I-TECH, in close partnership with voluntary medical male circumcision (VMMC) implementing partner, the Aurum Institute and technology partner, Medic, is conducting a five-year study funded by the National Institutes of Health to further evidence on the efficiency, safety, and scalability of two-way text-based (2wT) follow-up for VMMC services.
2wT is SMS-based telehealth, providing direct patient to provider communication that improves the quality of post-operative VMMC care. A daily educational message is sent to each participant, requesting a response to report potential complications. 2wT allows the nurse to triage men to care when needed or desired while supporting most men to heal independently at home. 2wT-based follow-up dramatically reduces unnecessary post-operative visits, saving patient and provider costs, while improving patient care quality through swift identification and referral for potential adverse events. In South Africa, the 2wT intervention benefits were similar across routine VMMC programs in both rural and urban settings.
For nearly a decade I-TECH has worked in Côte d’Ivoire in collaboration with the US Centers for Disease Control and Prevention to develop and implement an electronic laboratory information system (LIS) in key laboratories. In order to respond to evolving data needs and ensure timely access to quality laboratory data, an electronic LIS requires ongoing development and continuous user training and technical support.
Previously, from 2015-2017 I-TECH worked closely with the Ivorian Ministry of Health and Public Hygiene (MSHP)’s Directorate of Informatics and Sanitary Information (DIIS) to identify, develop and reinforce the capacity of local professionals to lead and conduct LIS training, deployment, and maintenance activities in anticipation of national roll-out of the LIS at 96 general hospital laboratories. As part of this effort, and in collaboration with the DIIS, I-TECH trained users and deployed LIS at 13 national and regional level laboratories. Between 2013 and 2015, the total number of local professionals competent in LIS deployment increased to 24 local LIS support providers, while the number of in-country LIS trainers increased to 27. Within ten months, local IT providers and trainers trained over 75 health care workers to use an LIS and implemented an LIS at 36 laboratories. During supervision visits to 26 laboratories, within 4 to 6 months post-installation, 25 out of 26 (96%) of laboratories were actively using the LIS.
More recently, Côte d’Ivoire International Training and Education for Health (I-TECH CIV), I-TECH’s local partner in Côte d’Ivoire, has started working directly with CDC and DIIS and continued to engage I-TECH computer developers and deployment strategists to continue the progress with LIS.
I-TECH continues to make considerable progress with code base development for OpenELIS. For more information, visit the OpenELIS Global website.
“I-TECH prides itself on working collaboratively with our international partners. We held the principle from day one that the most successful programs happen when the locus of control sits in-country,” said Marrianne Holec, Senior Program Manager at I-TECH. “We had the foundation in place with our local staff, what was missing was the organizational structure to allow the team in-country to truly lead the project. With the formation of Zim-TTECH, I’m happy to say we are there.”
Among USG funders, it’s recognized that future models for sustainable healthcare rely on local country ownership and leadership. But making the transition from US-based ownership to country ownership isn’t a one-time event, added Holec, “It’s a process that takes time. We wanted to document our process so that other international organizations who are looking to pursue decolonizing global health programming can learn from our experience.”
Through 16 key informant interviews, the team gathered views on transition planning, implementation, and technical support, ethics, and success. Five themes emerged from the data collected:
Develop a vision and empower leadership for change by delegating clear roles and supporting local ownership;
Plan and strategize for transition in a manner that accounts for historical context;
Communicate with and inform stakeholders to understand transition perceptions, understand barriers to transition, and enable open communications related to risks and benefits;
Engage and mobilize staff by constructing necessary infrastructure and providing technical assistance as needed; and
Define short-term and long-term success.
“Sustainability of successful donor funded public health programs is critical if we want to maintain the important gains that have been made over the years,” says Dr. Batsi Makunike, Executive Director of Zim-TTECH. “Strong local organizations with good governance, management, and technical capacities are an important cornerstone of sustainability.
“The process of transitioning from an international to a local organization is daunting,” she continues. “We hope that this study is helpful to other organizations in their efforts to transition.”
 Goosby E, Von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the Bar: PEPFAR and New Paradigms for Global Health. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2012;60.
The initiative, conducted in partnership with the U.S. Centers for Disease Control and Prevention (CDC) and the Faculty of Medicine and Pharmacy (FMP) of the Université d’État d’Haïti, aims to contribute to the strengthening of human resources in health, increasing the number of qualified clinicians in Haiti. The year-long training comprises theoretical and practical components; this cohort’s practica took place at seven different university hospitals and other health institutions around the country.
“Haiti faces a serious problem of shortage of human resources in health, due in part to the ‘brain drain’ abroad,” says Dr. Jean Guy Honoré, Executive Director of CHARESS. “In some health facilities located in remote parts of the country, there are no physicians, and patients are seen by nurses who sometimes have limited knowledge of the management of infectious pathologies. This training aims to improve the skills of these nurses.”
This aptly fits the vision of CHARESS, which is “to be the reference center, in terms of training, research and technical assistance, allowing populations to receive quality care, with humanity,” says Dr. Honoré. Two other cohorts of nurses have already started this specialized training.
Dr. Bernard Pierre, Dean of the FMP, expressed a wish to strengthen the collaboration between the FMP and CHARESS to extend similar specialized training to doctors — in particular, general practitioners.
I-TECH and its partners have been working in Haiti since 2006, delivering training, clinical mentoring, health information systems, and other health systems strengthening interventions.
Julianne Meisner, PHD, MS, BVM&S, is an epidemiologist, veterinarian, and Assistant Professor in the Department of Global Health at the University of Washington (UW), researching issues related to One Health and pandemics. Her work focuses on human health at the human-animal-environment interface, with an emphasis on novel pathogen emergence, the human health effects of livestock keeping, and anticolonial approaches to global One Health research. She has many years of experience conducting linked human-animal research among livestock-keeping communities in sub-Saharan Africa, and strong teaching and research interests in epidemiologic methods and biostatistics, in particular spatial epidemiology and methods for drawing causal inference from observational studies. She holds her veterinary degree from the University of Edinburgh, and her MS and PhD in Epidemiology from UW.
Her current projects focus on novel virus emergence at high-risk human-animal interfaces in South America, Africa, and Asia, and the role of land use change in disease emergence; methods for modeling human-animal contact networks for more accurate modeling of disease transmission between animals and humans; the role of land tenure and land rights in human and animal health; and One Health surveillance system strengthening.
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.
The meeting attendees discussed 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. The Collaborative Care Model is an evidence-based approach to treating common mental health conditions (e.g., depression, anxiety) in primary care settings and was developed at the University of Washington.
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 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.”
On 18-19 May 2022, the International Training and Education Center for Health (I-TECH), in collaboration with the Programme National de Lutte Contre le Sida (PNLS; National AIDS Control Program) under the coordination of the General Directorate of Health, hosted its first national HIV prevention, care, and treatment quality improvement (QI) conference in Abidjan, Côte d’Ivoire. The conference brought together over 100 representatives from the Centers for Disease Control and Prevention, United States Agency for International Development, the Human Resources and Services Administration (HRSA), US President’s Emergency Plan for AIDS Relief (PEPFAR), and PEPFAR implementing partners from around the country to agree on a national approach to QI; update the national strategic plan for improving Quality, Health, and Safety; and learn about the unique QI approach being implemented by I-TECH through the Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) program.
“This is an historic workshop. [There have been] many conversations and meetings with the PNLS/Ministry of Health and USG agencies [over the years] to gather all the stakeholders to harmonize QI interventions,” says Dr. Jean T. N’Guessan, QISSEC QI Consultant. “This national QI workshop was a success because the leadership was carried by the PNLS, the national Program to fight AIDS, and supported by I-TECH.”
The goal of the conference was to elevate QI practices on a national level and work with stakeholders to adopt and integrate the QISSEC QI approach into their own HIV prevention, care, and treatment programs to improve HIV services while identifying and addressing gaps in care (e.g., viral load monitoring, antiretroviral therapy uptake).
“In Côte d’Ivoire, all hospitals—both public and private—are required to implement continuous quality improvement for all care and services, which can lead to a one-size-fits-all approach to QI,” explains Dr. Nathalie Krou Danho, I-TECH QISSEC Project Director. “This workshop made it possible for us to identify gaps in national standards for the prevention, care, support, and treatment of HIV infection, while also providing an effective QI framework that helps clarify the roles and responsibilities of the stakeholders implementing QI initiatives across the country.”
QI interventions are often applied unilaterally across all sites regardless of analysis of the sites’ specific needs, but I-TECH’s approach tailors each QI intervention and related activities to the needs of the site according to self-identified gaps by the sites. This approach allows sites to be involved in each step of the process, reinforces skills and knowledge, and ultimately creates a sustainable approach to QI. By using the QISSEC approach, HIV programs around Côte d’Ivoire will be able to align their QI work and substantially improve HIV services, while also fulfilling PEPFAR priorities and targets.
“Since I-TECH’s approach works in collaboration with all levels (national, district, and site) of the health system pyramid, we are able to coach sites to develop a QI plan based on the identified gaps, implement it, as well as monitor and evaluate it,” says Dr. Nathalie Krou Danho. “Through data analysis of MER indicators and SIMS data, the approach takes into account the organizational improvement of the quality and the services offered to the patients.”
The QISSEC project, a five-year cooperative agreement with HRSA under PEPFAR, works with local partners to implement customized site-level QI interventions using patient-centered approaches in clinics to ensure a facility-owned and locally led response to the persistent challenges seen in HIV prevention, care, and treatment programs (e.g., HIV testing, retention, suppression, PrEP, TB prevention) and support Côte d’Ivoire in reaching the UNAIDS 95-95-95 targets. The project has initially been focused on 60 priority sites throughout the country but plans to expand to Abidjan’s 75 high-impact sites next year, bringing the total number of sites to 101.
“The QISSEC project aims to strengthen ownership of continuous QI at all levels of the health system pyramid,” says Dr. Nathalie Krou Danho. “To do this, I-TECH collaborates with all national stakeholders, including PEPFAR implementing partners and civil society organizations who can help motivate beneficiaries to take part in QI efforts and extend its QI approach to the community.”
I-TECH’S WORK IN CÔTE D’IVOIRE IS SUPPORTED BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) UNDER 1 U1NOA45176-01-00 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.
After facing incredible obstacles, three resilient 22-year-old women from Tsholotsho District, Zimbabwe, found their lives intersecting: Sitheni, Clemencia, and Faith are DREAMS ambassadors, equipping adolescent girls and young women with skills to reduce their vulnerability to contracting HIV–and helping them to find their own strengths.
DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) is a PEPFAR-funded program that aims to reduce HIV infections among adolescent girls and young women through not only prevention and treatment, but also a core curriculum that addresses HIV prevention, financial literacy, and gender-based violence (GBV). Participants can also access services such as HIV testing, family planning, pre-exposure prophylaxis (PrEP), counseling, and screening for GBV.
The International Training and Education Center for Health (I-TECH) has been supporting the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH) and its ZimPAAC consortium to implement the DREAMS program since 2020. To date, nearly 20,000 girls and young women in Zimbabwe have completed the primary DREAMS curriculum, Health for Life.
Sitheni, Clemencia, and Faith were initially enrolled in the DREAMS program as beneficiaries, having turned to transactional relationships (trading sex for money or necessities) to survive poverty amid the deepening economic crisis in Zimbabwe. They now use their own experiences to give back to young women who face similar choices.
Sitheni had to abandon her life-long goal of attending university to support her parents and four siblings; carrying the burden of sole provider for her family took a toll on her. When earnings from her part-time jobs weren’t enough, she became involved in sexual relationships with older, cross-border traders—known as omalayitsha—to make extra money.
Once enrolled in the DREAMS program, she thrived within the Health for Life courses, which cover financial literacy, social asset building, condom education, and violence and HIV prevention. “I encourage young girls in my community not to depend on men, but to use their skills instead of waiting to be given money by men who will abuse them,” Sitheni says.
Training and services are often provided in a safe space such as a school or community center, where participants meet with a mentor trained to deliver the Health for Life curriculum.
“At the moment I mentor 140 adolescent girls and young women aged 15-24 in the district,” says Faith, who also dated older men for money in order to make ends meet. “It is my duty to link adolescents with the district clinical nurse to access services at health facilities and safe spaces. I also encourage women to support people living with HIV/AIDS in the community. I teach them about human rights and encourage them to utilize their talents to make a living.”
Another part of Faith’s job is enrolling and following up on beneficiaries as well as supporting community-based facilitators who teach social asset building. This includes facilitating relationships and connections within DREAMS safe spaces to share encouragement and survival skills.
These safe spaces were critical to providing hope and new options for Clemencia. “After my father passed away, there was no one to pay for my school fees,” she says. “I came to my wits’ end, and I ended up exchanging sex for livelihood. At that time, it seemed the only viable option.”
Clemencia traded sex for two-and-a-half years, placing her among those at highest risk for HIV acquisition in Zimbabwe. “Luckily for me, I did not get infected with HIV,” she says. “Ever since joining DREAMS, I have become empowered, and I know how to protect myself from sexual violence.”
Thanks to what she learned in her financial literacy sessions, Clemencia has started a small business of breeding hens and selling them to community members. “I also sell clothes for extra income,” says Clemencia, who now encourages other young women to complete their financial literacy sessions so they can start their own businesses and become independent.
Faith is thrilled to be able to foster this independence, as well. “Little did I know that I could make an honest living without anyone having expectations from me,” she says. “I am now able to encourage other girls and young women to stop engaging in transactional relationships. I am able to do this because I have been mentored and I have knowledge about HIV/AIDS and violence against women.”
 Chiyaka T, Mushati P, Hensen B et al. Reaching young women who sell sex: Methods and results of social mapping to describe and identify young women for DREAMS impact evaluation in Zimbabwe. PLoS One. 2018 Mar 15;13(3):e0194301. doi: 10.1371/journal.pone.0194301. eCollection 2018.
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.
“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.”
The International Training and Education Center for Health (I-TECH) presented findings from two I-TECH-supported programs during the 2022 Conference on Retroviruses and Opportunistic Infections (CROI). The annual conference took place virtually this year, from 12-16 February 2022, and brought together researchers, academics, and experts to discuss and present on scientific achievements and new research.
During the “Shifting Paradigms in HIV Testing” oral abstract session that was held on 16 February 2022, representatives from I-TECH presented two abstracts (full text linked below) that focused on findings from two HIV partner notification programs in Mozambique and Namibia: