Category Archives: Pamela Collins

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.

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 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.”