Category Archives: Pamela Collins

I-TECH to Expand Psychosocial and Gender-based Violence Support in Trinidad and Tobago

From left to right: Conrad Mitchell, Program Coordinator, I-TECH Trinidad; Belinda White, Clinical Psychologist, I-TECH Trinidad; Heather Rodney, Chairperson, NACC Secretariat; Ian Ramdahin, Permanent Secretary, NACC Secretariat; Dr. Omoye Imoisili, Senior Public Health Analyst, HRSA; Aliyah Abdul Wakil, Strategic Information, HRSA; Alana Lum Lock Cardinez, Program Advisor, I-TECH Trinidad; Misti McDowell, Program Director, I-TECH headquarters.

Recently, representatives from the International Training and Education Center for Health (I-TECH) met with health officials in Trinidad and Tobago to discuss potential areas of support for strengthening the national response to HIV and AIDS in the country.

Several activities discussed focused on strengthening advocacy for people living with HIV (PLHIV); psychosocial support for vulnerable PLHIV; and providing services at the intersection of HIV and AIDS and gender-based violence (GBV).

With support from the Health Resources and Services Administration (HRSA), I-TECH has worked in Trinidad and Tobago since 2009, collaborating with the Ministry of Health and other partners to focus on healthcare worker training and technical assistance to improve the quality of care for PLHIV.

“I’ve always been impressed with the team and activities in Trinidad and Tobago,” says Misti McDowell, I-TECH Program Director, “especially the integration of much-needed mental health services into the HIV program.”

The assessment “Strengthening Delivery and Oversight of Mental Health and Psychosocial Services for PLHIV in Trinidad and Tobago” was completed by I-TECH and shared with the National AIDS Coordinating Committee (NACC), in an effort to identify future areas of collaboration. One of the intended outcomes is the establishment of a technical working group of national stakeholders who will collaborate with I-TECH to craft a strategy for implementing all priority interventions.

“The findings of this assessment revealed that there is a tremendous need for improved mental health support specifically in the areas of assessment and treatment throughout the national HIV treatment and care sites,” says Belinda White, Clinical Psychologist with I-TECH. “One treatment and care site reported that as much as 90% of its client population experiences symptoms of mental illnesses.”

The most common mental illnesses encountered within treatment and care sites include depression, anxiety, bipolar disorder and schizophrenia; substance use disorder is also common within the PLHIV client population. A key area of interest is the integration of the collaborative care model into the already existing treatment and care system, in a manner that incorporates the unique features of each site. Collaborative care is an evidence-based approach that integrates behavioral and physical health.

I-TECH also assisted the NACC with the establishment of the National HIV Helpline and will continue to provide support over the next six months, while working to transition the program fully to NACC. This includes support for the HIV Helpline Coordinator and Active Listeners, as well as training of new Active Listeners.

“We must continue fighting the stigma associated with living with HIV,” says Conrad Mitchell, Program Coordinator. “It’s important to continue to battle misinformation and to have that coupled with positive true-life experiences. The Helpline–manned by persons living with HIV together, with HIV NGO advocates and allies–provides a unique opportunity to combat misinformation though empathy and education in direct, one-on-one engagements with the public.”

A 2017 Inter-American Development Bank (IDB) National Women’s Health Survey for Trinidad and Tobago[1] showed that more than 30 percent of women in Trinidad and Tobago had reported having experienced at least one incidence of either physical or sexual partner violence. The NACC is seeking support related to GBV and the risks it poses to the health and well-being of PLHIV. Activities would focus on raising awareness and providing resources and psychosocial support for vulnerable groups.

“There is a lack of general knowledge about GBV and what it entails among the public as well as in some health care settings,” says Ms. White. “There is an opportunity to yield enormously positive results by increasing the knowledge and insight of health care workers, and people living with HIV, regarding GBV.

“My hope is that the information that is shared empowers people living with HIV to advocate for themselves if they come to the realization that they are experiencing,” she continues, “and to make contact with the local resources that are available to receive the necessary support.”

I-TECH will also seeks to help strengthen civil society organizations through enrollment in I-TECH-developed courses such as UW Leadership and Management in Health, Fundamentals of Implementation Science, Project Management in Global Health, Global Mental Health, and Policy Development and Advocacy for Global Health.

[1] https://publications.iadb.org/publications/english/document/National-Women-Health-Survey-for-Trinidad-and-Tobago-Final-Report.pdf

 

I-TECH Celebrates 20 Years

In 2008, I-TECH Mozambique celebrated I-TECH’s sixth birthday. “Sempre crescendo” = “always growing.”

On April 1, the International Training and Education Center for Health (I-TECH) celebrates 20 years since its founding. It has since grown into the largest center in the Department of Global Health (DGH) and one of the largest centers at the University of Washington (UW).

“We are proud to mark this milestone,” says Dr. Pamela Collins, Executive Director of I-TECH, Professor of Psychiatry and Behavioral Sciences, and Professor of Global Health at UW. “For 20 years I-TECH has helped to save lives through its support of public health systems in the Caribbean, Europe, Africa, and Asia. Over the years, our scope has broadened, but responsive partnerships with ministries of health, collaborating NGOs, and our donors have been central to the work.”

I-TECH comprises a global network, operating in 17 countries, that fosters healthier communities around the world through equitable partnerships in research, training, and public health practice. Its work is rooted in health care training and draws on a culturally rich community that includes UW faculty, global partners, and U.S. and global staff and students. This community of people with diverse backgrounds, experiences, and opinions encourages learning from one another while working toward high quality, compassionate, and equitable health care.

“COVID-19 has reminded me, and many of us, about the critical and life-saving role of health care workers, a group that often lacks proper support,” says Ivonne X. “Chichi” Butler, Associate Director at I-TECH. “At the same time, collectively, we have come to understand the urgent need for stronger and better prepared health systems to respond to the COVID crisis.

“At I-TECH, these concerns have been at the heart of our work for the past 20 years,” she continues. “We have invested–and continue to invest–in health workers and in the systems in which they work. I am proud to be part of a center that has transformed the delivery of HIV care and treatment in so many countries and that truly puts individuals and communities at the forefront to meet their particular needs.”

I-TECH began in 2002 with its first award, the International AIDS Education & Training Center (IAETC) grant. The IAETC was administered by the Center for Health Education and Research (CHER), within the Department of Health Services (now the Department of Health Systems and Population Health). This was one of CHER’s first forays into what would become known as “global health.”

“The IAETC award was the first of its kind at UW,” says Shelly Tonge-Seymour, Associate Director of I-TECH, who has been with the center for 20 years, “the first to translate lessons from the U.S. to improve the training of health care workers and delivery of care globally.”

With the advent of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, I-TECH’s portfolio expanded rapidly, reflecting the evolution of PEPFAR from “emergency” to a longer-term investment in health systems strengthening. I-TECH became an official UW center in 2008, a year after joining UW’s new Department of Global Health at the invitation of Dr. King Holmes, then-chair of DGH. “It became clear that we had grown so large that we needed our own administrative core,” says Tonge-Seymour.

Through its work with PEPFAR, I-TECH’s efforts have contributed meaningfully to the huge advancements in HIV prevention, care, and treatment seen across the globe, with a particular emphasis on groups that have been marginalized or stigmatized.

“One of the most powerful changes in the past 20 years in the Caribbean Region has been in the attitude toward key population groups,” says Natalie Irving-Mattocks, Executive Director of the Caribbean Training and Education Center for Health (C-TECH), one of I-TECH’s independent partner organizations. “Through the Key Populations Preceptorship Program, I-TECH has contributed significantly to better health in the Caribbean region by training healthcare workers to provide nonjudgmental, high-quality, comprehensive HIV care to men who have sex with men, transgender women, and sex workers.”

C-TECH is just one of the independent organizations I-TECH has helped to establish worldwide. Once operating as I-TECH Zimbabwe, the team at the Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH) has a long history of partnering with local organizations and community-based health care workers to increase access to care.

“I’ve been involved with I-TECH for its entire 20 years, and the most impactful thing for me has been the contribution I-TECH has made in Zimbabwe to supporting the development of lay cadres into primary counselors,” says Abisha Jonga, Senior Program Manager at Zim-TTECH. “This program created a career path for so many, made HIV counseling services more accessible to the general population, demystified HIV testing, and shaped the individuals’ lives.”

Dr. Batsi Makunike, Executive Director of Zim-TTECH, agrees that fostering local connection has been the key to success. “I am particularly proud of the fact that I-TECH has succeeded in nurturing local organizations,” says Dr. Makunike. “Providing full support without competition–that is huge. Without I-TECH, there would be no Zim-TTECH.”

Malawi has seen its health care landscape change dramatically in the past 20 years and is now close to meeting the UNAIDS 95-95-95 targets for the elimination of HIV. Since 2008, I-TECH has partnered with the Malawi Ministry of Health’s Department for HIV and AIDS and helped to generate pioneering policy initiatives such as the 2011 adoption of Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV. Option B+ provides universal, lifelong ART for pregnant and breastfeeding women. Based on Malawi’s documented success, the World Health Organization formally adopted Option B+ as a global policy in 2013.

“We truly believe that I-TECH has significantly contributed to the prevention of thousands of infant infections and AIDS deaths among children, adolescents, and mums and dads in Malawi,” says Dr. Andreas Jahn, Senior Technical Advisor with I-TECH Malawi. “We have walked this journey with a whole generation of Malawian HIV program colleagues, and we have learned a tremendous amount from each other.”

I-TECH’s funding has grown from $500,000 for its initial award in 2002 to a cumulative total of more than $1 billion. The center currently has 26 awards, harnessing UW technical expertise in multiple technical areas from mental health to electronic health information systems to global health security and emerging health threats.

As I-TECH has adapted to changing needs, at its core remains a commitment to creating equitable partnerships and facilitating knowledge sharing throughout the I-TECH network, which includes I-TECH’s own country offices, independent partner organizations fledged from I-TECH, ministries of health, academic institutions, community groups, and others.

“When I reflect on the success of I-TECH in reaching the age of 20, two observations keep coming up for me,” says Dr. Ann Downer, co-founder and former Executive Director of I-TECH and Professor Emeritus in the Department of Global Health. “One is about the power of unity. I believe that the ability of a diverse group of individuals and teams to hold a common vision and set of values generates resilience. This unity allows I-TECH to continue operating after 20 years with integrity and grace across enormous geographic, linguistic, and cultural borders and despite regular economic and social challenges.

“The other observation is about the importance of encouraging leadership from all parts of an organization,” she continues. “This requires us to embrace the value of humility and results in our ability to listen and learn. Both are critical actions for successful work anywhere but are essential for working ethically on a global stage.”

The I-TECH story continues to unfold. From a modest grant with limited staff to a vital, resilient, and animated worldwide network of more than 1,600 dedicated personnel, I-TECH will continue to work alongside its global partners in its commitment to stronger health systems and safer, healthier communities.

“There’s so much to celebrate and a wealth of lessons to light the way forward,” says Dr. Collins. “In this era of pandemic, war, and fractured communities, our vision for health is needed now more than ever.”

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, the U.S. Centers for Disease Control and Prevention (CDC) 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 and in partnership with CDC, 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.

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.”