To reduce the number of new cases of tuberculosis and improve diagnosis and treatment, I-TECH collaborates with governments and ministries of health to strengthen their health systems through facilitating trainings, advising on health policy and clinical guideline updates, supporting laboratory quality management, upgrading national health information systems, and implementing integrated TB/HIV care and treatment services.
Category: Ann Downer
HIV and STI Prevention
HIV Counseling and Testing
Index testing, including partner notification services (PNS), is a key strategy to identify and support those most at risk of acquiring HIV: sexual contacts, needle-sharing partners, and biological children of newly diagnosed HIV+ individuals. Its implementation is critical to controlling the HIV epidemic and meeting the UNAIDS target that 95% of people living with HIV will know their status. Evidence from Cameroon, Kenya, Malawi, and Mozambique has demonstrated PNS is feasible, safe, and highly effective.[2-6] Additional data suggest PNS improves HIV prevention uptake, linkage to treatment, and sustained engagement in HIV care.[7-9] In December 2016, the World Health Organization issued guidelines recommending that PNS “be offered as part of a comprehensive package of testing and care offered to persons with HIV.” PEPFAR has since supported efforts to bring PNS to scale across supported countries.
I-TECH and the University of Washington have extensive experience in index testing research and programming including direct service delivery; quality improvement; training; policy and guideline development; and monitoring and evaluation. I-TECH promotes evidence-based index testing and counseling strategies focused on reaching recent sexual contacts and all biological children, placing them at the forefront of HIV case identification programs to reach epidemic control.
- Golden M, et al. Partner notification for sexually transmitted infections including HIV infection: an evidence-based assessment. Sexually transmitted diseases. 4th edn. McGraw-Hill; New York, NY: 2007.
- Brown LB, et al. HIV partner notification is effective and feasible in sub-Saharan Africa: opportunities for HIV treatment and prevention. J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):437-42.
- Henley C, et al. Scale-up and case-finding effectiveness of an HIV partner services program in Cameroon: an innovative HIV prevention intervention for developing countries. Sex Transm Dis. 2013 Dec;40(12):909-14.
- Rosenberg NE, et al. Recruiting male partners for couple HIV testing and counselling in Malawi’s option B+ programme: an unblinded randomised controlled trial. Lancet HIV. 2015 Nov;2(11):e483-91.
- Myers RS, et al. Acceptability and Effectiveness of Assisted Human Immunodeficiency Virus Partner Services in Mozambique: Results From a Pilot Program in a Public, Urban Clinic. Sex Transm Dis. 2016 Nov;43(11):690-695.
- Cherutich P, et al. Assisted partner services for HIV in Kenya: a cluster randomised controlled trial. Lancet HIV. 2017 Feb;4(2):e74-e82.
- Myer L, et al. Family matters: Co-enrollment of family members into care is associated with improved outcomes for HIV-infected women initiating antiretroviral therapy. J Acquir Immune Defic Syndr. 2014 Dec 1;67 Suppl 4:S243-9.
- Vreeman RC, et al. Disclosure of HIV status to children in resource-limited settings: a systematic review. J Int AIDS Soc. 2013 May 27;16:18466.
- Walcott MM, et al. Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study. BMC Public Health. 2013 Dec 2;13:1115.
- World Health Organization. Guidelines on HIV Self-Testing and Partner Notification. 2016.
HIV Care and Treatment
I-TECH provides technical assistance on the clinical care and treatment of HIV and related opportunistic infections on a continuum that ranges from direct patient service delivery, to training and mentoring health care workers, to the development of national policies and health systems infrastructure. In particular, together with ministries of health and other key stakeholders, I-TECH has developed numerous curricula and clinical mentoring programs to train health care workers to safely and effectively treat patients who have HIV and TB or other opportunistic infections at a level of care commensurate with national and international standards.
I-TECH has also assisted ministries of health to create national prevention and care and treatment guidelines for infectious diseases, which has lead to standardized care and treatment for HIV, including antiretroviral therapy (ART) dosing for adults and children.
I-TECH’s quality improvement approach emphasizes ongoing assessments of program aims and operations. Country projects apply continuous quality improvement (CQI) strategies targeting both programmatic and management activities. Small-scale, practical Plan-Do-Study-Act (PDSA) cycles are used to construct improvement goals, test proposed changes, and implement adjustments, leading to increased quality of operations, service delivery, and care.
Integrating Research and Practice
Monitoring & Evaluation
I-TECH’s monitoring and evaluation staff work to ensure the efficacy of health care training sessions and programs by applying their expertise in cost analysis, data collection, and measurement to rigorous evaluations of these interventions.
In addition to routine monitoring and evaluation (M&E) and continuous quality improvement (CQI), I-TECH designs and implements operations research (the application of research methodology to inform and improve program design and management) and special studies for both I-TECH country programs and our partners. These activities enable us to answer strategic questions concerning the selection and effectiveness of program interventions. The team analyzes and designs evidence-based solutions to increase relevance, access, and scope of HIV services.
Monitoring ongoing projects and programs allows for midstream corrections; key findings are communicated to managers and leaders to improve programmatic decision making. Results are disseminated through publication, when appropriate.
Additionally, I-TECH has significant capacity in the rapidly expanding field of health informatics for resource-limited clinical settings. I-TECH develops tools and systems—such as the Training System Monitoring and Reporting Tool (TrainSMART)—and provides technical assistance for electronic medical records, training management, and remote clinical diagnostic systems.
I-TECH specializes in developing appropriate research designs and methods for application in resource-limited settings, to get answers to research questions in real time. A university-based program, I-TECH draws from experts in qualitative and quantitative methods in a wide range of theoretical and practical disciplines, including health economics, anthropology, health sciences, medicine, and education.
Human Resources for Health
The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated health care workforce, and sustainable systems to educate and train those workers. I-TECH uses a systemic approach to build the skills and knowledge of, and foster attitude changes in, health care staff and those who train and educate them.
The following model outlines I-TECH’s human resources for health-based approach to achieving comprehensive patient-centered care. Each component of the model, including a strong enabling environment, supports an optimized health workforce as the foundation of an effective service delivery system.
I-TECH’s distance learning and e-learning projects provide opportunities for health care professionals in resource-limited settings to gain knowledge and skills while minimizing their need to leave the workplace.
I-TECH distance learning projects typically have four goals:
- Increase the capacity of health care workers in resource-limited settings to deliver high quality care and treatment while allowing them to remain in their workplaces to provide services at their sites.
- Build the capacity of ministries of health and governmental institutions to use learning technologies and design blended learning, e-learning, and distance learning programs for health care workforce development.
- In collaboration with the UW Department of Global Health’s E-Learning Program (eDGH), provide technical assistance in effectively using e-learning, blended learning, and distance learning for health care workforce development.
Examples of I-TECH’s e-learning products are available in eDGH’s E-Learning Library.