Honorees from well-performing sites in the QISSEC project
In late February, the International Training and Education Center for Health (I-TECH) hosted an awards ceremony for the 10 best-performing health facility-based quality improvement teams focused on improving HIV prevention, care, and treatment services in Côte d’Ivoire. I-TECH currently operates in 80 HIV care and treatment (C&T) health facilities throughout Côte d’Ivoire.
Out of a total of 20 points, and using strict criteria, 10 sites received scores greater than or equal to 18 and were honored at the ceremony. Awards included computer equipment, printers, video projectors, blood pressure monitors, and other vital office equipment.
The ceremony was part of the U.S. Health Resources and Services Administration (HRSA)-funded Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) project, which seeks to improve interventions such as the provision of pre-exposure prophylaxis (PrEP), decreasing treatment interruption, and improving viral load testing coverage and suppression.
“This ceremony was a way to applaud the enthusiasm from the teams, demonstrate an understanding of the methodology, and share the projects that have so far been implemented,” said Dr. Nathalie Krou Danho, QISSEC Project Director.
PEPFAR Coordinator Bibola Ngalamulume
In addition to Dr. Danho, ceremony attendees included the National AIDS Control Program (PNLS) Director, PEPFAR Coordinator Bibola Ngalamulume, HRSA representatives, QISSEC Principal Investigator Ellen MacLachlan, CDC and USAID Country Directors, and representatives from the regions, districts, and sites.
“It is important that we put an accent on service quality,” said Ms. Ngalamulume. “The CQI project that is being implemented by I-TECH is an initiative that is extremely important because not only does it ensure that we improve access to care for all the HIV population–those who are infected and affected–but also it gives us the opportunity to create some kind of a mentorship network between health facilities that are performing well and facilities that need support. [This ceremony] is going to drive even more innovation moving forward.”
Within the QISSEC project, I-TECH has been working closely with the Ministry of Health and Public Hygiene (MSHP) and implementing partners to strengthen provider and community counselor capacity in quality improvement to ensure HIV epidemic control.
I-TECH’s methodology is to build a culture of quality improvement from central, to regional, to site levels. Importantly, I-TECH supports sites to work with the community to center their needs, and patient needs, in providing quality care.
One of the sites honored, an urban health center in Libreville, had set a goal to increase individuals on PrEP from 23 in December 2021 to 78 in June 2022. Their root cause analysis revealed that training in PrEP was insufficient. After orienting prescribers and clinical advisors to PrEP, and organizing community awareness sessions where eligible individuals were identified, the site surpassed their goal by 200%, initiating 230 individuals on PrEP by June 2022. The site continued to increase that pace, reaching 353 by August of that year.
“It’s been a lot for the teams to do this work on top of their day-to-day jobs: to form a quality improvement team, brainstorm, and think of ideas on how to implement the changes,” said Dr. MacLachlan, “but they have taken great care in this work. The quality of HIV care in Côte d’Ivoire will be better for it.”
THIS PROJECT 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.
The Alto Maé Reference Center (CRAM). Photo courtesy of I-TECH Mozambique.
Four decades into the HIV epidemic, more than 50,000 people per year in Mozambique continue to die from HIV-related conditions.
The Alto Maé Reference Center (CRAM) provides a specialized package of care and treatment services for patients with advanced HIV disease from the urban health network of Maputo, Mozambique. Since January 1, 2021, the International Training and Education Center for Health (I-TECH) has served as the Ministry of Health’s primary partner for managing CRAM, a role handed over by Médecins Sans Frontières (MSF), which established the clinic in 2010.
Since I-TECH started its activities at CRAM, the center has had 1,599 active patients in follow-up care.
“More than 80% of patients admitted to CRAM for specialized care are referred by other health centers,” explains Dr. Florindo Mudender, Country Director for I-TECH Mozambique. “Critically ill patients are treated at CRAM until they are stable, then sent back to their facilities of origin to continue treatment. In addition to acute care, CRAM also provides individualized supportive services to patients who often present with dire psychological, social, and economic conditions.”
These supportive services proved crucial to Aisha,* a 43-year-old mother of five who had difficulty accepting her HIV status, believing that her church’s pastor had cured her disease through prayer.
Referred to CRAM five years ago with a diagnosis of Kaposi’s sarcoma, Aisha was prescribed second-line antiretroviral therapy (ART). However, after losing her job due to COVID-19, Aisha was subject to food insecurity, discrimination, social stigma, and physical, psychological, and financial abuse by her partner.
After routinely presenting a high viral load and suffering severe weight loss, Aisha’s care team at CRAM assumed she had not been taking her medication – possibly because of her religious beliefs and a lack of food. She was severely depressed, to the point of attempting suicide.
Worried about her condition, the team at CRAM enrolled Aisha in wraparound services, including behavioral psychotherapy, education in self-care and self-esteem, treatment adherence support, positive prevention, couple’s therapy and socio-family integration, group therapy with other patients with depression, and antidepressant medication.
After several months, Aisha’s last viral load test showed a result of “undetectable,” and her depressive symptoms abated. Thanks in part to the support from CRAM, Aisha is now adhering to her ART, has regained her self-esteem, is working again, and eats regular meals. Her partner tested HIV-negative and has learned to support her so that she feels valued and loved. Aisha attends psychotherapeutic sessions quarterly at the CRAM to monitor her psychological and social well-being.
“[My husband] helps me a lot, so I don’t forget to take my pills, and I am very happy about that and with the improvement I made with my health,” says Aisha. “Before, we were hungry, and now, I am back to work. With the little I earn I can help with the household expenses.”
CRAM is considered a center of excellence and the main training site for AHD for Mozambique Ministry of Health clinicians and PEPFAR-funded implementing partners.
“I-TECH is currently refining a referral and counter-referral system between CRAM and Maputo City’s health centers, to ensure patient care continues after discharge,” says Dr. Mudender “The system will include a free mobile line to assist clinicians with advice from senior specialists.”
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.
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.”
“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), under the leadership of Government of Namibia ministries overseeing child welfare and health and in close collaboration with the Namibia Statistics Agency (NSA), UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC), supported the implementation of Namibia’s first Violence Against Children and Youth Survey (VACS).
The final Namibia VACS report was published by the Government of Namibia and Together for Girls, a global partnership working to end violence against children, on 28 September 2021. Photo Credit: Together for Girls: www.togetherforgirls.org/.
VACS are national surveys that measure the prevalence and impact of violence on children and youth around the world. The survey results help inform future program decisions and policy approaches to ensure the safety of children and youth. On 28 September 2021, the Day of the Namibian Child, the Government of Namibia published the final Namibia VACS report.
The survey, funded by the U.S. President’s Emergency Plan for AIDS Relief and led by the Ministry of Gender Equality, Poverty Eradication and Social Welfare (MGEPESW), interviewed households with children aged 13-24 years in all 14 regions of Namibia from March 2019 through June 2019.
Survey operations—including data collection by field teams, data generation, and analysis—were carried out by the NSA, the central statistical authority responsible for all official statistics in Namibia. “It has been a pleasure working together with the Ministry of Gender Equality, the University of Washington, I-TECH, and CDC on this important survey,” says Ottilie Mwazi, Namibia’s Deputy Statistician General. “Our team has learned a lot from the process and is very proud to have contributed important data that will help to improve child welfare in Namibia.”
Prior to data collection, I-TECH alongside CDC colleagues hosted a two-week training for 130 enumerators, focused on best practices for data collection, interview techniques, and key aspects of the survey protocols. In addition to supporting VACS training, I-TECH and the Ministry of Health and Social Services (MoHSS) ensured all selected enumerators were trained and certified by the Namibia Institute of Pathology to conduct HIV rapid testing so any survey respondent aged 14-24 years who did not know their HIV status and wanted a test during their interview could immediately be tested.
In total, 5,191 individual interviews among 6,042 households (86.35% overall response rate) and 3,232 HIV rapid tests were conducted as part of data collection. Any respondent testing positive for HIV during the survey was linked to psychosocial and HIV/AIDS care and support in line with well-established MoHSS guidelines and the survey protocol.
Expanding Post-Violence Clinical Care
The survey results have informed important initiatives across Namibia’s wider social welfare and health systems. MGEPESW has moved forward with drafting the National Action Plan on Violence against Children and has accelerated the training of various child welfare stakeholders such as police officers and social workers, while operationalizing the establishment of more child shelters in several regions.
“The data coming out of Namibia’s VACS have really brought home how prevalent and serious violence against children and adolescents really is,” says Helena Andjamba, Director for Child Welfare at MGEPESW. “Having these hard facts readily available has helped greatly during our policy and planning engagement with multiple stakeholders during the past year. We are now moving forward with the Ministry of Justice in drafting a new Child Justice Bill, and at the same time we are engaged with the Ministry of Education on strengthening the National School Safety Framework.”
Following the completion of the survey, the MoHSS convened a technical working group with I-TECH, the World Health Organization, UNFPA, Project Hope, and other stakeholders to coordinate and strengthen first-line post-violence clinical care in primary health care facilities across Namibia. I-TECH also supported the compilation of clinical guidance on emergency care for survivors of sexual violence and its inclusion in the 2021 edition of the Namibia Standard Treatment Guidelines published by the MoHSS.
Much of the focus during the second half of 2021 was on integrating post-gender-based violence (GBV) clinical care in MoHSS HIV/AIDS clinics and antiretroviral therapy (ART) services throughout Namibia. As part of this work, I-TECH conducted a mentorship training-of-trainers for 28 HIV clinical providers, nurses, and testing services staff. These mentors now provide ongoing technical guidance and supportive supervision to frontline health workers through monthly facility visits.
To further improve post-violence care in clinics, I-TECH compiled a GBV care implementation guide for Namibian healthcare providers. This includes elaboration of best practices, as well as a suite of materials including posters, pamphlets, job aids, and a pocket booklet for communities, clients, health workers, and health facility managers, respectively. An intimate partner violence/GBV screening tool to be administered to ART patients with persistent high viral loads is also currently being piloted in ten health facilities.
Tiwonge Chimpandule, I-TECH Malawi’s Strategic Information Officer, presents the results of the 2020/21 Malawi Population-based HIV Impact Assessment (MPHIA) to guest of honor Chrissy Kalamula Kantaso, Deputy Minister of Health (right). Looking on are Jeremy Neitzke, Deputy Chief of Mission, U.S. Embassy (center) and Dr. Rose Nyirenda, Director, HIV and AIDS Department in the Ministry of Health (left). Photo credit: I-TECH Malawi
On World AIDS Day, December 1, staff from the International Training and Education Center for Health (I-TECH) convened with the Ministry of Health (MOH), Columbia University’s ICAP, and other national stakeholders in Malawi to present the results of the 2020-21 Malawi Population-based HIV Impact Assessment (MPHIA). The commemoration, with the theme of “End Inequalities, End AIDS, End Pandemics,” was held at Bumba Primary School grounds in Rumphi District.
Preliminary results of the assessment, led by the MOH and ICAP, show that the national HIV testing program, supported by I-TECH, has achieved a significant increase in the awareness of status among HIV-positive adults—from 77% in 2016 to 90.9% in 2020-21.
Malawi has also made great strides toward reaching the UNAIDS 95-95-95 Fast Track targets, surpassing both the second 95 (results indicate that 98% of those who know their status are initiated on treatment) and third 95 (results indicate 97% of those on treatment are virally suppressed).
The assessment will be critical to informing future programming, says Dr. Rose Nyirenda, Director of the Ministry of Health’s HIV and AIDS Department. “The 2020-21 MPHIA has produced a wealth of information that will be critical for tailoring our services and to refine strategies for closing the remaining gaps,” says Dr. Nyirenda.
The HIV and AIDS Department also exhibited commodities (antiretroviral medications, testing kits, opportunistic infection (OI) and sexually transmitted infection (STI) medicines, condoms, voluntary medical male circumcision kits) that are procured and managed through the Supply Chain and Logistics Unit.
Correction: A previous version of this article misstated the organization that conducted the 2020-21 Malawi Population-based HIV Impact Assessment. This assessment was led by the Malawi Ministry of Health and Columbia University’s ICAP.
Since 2018, I-TECH has supported the Ukraine Ministry of Health (MOH), through the MOH Public Health Center, in introducing and adopting WHO-recommended safe and effective antiretroviral therapy (ART) regimens.
For the past 10 months, Kayla Cody-Lushozi has served as the inaugural Global Health Program Officer for I-TECH’S Global Health Leadership Development Program. The aim of this program is to support the development of skills in global health program implementation, management, and leadership for recent master’s degree graduates with diverse backgrounds who are transitioning into the public health field.
This program is structured to directly support the programmatic needs of multiple I-TECH projects while providing the Program Officer with mentorship across the I-TECH network and supporting the transition into a non-temporary global health position. In 2019, Cody-Lushozi received her Master’s in Social Work (MSW) from the University of Washington (UW) and has used this background, along with her unique experiences and expertise, to inform her work at I-TECH.
During her time as a Program Officer, Cody-Lushozi has worked with three teams across the I-TECH network, plunging into a few of the many areas of work I-TECH implements and supports. In collaboration with partners from FHI 360 and leaders from the Cambodian Ministry of Health, Cody-Lushozi supported a health informatics program, working to streamline databases and strengthen health systems in Cambodia. Additionally, she explored how to revive Community Advisory Boards for people living with HIV (PLHIV) in Jamaica in a sustainable and community-centered way with I-TECH network partner the Caribbean Training and Education Center for Health (C-TECH). She worked with community partners in Zimbabwe, as well, exploring the support systems in place for case managers supporting young PLHIV. This work was done with I-TECH partner the Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH).
September marks the end of Cody-Lushozi’s time with I-TECH. Below, she shares some reflections on her time in the Leadership Development Program, as well as what might come next.
What has the experience of being a Program Officer at I-TECH meant to you?
This has been an incredible experience, and it came at a perfect time. Right before I-TECH, I was working at the Washington State Department of Social and Health Services doing direct service social work with economically marginalized clients with mental and physical health needs. While I enjoyed this role and understood its importance, this was not the type of social work practice that I wanted to pursue in the long run.
My passion and interests lie in research, especially community-centered research that allows me to work directly with Black communities in improving access to health justice. I-TECH came along at the right time and allowed me to dive deeper into the world of global health implementation.
The projects I’ve done at I-TECH have been really varied, and I’ve gotten an inside look and experience across different areas. I am constantly learning at I-TECH. I-TECH does a million things, which might have been overwhelming to a new person entering the organization, but I always felt very supported by my teams. They made it clear that I didn’t need to have all the answers.
I also appreciate that this program aims to attract a diversity of experience, background, and perspective. It encourages more than just a singular lens. I’ve been able to share my unique background and experiences as a Black woman social worker in global health. I’m excited to see where this program goes and how it continues to support I-TECH’s evolution.
This has been a beautiful experience for me. Working at I-TECH served as a great affirmation that this is the area of work that I want to continue to grow in.
How has your background in social work shaped how you’ve entered the global health field?
Before getting my MSW I already had an interest in public health, even before I was calling what I was doing public health. I wanted to use the framework and the lens that social work provides within a public health setting. I always gravitate toward work that is community-centered and centers the voices and expertise of those in the margins. These are some of the values that I bring with me into the global health space and that I hold very close to my professional and personal practice.
These values have helped me in this field because public and global health work is not always operating from the pillars of anti-oppressive practice. There’s so much historical and contemporary discourse that needs to be addressed and often isn’t in this field. You can’t be ahistorical if you’re truly trying to get to the root causes of global health inequity and injustice. Many of the issues that we see in global health are connected to issues of global white supremacy, imperialism, and resource extraction. It’s a tension that I hold in this field but something I try to do my part to shed light on.
You have done a lot of meaningful work during your time with I-TECH. What does your life look like when you’re not working?
I’ve gone through a lot of life changes these past 10 months. I’m a newlywed; I got married in June to my now husband Mawande. Being a new wife is really exciting.
A big chunk of my husband’s and my time outside of work is dedicated to our small homemade skincare business, K+M Homemade Skincare, that we officially launched during COVID. We do a lot of farmer’s markets and pop-ups on the weekends. Ask anyone and they can tell you that we love making and talking about our skincare.
In what direction do you see yourself moving after I-TECH?
After I-TECH, I see myself continuing to engage in global and public health spaces that are truly committed to community work and radical racial and social justice transformation. I am not comfortable doing this work in the absence of working directly with community members and local stakeholders. Top-down approaches have colonial and imperialist roots. I believe in doing “with” and not doing “to” and actively partnering with communities for long-term sustainability and quality health care reform.
I will be packing up and moving to South Africa in 2022 and am currently open to a position that will allow me to continue to practice in this exciting field. My interests lie in research, project management, and implementation work related to HIV care and treatment, maternal and child health, and mental health. I am also contemplating pursuing an MPH or a PhD in global health and implementation science sometime in the future. It’s been an incredible past 10 months with I-TECH and I am excited to stay in contact with this global network. I thank everyone who has been part of this journey with me!
The I-TECH network thanks Kayla Cody-Lushozi for her work and wishes her well as she continues to forge her path in global health!
If you are interested in participating in the Global Health Leadership Development Program, more information is available here.
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.
The International AIDS Society (IAS) virtually hosted the 11th Conference on HIV Science on 18-21 July 2021. The conference also included a “local partner hub” in Berlin, the original host city, for local experts to gather in person. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.
Representatives from the International Training and Education Center for Health (I-TECH) virtually presented the following posters:
Representatives from I-TECH’s partner network organizations and the Centers for Disease Control and Prevention (CDC) also presented data from I-TECH-supported programs in Malawi, India, and Zimbabwe.
This story was first reported in 
