TECH) Ukraine, in partnership with the Ukrainian Family Medicine Training Center of Bogomolets National Medical University, conducted a three-day training course for clinical educators on principles and innovative methods for effective teaching. The course was held outside Kyiv from 18-20 September 2018.

Facilitating the training were Ann Downer, EdD, I-TECH Executive Director and Professor in the University of Washington Department of Global Health, and Michael Reyes, MD, MPH, I-TECH co-founder and Professor in the University of California, San Francisco Department of Family and Community Medicine.

The course focused primarily on new teaching methods and stronger instructional design for clinical courses taught by faculty, especially those with content on HIV/AIDS, Tuberculosis, and malaria. The objectives included helping clinical educators to:

  • strengthen learning objectives and measurement of student learning;
  • vary their use of teaching methods; and
  • revise lectures to make them more interactive.

Ann Downer, I-TECH Executive Director, conducts a session, “Competencies, Learning Objectives, and Domains of Learning,” on the first day of the training. Photo source: I-TECH Ukraine.

The course modeled these objectives by using small group work and other teaching methods to increase engagement.

“Over the course of three days, I was able to learn techniques and best practices to actively engage my course participants into the learning process,” says Galyna Vynogradova, Associate Professor of the Ukrainian Family Medicine Training Center and participant of the training.

This training course is a part of a larger I-TECH effort to build the clinical and managerial capacity of HIV/AIDS service providers throughout Ukraine.

I-TECH Ukraine Conducts In-Service Nurse Training Pilots for Achieving 90-90-90

Recent public health care reform in Ukraine has called for the growing role of primary health care, task shifting, and decentralization of HIV services while providing care and treatment for people living with HIV (PLWH). In June 2018, the International Training and Education Center for health (I-TECH) Ukraine conducted two back-to-back, five-day in-service training programs on HIV testing services for two cohorts of participants from twelve regions across Ukraine.

Dr. Serhii Rabokon facilitates a training on the role of nurses in achieving UNAIDS 90-90-90 targets.

Dr. Serhii Rabokon, Head of the Treatment Programs at the CPH of the MoH of Ukraine, delivers a presentation on the nurse’s role in achieving UNAIDS 90-90-90 targets. Photo source: I-TECH Ukraine.

The concept and design of these unique pilot training programs were influenced by the recent reform to actively involve general practice/primary care nurses into the process of achieving UNAIDS 90-90-90 targets in Ukraine.

A group of 10 national HIV and health care reform experts, I-TECH’s international consultant-nurse practitioner, and the I-TECH Ukraine training development team carefully designed the learning objectives and content of the training program with consideration of the specifics of the national HIV epidemic, participant backgrounds, as well as anticipated task shifting. Together, these experts synthesized and presented international and national clinical and nursing best practices in the area of serving PLWH.

Training participants included nurses from primary care facilities, specialized HIV clinics, as well as faculty of seven local nursing colleges, including I-TECH Ukraine’s national partners – Ternopil State Medical University and the Nursing College of Poltava Ukrainian Medical and Dental Academy.

The training programs outlined roles for general practice/primary care nurses in achieving UNAIDS 90-90-90 targets, taught HIV basics, helped develop skills for HIV testing services with rapid HIV test kits, and coached participants on conducting counseling for PLWH using a non-discriminatory, patient-centered approach.

Participants working in small groups at the June 2018 training.

Participants in the second pilot training work in small groups. Photo source: I-TECH Ukraine.

Facilitators used interactive training tools and approaches during the program to fully engage participants and strengthen the capacity of the nursing college’s faculty to teach up-to-date HIV content in an appealing and efficient way.

One of the central elements of the program was to educate the participating nurses about the challenges surrounding HIV-related stigma and discrimination with a major goal to overcome it in the nursing community and encourage respectful delivery of services for PLWH.

“[I-TECH Ukraine and its partners are] doing such a[n] important thing,” says Valentyna Borysova, lecturer of Zaporizhzhia Nursing College. “Educating nurses on HIV has been so much underestimated and under-invested in Ukraine.”

In addition to feeling as though this training addressed a critical gap in education, participants also provided positive feedback about the content and facilitation of the training, especially the parts of the training that were facilitated by the international and national peer nurses.

Participants attend a training about HIV fundamentals.

Participants in the first pilot training focus on a presentation about HIV Fundamentals. Photo source: I-TECH Ukraine.

“The knowledge on testing and post-exposure prophylaxis are badly needed at our clinic,” says Liudmyla Samolelis, Senior Nurse of the Psychiatric Clinic in Poltava, Head of Poltava Oblast Nurse Association. “I plan to conduct an on-the-job training for the nurses, using the materials from the training.”

Due to the success of the pilot trainings, I-TECH Ukraine intends to finalize training materials, institutionalize the course through its local partners, and develop a manual that could be used in different training formats, including state-owned colleges and medical universities. In addition, an ambitious regional rollout of the training program is anticipated during the next year of the project.

 

Ukraine Partnerships

I-TECH began working in Ukraine in 2011 at the invitation of the U.S. Centers for Disease Control and Prevention (CDC) and the Ukrainian Ministry of Health. Today, I-TECH’s key partners in Ukraine include the Public Health Center (PHC) of the Ministry of Health (MoH) of Ukraine and the Ukrainian Family Medicine Training Center (UCFM) of the Bogomolets National Medical University (NMU) as well as 107 high- and low-volume regional ART sites, based at various healthcare facilities in twelve regions of Ukraine most affected by the HIV epidemic.