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Best Practices

To address the UNAIDS Sustainable Development Goals for elimination of HIV/AIDS, tuberculosis, malaria and other diseases by 2030, and the PEPFAR 3.0 goals, I-TECH leverages the technical expertise of its universities and partners, the broad experience of its funders, and best practices from 15 years of implementing programs.

 

Transition & Sustainability

The International Training and Education Center for Health (I-TECH) works in partnership with host country governments, universities, professional associations, non-governmental organizations, private sector groups and funding agencies to strengthen local capacity and build sustainable health systems.

I-TECH follows a partnership model that guides the provision of technical services and technical assistance toward local ownership and sustainability, creating projects and programs that can be readily transitioned into national systems.

Based at the University of Washington, I-TECH draws upon a strong global network of public health professionals. The approach described in this document is customized in each country to respond to local needs and priorities. In addition, each I-TECH country office team aligns the model with the unique Partnership Framework Implementation Plans of the partner host government.

1. IDENTIFY NEEDS in consultation with host country governments

I-TECH works with host country governments to assess existing health systems and identify specific areas where the delivery of health care could be improved. This early collaboration helps to ensure that technical assistance accurately reflects the country’s specific health strategies and priorities.

2. STRUCTURE PARTNERSHIPS that integrate projects into existing systems

In each partnership, I-TECH develops roles, responsibilities, and timelines based on a long-term vision of integrating projects into existing national systems. As part of this vision, I-TECH recognizes and leverages the strengths and resources of national systems, building on and maximizing these efficiencies. The partnerships that emerge are attuned to the needs, realities, and structure of host country systems. Thus, they build and maintain lasting capacity within host country systems, maximize cost-effectiveness, and produce projects that can be more readily scaled up to meet national goals.

3. SECURE TECHNICAL RESOURCES from affiliated universities, partners, and the I-TECH network

As a center based at the University of Washington, I-TECH has direct access to a wide variety of technical specialists. In addition, I-TECH draws upon a robust global network of locally based public health professionals. These specialists provide a wide range of technical expertise to meet project needs.

4. PROVIDE TECHNICAL ASSISTANCE AND SERVICES tailored to actual needs and resources

I-TECH is committed to technical services and technical assistance approaches that build upon and support the existing strengths of local health systems. In addition, I-TECH prioritizes the use of local and regional expertise, an approach that builds the capacity of local experts to meet locally determined needs.

5. MONITOR PERFORMANCE; evaluate achievement of objectives and measure outcomes

I-TECH implements projects within a quality improvement framework designed to track progress in institutional capacity building and guide successful implementation. Using the framework, implementers monitor the progress of each project against specific benchmarks of success; for example, the progressive transfer of skills and capacity to local institutions. This methodology ensures that objectives are met and provides data to adjust approaches as projects evolve.

6. TRANSITION PROJECT into national systems to ensure sustainability

The ultimate goal of I-TECH’s partnership model is to improve health outcomes by strengthening local capacity and building sustainable health systems. I-TECH’s technical services and technical assistance are tailored from the initial planning stage to produce projects that can be successfully absorbed into national systems within mutually determined and realistic timeframes. Recognizing that a successful transition takes time, I-TECH offers transition support in a variety of technical areas including quality improvement and grant management.

Mental Health

Mental health and substance use disorders are a growing global burden that is responsible for one out of every ten lost years of health. Additionally, people living with HIV experience higher rates of common mental health conditions, such as depression, which can pose a threat to the success of treatment programs and contribute to decreased antiretroviral therapy adherence.

In South Africa, I-TECH worked with local partners and the National Department of Health to integrate mental health services into routine primary and chronic care as a way to increase access to care, ensure treatment adherence, and improve patient engagement through the Mental Health Integration (MhINT) program.

Past Programs

Mental Health Integration (MhINT) Program in South Africa

In collaboration with the University of KwaZulu-Natal, and The Knowledge Translation Unit, I-TECH worked with the National Department of Health ...
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Recent Presentations

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.

Program Highlights

Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania
High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization's (WHO) recommendation to “Treat All," eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) ...
Read More
Clinical Mentoring in Haiti
I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
Read More
Continuous Quality Improvement Collaborative in the Caribbean
Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region, enabling multidisciplinary teams at health facilities to work toward a common goal of improving care and treatment for HIV-positive patients ...
Read More
Differentiated HIV Service Delivery Models in Tanzania
In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania ...
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Key Populations

Key populations (KP) bear disproportionate burdens of HIV infection. Globally, new infections among KPs and their sexual partners account for 36% of all new HIV infections.1 Achieving the UNAIDS “fast track” treatment targets will require a renewed and focused approach to identify most at-risk and vulnerable populations and respond to their specific needs.

Evidence suggests that KPs—notably men who have sex with men (MSM), people who inject drugs, sex workers, and transgender persons—are underserved and face violence, criminalization, ineffective policies that don’t protect their rights, and stigma and discrimination, including in health care settings. This reality prevents KPs from accessing needed HIV prevention and care services, leading to low service coverage, an important driver of ongoing HIV transmission in many resource limited settings. Young women and girls are also increasingly at risk of acquiring HIV. Acquisition of HIV is often associated with the incidence of unintended pregnancies, transactional sex, and gender-based violence.

1UNAIDS, Gap Report, 2016.

Program Highlights

Continuous Quality Improvement Collaborative in the Caribbean
Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region, enabling multidisciplinary teams at health facilities to work toward a common goal of improving care and treatment for HIV-positive patients ...
Read More
Differentiated HIV Service Delivery Models in Tanzania
In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania ...
Read More
eLearning Programs in the Caribbean
I-TECH has partnered with universities and ministries of health (MoH) in the region to develop accessible in-service training opportunities for HIV providers using distance and blended learning ...
Read More
Expanding HIV Care and Treatment in Zimbabwe
The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:

  • Diagnose 95% of all persons living with HIV through integrated testing
  • Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained ...
    Read More

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Gender/Women & Girls

UNAIDS estimates that there are 870,000 new HIV infections among women and girls each year.1 Globally, adolescent girls and young women often lack adequate health care services; access to programs that prevent and address violence; and access to HIV/STI education, testing, and treatment.

I-TECH has worked to increase access and improve health care programs and services for adolescent girls and young women through innovative in-service training in Tanzania, supporting the build of a gender-based violence database in Kenya, building clinician capacity in the Caribbean region, and starting the DREAMS program in Namibia.

1UNAIDS, 2017

Program Highlights

Expanding HIV Care and Treatment in Zimbabwe
The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:

  • Diagnose 95% of all persons living with HIV through integrated testing
  • Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained ...
    Read More
Pre-Exposure Prophylaxis for HIV Prevention in Namibia
I-TECH began supporting the implementation of pre-exposure prophylaxis (PrEP) as part of Namibia’s combination HIV prevention strategy in 2017 ...
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Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women (DREAMS) in Namibia
In 2017, I-TECH began the DREAMS program in Khomas and Zambezi regions. The DREAMS program aims to reduce HIV infections among adolescent girls and young women (AGYW) through a core package of evidence-based interventions across health, education, and social sectors. At a safe space such as a school or community ...
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Health Information Systems in Kenya
In 2012, I-TECH designed and developed an electronic medical records (EMR) system, KenyaEMR, to support the care and treatment of HIV/AIDS. KenyaEMR is built on the OpenMRS platform. I-TECH supported the implementation of KenyaEMR in over 300 health facilities throughout Kenya—one of the largest open source EMR rollouts in Africa ...
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Implementation Science

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.

Program Highlights

Ensuring High-Quality Service Provision in Zimbabwe
Describing Adverse Events within VMMC Programs at Scale I-TECH works diligently to review and revise procedures to identify, manage, and report adverse events (AEs). I-TECH’s previous publications on AEs reveal efforts to maintain high quality programming and emphasize patient safety alongside achievement of targets. An evaluation published in the Journal ...
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Laboratory Quality Stepwise Program in Cambodia
From September 2013 to September 2016, I-TECH conducted an implementation science research project to improve laboratory quality in Cambodia. The primary objective of the project was to implement a mentored laboratory quality stepwise implementation (LQSI) program to strengthen the quality and capacity of Cambodian hospital laboratories. As a result, target ...
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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.

Program Highlights

Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania
High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization's (WHO) recommendation to “Treat All," eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) ...
Read More
Building the Capacity of the Health Workforce in India
I-TECH India PL has worked with stakeholders to develop national training curricula for health care staff on delivering HIV care and treatment services. In addition, it has:

  • Planned and implemented training programs for various cadres of clinical and program staff;
  • Participated in medical officer training programs at the national ...
    Read More
Clinical Mentoring in Haiti
I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
Read More
Field Epidemiology Training Program (FETP) in Tanzania
For Tanzania to meet a WHO-specified target of one or more epidemiologists per 200,000 population [1] it will require an additional 250 epidemiologists who are well-trained and geographically distributed in all regions of the country. To help address this gap, I-TECH, in collaboration with the Centers for Disease Control and ...
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e-Learning/Distance Learning

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:

  1. 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.
  2. 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.
  3. 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.

Program Highlights

Building the Capacity of the Health Workforce in India
I-TECH India PL has worked with stakeholders to develop national training curricula for health care staff on delivering HIV care and treatment services. In addition, it has:

  • Planned and implemented training programs for various cadres of clinical and program staff;
  • Participated in medical officer training programs at the national ...
    Read More
Continuous Quality Improvement Collaborative in the Caribbean
Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region, enabling multidisciplinary teams at health facilities to work toward a common goal of improving care and treatment for HIV-positive patients ...
Read More
eLearning Programs in the Caribbean
I-TECH has partnered with universities and ministries of health (MoH) in the region to develop accessible in-service training opportunities for HIV providers using distance and blended learning ...
Read More
Global Health Security Agenda in Kenya
I-TECH Kenya’s Global Health Security (GHSA) funded programs aim to advance the GHSA  through strengthening information systems and reporting ...
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Clinical Mentoring

Clinical mentoring is a critical component of I-TECH’s comprehensive approach to training, as it provides a bridge between didactic training and independent clinical practice. Clinical mentoring enables health care workers (HCW) to practice new skills in clinical settings with the support and guidance of a more specialized and experienced clinician. Intensive, practical training is especially important in HIV care and treatment given the diversity of illnesses associated with AIDS and the complexities of antiretroviral therapy (ART).

Typically, the clinical mentor is an experienced clinician-trainer who provides onsite training and consultation on complex cases; supports and enhances high level problem solving, diagnostic, and decision-making skills; leads case discussions; and addresses issues of quality assurance and continuing education. These mentoring activities take place in the context of an ongoing, two-way relationship between the mentor and the clinicians working at the site.

The I-TECH approach to mentoring includes five key components:

  1. Relationship building. The establishment of a trusting, receptive relationship between the mentor and mentee(s) that evolves and grows over the course of mentorship is the foundation of effective mentoring practice.
  2. Identifying areas for improvement. Observation and assessment of existing systems, practices, and policies leads to the identification of areas for improvement. I-TECH has developed a number of tools for use during the assessment phase. Information obtained during an assessment helps to inform the establishment of goals and objectives for the mentorship.
  3. Responsive coaching and modeling of best practices. Mentors must demonstrate proper techniques and model good clinical practice. Targeted activities with mentees may include demonstrating appropriate examination techniques, modeling proper infection control measures, and setting examples for establishing good rapport with patients.
  4. Advocating for environments conducive to quality patient care and provider development. This component relates to technical assistance in support of systems-level changes at a site. Mentors work with colleagues to enhance the development of clinical site infrastructure, systems, and approaches that can support the delivery of comprehensive HIV care.
  5. Data collection and reporting. Mentors support the utilization and integration of patient data into clinical practice by encouraging staff to adopt documentation practices that promote effective chronic disease management. Mentors can help demonstrate the utility of data collection and reporting to mentees during mentorship.

The ultimate goal of I-TECH’s clinical mentoring programs is to build the skills of local clinicians to become clinical mentors themselves. Ideally, as the pool of expert HIV/ART clinicians in each country expands, a network of local HIV clinical mentors will emerge to support and train other HIV clinicians with less experience.

Program Highlights

Advanced Disease and Patient Care/Cryptococcal Antigen Screening and Treatment in Tanzania
High-quality, effective, and evidence-based service delivery for HIV care and prevention requires a broad continuum of integrated and linked services to ensure consistent and high-quality client management over time. With the World Health Organization's (WHO) recommendation to “Treat All," eligibility for antiretroviral therapy (ART) among People Living with HIV (PLHIV) ...
Read More
Case Finding and Retention in Care in Mozambique
I-TECH works with the Mozambique Ministry of Health (MISAU) to expand a pilot project to provide an assisted partner services intervention. The project is aimed at encouraging patients newly diagnosed with HIV infection to disclose their status to their partners, and bring them to the clinic for testing ...
Read More
Clinical Mentoring in Haiti
I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds ...
Read More
Continuous Quality Improvement Collaborative in the Caribbean
Since 2013, I-TECH has led quality improvement (QI) collaboratives in the Caribbean region, enabling multidisciplinary teams at health facilities to work toward a common goal of improving care and treatment for HIV-positive patients ...
Read More

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