On March 28, 2024, the International Training and Education Center for Health (I-TECH), the UW Behavioral Research Center for HIV (BIRCH), and the UW Department of Global Health (DGH), hosted a conversation with two critical members of the I-TECH Ukraine team, Oksana Danylenko, MD, MPMA, and Alyona Ihnatiuk, MPH.
During Two Years of War in Ukraine: I-TECH and Healthcare System Resilience, Dr. Danylenko and Ms. Ihnatiuk presented on the impact of the war on critical infrastructure and I-TECH’s activities in Ukraine to address the impacts, including new challenges, needs, and new service delivery models, as well as calling upon action and support.
Dr. Danylenko has 20+ years’ experience working in HIV/AIDS prevention, treatment, policy, and guidelines and serves as a Strategic Clinical Lead at I-TECH in Ukraine. Ms. Ihnatiuk is a Strategic Information Lead at I-TECH Ukraine, focusing on developing public health interventions, M&E system frameworks, data analysis, and program evaluation.
In 2019, I-TECH conducted an on-site assessment at Trinidad and Tobago’s largest HIV treatment site. The findings of that assessment led to the establishment of an integrated psychosocial program at this site that has yielded favorable results. This further inspired the need for expansion of this psychosocial approach to other HIV treatment and care sites.
In 2022, I-TECH collaborated with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH) to conduct a similar rapid assessment throughout the national treatment and care sites. The results reflected that there was a need for specialized staff to identify and treat common mental health and psychosocial concerns, as well as a standardized approach. Therefore, I-TECH is supporting the HACU to lead the expansion and strengthening of mental health and psychosocial (MHPS) service delivery for persons living with HIV at HIV treatment and care sites in Trinidad and Tobago. Goals include the standardization of psychosocial assessments to support the early identification of psychological distress, symptoms of co-morbid mental illness and psychosocial issues; as well as the standardization of the procedures for making interventions.
Activities include:
Developing a draft MHPS Protocol to include screening and intervention tools and psychosocial standard operating procedures (SOPs)
Establishing a standardized referral system
Training and supporting psychosocial team members in the use of the SOPs and all screening and assessment tools. Training will address areas of intimate partner violence, gender-based violence, and mental health challenges that are frequently encountered within the client population
Training and supporting psychosocial team members in data collection and reporting requirements
Training and capacity -building of psychosocial team members of the Psychosocial Coordination Unit being established by the HACU
I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) of the Office of the Prime Minister, and other local organizations to make accessible learning and capacity-building opportunities for all cadres of health care workers.
Learning Management System (LMS): I-TECH and the University of Washington Department of Global Health’s eLearning Program (eDGH) collaborated to adapt an LMS for Trinidad and Tobago from the Jamaica LMS. The LMS for Trinidad and Tobago will support ongoing, standardized capacity-building of an increased number of health care providers in a cost-effective way. The LMS will also function as a monitoring and evaluation tool for training and skill building. I-TECH will support, develop, and adapt HIV course material and provide local administration and coordination support.
Key Populations Preceptorship Web Modules: I-TECH is currently developing self-paced, eLearning training modules to improve providers’ knowledge, skill, and comfort in providing respectful and gender-affirming care for gay and bisexual men, other men who have sex with men, people of transgender experience, and people engaging in sex work. This module will be an adaptation of the innovative in-person Key Population Preceptorship (KPP) Program for Clinicians and will be made accessible on the I-TECH/eDGH LMS that is being developed. The modules will incorporate video recordings featuring local community members, modeling of best practices, and show interactive exercises.
UW eDGH Online Courses: I-TECH, through eDGH and in collaboration with HACU and the NACC Office of the Prime Minister, provides online certification courses to health care providers in Trinidad and Tobago. Courses include: Clinical Management of HIV; Leadership and Management in Health; Fundamentals in Global Health Research; Policy Development and Advocacy for Global Health; Project Management in Global Health; Monitoring and Evaluation in Global Health; Fundamentals of Implementation Science; Wellbeing for Healthcare Professionals; and Global Mental Health.
Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported MRFTT, the HIV treatment site with the largest adult population in Trinidad and Tobago, to become an ECHO® hub site. The hub provides virtual clinical consultation support as well as brief didactic sessions for healthcare workers in Trinidad and Tobago on a range of medical/clinical and psychosocial topics, as well as those relevant to HIV care, treatment and support. Healthcare workers (HCWs) who have benefitted from the series not only include those from Trinidad and Tobago, but also HCWs from Haiti, Barbados, Bahamas, St. Vincent, Grenada, and Florida, USA.
Management of HIV Infections Diploma Course: In 2014, I-TECH partnered with the University of the West Indies (UWI) – St. Augustine campus in Trinidad and Tobago to develop a blended eLearning course that enables HCWs to provide high-quality clinical management of patients living with HIV. This ten-month post-graduate diploma program is delivered through a series of online, self-paced courses taught by UWI faculty, and is augmented by synchronous virtual classroom discussions and hands-on, clinical practicum experiences. In recent years, I-TECH worked with the UWI to integrate extensive care and treatment content specifically focused on comprehensive care for key populations affected by HIV. The course is offered annually to healthcare workers from PEPFAR priority sites in the region. Course graduates include health care workers from Trinidad, Jamaica, Suriname, and Barbados.
Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider and a preceptorship trainer (PT), who is a member of a key population group, with the observation of a training facilitator. The PT takes on the role of a mock patient and uses a pre-scripted scenario as a guide to interact with the provider-in-training, giving feedback after each scenario. The KPP builds the provider’s capacity to provide comprehensive and nonjudgmental care to key population groups including gay and bisexual men, other men who have sex with men, persons of trans experience, and sex workers.
The KPP was adapted based on Jamaica’s KPP for clinicians in 2016 for physicians in Trinidad. In 2017, it was adapted for nurses and was delivered in-person over the course of a two-day period. In response to COVID-19 protocols, the KPP for social workers, which was adapted in 2020, was delivered virtually.
I-TECH Trinidad and Tobago collaborates with local organizations to implement programs focused on supporting the health and wellness of people living with HIV (PLHIV), including:
• National HIV Helpline: The COVID-19 pandemic highlighted the need for virtual support and information on HIV testing, care, treatment, and support, and an increased need for guidance and psychosocial support for PLHIV. This prompted the need for a central line for communication and connection to the HIV/AIDS network. For World AIDS Day 2021, the National AIDS Coordinating Committee (NACC), Office of the Prime Minister, in collaboration with the HIV AIDS Coordinating Unit (HACU) of the Ministry of Health and I-TECH, launched the national HIV helpline. I-TECH provides technical assistance, training, and capacity building support to the HIV Helpline Coordinator and Active Listeners and is supporting efforts to raise the social media profile to increase caller volume.
The NACC website has a new dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable to support health and treatment for PLHIV.
•Patient Health and Literacy: In collaboration with the National AIDS Coordinating Committee (NACC), Office of the Prime Minister and a technical working group comprised of PLHIV and non-governmental organization (NGO) representatives, I-TECH developed content across nine topic areas aimed at improving PLHIV health and treatment literacy. The content was integrated into the inaugural NACC website in a dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable. Topic areas were focused on promoting and encouraging U=U with content titled: U and Your Dream Team; A healthy U; All about U and HIV; What U may get wrong; Your journey to U; U and your Partner; U in the future – HIV and Aging; U and your Baby – HIV and Pregnancy; HIV and COIVD-19 . The website is expected to facilitate wider access and reach to the PLHIV community and is the first content of its kind to provide consolidated, standardized and culturally appropriate material on HIV and AIDS treatment, care, and support in Trinidad and Tobago.
Trinidad and Tobago
Since 2005, I-TECH has been partnering with the local health ministry, national programs, and local organizations in Trinidad and Tobago to provide technical assistance and capacity building in support of the national response to HIV and AIDS. I-TECH Trinidad and Tobago is currently funded by the Health Resources and Services Administration (HRSA), through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and aims to support sustainable health systems, build healthcare worker capacity to provide comprehensive HIV treatment and care and strengthen self-advocacy for people living with HIV.
Trinidad and Tobago is part of I-TECH’s Caribbean Regional Program and collaborates with the Caribbean Training and Education Center for Health (C-TECH) to share, adapt and consolidate materials and efforts. The program also, where possible, includes participants from other Caribbean countries in its capacity-building activities.
I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) ... Read More
I-TECH Trinidad and Tobago collaborates with local organizations to implement programs focused on supporting the health and wellness of people ... Read More
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.
In collaboration with the University of KwaZulu-Natal, and The Knowledge Translation Unit, I-TECH worked with the National Department of Health ... Read More
Since 2003, I-TECH has been providing technical support and capacity building with health ministries and local organizations in the Caribbean Region to respond to the local HIV epidemic. Technical assistance has focused on continuous quality improvement, clinical mentoring of physicians and nurses, health systems strengthening, e-learning, and instructional design. Currently, the team is doing pioneering work to improve provider-patient communication with key populations affected by HIV in the region—gay and bisexual men, other men who have sex with men, transgender people, and sex workers.
In 2020, I-TECH launched the Caribbean Training and Education Center for Health (C-TECH), an independent, locally registered organization. C-TECH and I-TECH work in close partnership to support activities to improve retention in care, interruption in treatment, and viral suppression and to reduce loss to follow-up in HIV care and treatment programs. Together, the partners implement programs to strengthen access and quality of care for all people living with HIV, with an emphasis on key population groups that bear a disproportionate burden of HIV infection.
I-TECH currently works in Jamaica, Trinidad and Tobago, and Suriname and has worked in many other Caribbean countries in the past including Barbados, the Bahamas, Belize, Guyana, St. Lucia, St. Vincent and the Grenadines, St. Kitts and Nevis, Antigua and Barbuda, Grenada and Dominica.
I-TECH supports a variety of activities aimed at improving HIV care and treatment in the Caribbean region, such as on-site clinical mentoring, development of training curricula, and providing clinical support materials to improve care and treatment for HIV/AIDS in the Caribbean region ... Read More
I-TECH facilitates an HIV ECHO® program, a distance-based tele-mentoring program for providers and clinics across the region. Weekly sessions provide access to brief HIV clinical updates along with an opportunity to present and receive consultation on challenging or unusual clinical care issues from a team of multi-cadre HIV experts as ... Read More
Key, at-risk populations in the region include men who have sex with men (MSM), bisexual men, transgender women, and sex workers. In Jamaica, HIV prevalence among MSM was estimated at 32.8%,1 as compared to an estimated prevalence of 1.8% in the general adult population in 2017.1 Among transgender women, the ... Read More
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
I-TECH began working in India in 2003 at the Government Hospital of Thoracic Medicine (GHTM) as a technical partner in capacity building activities benefiting clinical and program staff assisting the National AIDS Control Organization (NACO). Through an annual residential HIV fellowship program—funded by the U.S. Centers for Disease Control and Prevention (CDC) and managed in collaboration with the Directorate of Medical Education and Tamil Nadu State AIDS Control Society—I-TECH provided clinical and leadership training to doctors.
I-TECH also played a key role in selecting, establishing and building the capacity of 10 Centers of Excellence (CoE) in HIV/ AIDS care under NACO, who is, in turn, responsible for providing technical mentoring and trainings to all 540 Antiretroviral Therapy (ART) Centers across the country.
I-TECH India Private Limited (I-TECH India PL) was established as an independent entity in India in 2015 but remains closely affiliated with its longtime partner, the University of Washington. I-TECH India PL works with national and state governments and organizations to create robust and well-organized health systems through: better service delivery, capacity building of the health workforce, enhancement of health information systems and data quality, and formulation of guidelines and operating procedures.
I-TECH remains the lead partner to the Government of India and the CDC for implementation of HIV/ AIDS care and treatment activities in India. We support interventions at the national, regional, and site level, including online learning programs for health professionals in the Southeast Asia region. I-TECH India PL program activities are in line with the UNAIDS 95-95-95 targets and focused on the “middle and third 95” through work in cluster regions of Maharashtra and three North Eastern states of Nagaland, Manipur and Mizoram.
I-TECH India PL is part of various national ART and testing guideline groups of NACO in India, including Journey of ART Programme in India; HTS Guidelines; ART Guidelines for HIV-Infected Adults and Adolescents, May 2013; National Guidelines on Second-line and Alternative First-line ART For Adults and Adolescents, May 2013; Operational ... Read More
I-TECH India PL has successfully designed and implemented four differentiated ART service delivery models, including models for key population clients, in collaboration with other stakeholders in states of Maharashtra, Nagaland, Manipur and Mizoram to develop a proof of concept for the national level scale up; Improved delivery of health services ... Read More
I-TECH India PL has provided national, state, and facility level technical assistance for improving quality, analysis and presentation of ART program data; developed innovative tools for tracking program progress based on data analysis of selected indicators over a period of time and submitted for national scale-up; and provided technical mentoring ... Read More
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 level; ... Read More
Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported 
Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider and a preceptorship trainer (PT), who is a member of a key population group, with the observation of a training facilitator. The PT takes on the role of a mock patient and uses a pre-scripted scenario as a guide to interact with the provider-in-training, giving feedback after each scenario. The KPP builds the provider’s capacity to provide comprehensive and nonjudgmental care to key population groups including gay and bisexual men, other men who have sex with men, persons of trans experience, and sex workers.
