The theme of this year’s World AIDS Day is “Let Communities Lead.” This is not only a call to action, but also a recognition of the irreplaceable contribution of community members in the success of global programs and their critical role in their own health care.
We had the honor of capturing a brief interview between two of our wonderful I-TECH colleagues in Trinidad and Tobago–Alana Lum Lock Cardinez, Program Advisor, and Conrad Mitchell, Program Manager. Here, Alana asks Conrad for his perspective as both a community member and project lead, as well as about the lessons learned when communities aren’t engaged (4:15).
In 2019, I-TECH conducted an on-site assessment at Trinidad and Tobago’s largest HIV treatment site. The findings of that assessment led to the establishment of an integrated psychosocial program at this site that has yielded favorable results. This further inspired the need for expansion of this psychosocial approach to other HIV treatment and care sites.
In 2022, I-TECH collaborated with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH) to conduct a similar rapid assessment throughout the national treatment and care sites. The results reflected that there was a need for specialized staff to identify and treat common mental health and psychosocial concerns, as well as a standardized approach. Therefore, I-TECH is supporting the HACU to lead the expansion and strengthening of mental health and psychosocial (MHPS) service delivery for persons living with HIV at HIV treatment and care sites in Trinidad and Tobago. Goals include the standardization of psychosocial assessments to support the early identification of psychological distress, symptoms of co-morbid mental illness and psychosocial issues; as well as the standardization of the procedures for making interventions.
Developing a draft MHPS Protocol to include screening and intervention tools and psychosocial standard operating procedures (SOPs)
Establishing a standardized referral system
Training and supporting psychosocial team members in the use of the SOPs and all screening and assessment tools. Training will address areas of intimate partner violence, gender-based violence, and mental health challenges that are frequently encountered within the client population
Training and supporting psychosocial team members in data collection and reporting requirements
Training and capacity -building of psychosocial team members of the Psychosocial Coordination Unit being established by the HACU
I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) of the Office of the Prime Minister, and other local organizations to make accessible learning and capacity-building opportunities for all cadres of health care workers.
Learning Management System (LMS): I-TECH and the University of Washington Department of Global Health’s eLearning Program (eDGH) collaborated to adapt an LMS for Trinidad and Tobago from the Jamaica LMS. The LMS for Trinidad and Tobago will support ongoing, standardized capacity-building of an increased number of health care providers in a cost-effective way. The LMS will also function as a monitoring and evaluation tool for training and skill building. I-TECH will support, develop, and adapt HIV course material and provide local administration and coordination support.
Key Populations Preceptorship Web Modules: I-TECH is currently developing self-paced, eLearning training modules to improve providers’ knowledge, skill, and comfort in providing respectful and gender-affirming care for gay and bisexual men, other men who have sex with men, people of transgender experience, and people engaging in sex work. This module will be an adaptation of the innovative in-person Key Population Preceptorship (KPP) Program for Clinicians and will be made accessible on the I-TECH/eDGH LMS that is being developed. The modules will incorporate video recordings featuring local community members, modeling of best practices, and show interactive exercises.
UW eDGH Online Courses: I-TECH, through eDGH and in collaboration with HACU and the NACC Office of the Prime Minister, provides online certification courses to health care providers in Trinidad and Tobago. Courses include: Clinical Management of HIV; Leadership and Management in Health; Fundamentals in Global Health Research; Policy Development and Advocacy for Global Health; Project Management in Global Health; Monitoring and Evaluation in Global Health; Fundamentals of Implementation Science; Wellbeing for Healthcare Professionals; and Global Mental Health.
Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported MRFTT, the HIV treatment site with the largest adult population in Trinidad and Tobago, to become an ECHO® hub site. The hub provides virtual clinical consultation support as well as brief didactic sessions for healthcare workers in Trinidad and Tobago on a range of medical/clinical and psychosocial topics, as well as those relevant to HIV care, treatment and support. Healthcare workers (HCWs) who have benefitted from the series not only include those from Trinidad and Tobago, but also HCWs from Haiti, Barbados, Bahamas, St. Vincent, Grenada, and Florida, USA.
Management of HIV Infections Diploma Course: In 2014, I-TECH partnered with the University of the West Indies (UWI) – St. Augustine campus in Trinidad and Tobago to develop a blended eLearning course that enables HCWs to provide high-quality clinical management of patients living with HIV. This ten-month post-graduate diploma program is delivered through a series of online, self-paced courses taught by UWI faculty, and is augmented by synchronous virtual classroom discussions and hands-on, clinical practicum experiences. In recent years, I-TECH worked with the UWI to integrate extensive care and treatment content specifically focused on comprehensive care for key populations affected by HIV. The course is offered annually to healthcare workers from PEPFAR priority sites in the region. Course graduates include health care workers from Trinidad, Jamaica, Suriname, and Barbados.
Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider and a preceptorship trainer (PT), who is a member of a key population group, with the observation of a training facilitator. The PT takes on the role of a mock patient and uses a pre-scripted scenario as a guide to interact with the provider-in-training, giving feedback after each scenario. The KPP builds the provider’s capacity to provide comprehensive and nonjudgmental care to key population groups including gay and bisexual men, other men who have sex with men, persons of trans experience, and sex workers.
The KPP was adapted based on Jamaica’s KPP for clinicians in 2016 for physicians in Trinidad. In 2017, it was adapted for nurses and was delivered in-person over the course of a two-day period. In response to COVID-19 protocols, the KPP for social workers, which was adapted in 2020, was delivered virtually.
I-TECH Trinidad and Tobago collaborates with local organizations to implement programs focused on supporting the health and wellness of people living with HIV (PLHIV), including:
• National HIV Helpline: The COVID-19 pandemic highlighted the need for virtual support and information on HIV testing, care, treatment, and support, and an increased need for guidance and psychosocial support for PLHIV. This prompted the need for a central line for communication and connection to the HIV/AIDS network. For World AIDS Day 2021, the National AIDS Coordinating Committee (NACC), Office of the Prime Minister, in collaboration with the HIV AIDS Coordinating Unit (HACU) of the Ministry of Health and I-TECH, launched the national HIV helpline. I-TECH provides technical assistance, training, and capacity building support to the HIV Helpline Coordinator and Active Listeners and is supporting efforts to raise the social media profile to increase caller volume.
•Patient Health and Literacy: In collaboration with the National AIDS Coordinating Committee (NACC), Office of the Prime Minister and a technical working group comprised of PLHIV and non-governmental organization (NGO) representatives, I-TECH developed content across nine topic areas aimed at improving PLHIV health and treatment literacy. The content was integrated into the inaugural NACC website in a dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable. Topic areas were focused on promoting and encouraging U=U with content titled: U and Your Dream Team; A healthy U; All about U and HIV; What U may get wrong; Your journey to U; U and your Partner; U in the future – HIV and Aging; U and your Baby – HIV and Pregnancy; HIV and COIVD-19 . The website is expected to facilitate wider access and reach to the PLHIV community and is the first content of its kind to provide consolidated, standardized and culturally appropriate material on HIV and AIDS treatment, care, and support in Trinidad and Tobago.
The International AIDS Society (IAS) hosted the 12th IAS Conference on HIV Science on 23 – 26 July 2023 in Brisbane, Australia, and virtually. This biennial conference brings together top HIV researchers, experts, and scientists for presentations and discussions on the latest advances in HIV research and practice.
This year, representatives from the International Training and Education Center for Health (I-TECH), I-TECH’s partner network organizations, and the Centers for Disease Control and Prevention (CDC) shared findings from I-TECH-supported programs in India, Malawi, and Zimbabwe. Read the ePoster abstracts below.
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.”
In honor of Transgender Awareness Week (November 13-19), the International Training and Education Center for Health (I-TECH) pays tribute to Trinidad & Tobago transgender activist and esteemed community leader Brandy Rodriguez, who passed away in late October.
Ms. Rodriguez leaves a legacy of leadership as president of the Trinidad and Tobago Transgender Coalition and a member of the Pan Caribbean Partnership against HIV and AIDS. She improved countless lives among those she supported in her many years as a peer navigator at the Family Planning Association of Trinidad and Tobago. Countless more lives were touched – and perspectives broadened – through her tenacity and compassion.
“A tireless champion for the trans community, Brandy held an open door and a willing ear to any lost children of our LGBTQ tribe,” says Conrad Mitchell, I-TECH’s Program Coordinator in Trinidad & Tobago. “Her fiery tongue and sharp wit kept us all in check, whilst her warm heart overflowed with a love that was unsurpassed. Her fearlessness was legendary both within the community and across local, regional, and international platforms. We are shaken to the core by this loss. The world is forever a little less ‘fierce’ with Brandy gone.”
The Key Populations Preceptorship program’s intensive trainings use targeted role-play scenarios to build clinicians’ capacity to provide nonjudgmental, high-quality comprehensive HIV care to communities most at risk: men who have sex with men, transgender people, and sex workers. Through this work with I-TECH, Ms. Rodriguez contributed to critical efforts to break down stigma and barriers to care experienced by marginalized communities. The first physician trained as part of the program in Trinidad & Tobago, Dr. Vedavid Manick, shared his experience with Ms. Rodriguez beautifully in a Trinidad and Tobago Newsday letter to the editor.
On October 1, the International Training and Education Center for Health (I-TECH) celebrated the launch of the local and independent Botswana Training and Education Center for Health (B-TECH) and Caribbean Training and Education Center for Health (C-TECH).
For more than 17 years, these teams have worked within the regional Botswana and Caribbean offices of I-TECH to respond to the health needs of individuals and communities infected and affected by HIV. B-TECH and C-TECH, as locally registered non-governmental organizations, will continue to build on those years of experience implementing innovative, locally driven HIV prevention, care, and treatment programs, as well as expand their work to tackle other pressing health issues within the Batswana and Caribbean communities.
As part of the I-TECH network, B-TECH and C-TECH are able to access the academic depth and regulatory structures of UW and, together with local and regional clinical and programmatic expertise, scale up best practices and strengthen health systems. As local entities, B-TECH and C-TECH will also be able to take advantage of expanded partnership opportunities.
Both teams have supported pioneering work in their regions to provide comprehensive, patient-centered care for the most vulnerable populations. The C-TECH team has implemented a groundbreaking preceptorship program to improve provider communication with key populations affected by HIV in Jamaica and Trinidad and Tobago. It has also implemented a successful telementoring program through a Project ECHO®-based platform and model, reaching 465 providers. The program connects groups of providers to form communities of practice throughout the region to facilitate clinical updates, case consultations, and strengthened practice in HIV treatment and care and, recently, COVID-19.
“We look forward to remaining within the I-TECH family,” said Natalie Irving-Mattocks, Executive Director of C-TECH. “But our team is equipped and ready to move into this next chapter, deepening our local relationships, expanding our reach throughout the Caribbean, and building on our commitment to support access to high quality health care for the region’s most vulnerable.”
For its part, the B-TECH team has made an enormous impact on the health systems of Botswana, enabling the policy environment for HIV clinical case management; developing and implementing an interoperable, standards-based health information system; and enhancing the capacity of the health workforce at all levels. The team has also implemented innovative, high-yield testing approaches to increase HIV case identification. Targeted HIV testing strategies include partner testing services; HIV self-testing; testing among presumptive tuberculosis cases; and the expansion of afterhours and weekend testing to target men.
“We are excited to begin this new endeavor to promote innovative, locally driven, and effective programs to respond to the HIV epidemic in Botswana,” said Dr. Odirile Bakae, Executive Director of B-TECH. “With a high level of technical assistance from I-TECH, combined with B-TECH’s boots-on-the-ground approach, we are a winning team. We look forward to a fruitful partnership with both I-TECH/UW and the Government of Botswana.”
I-TECH has worked closely with UW Global Operations Support over the past decade to inform the internal procedures and structures necessary for international office registrations. This work has promoted operational effectiveness by enabling a safe, compliant, and legal environment for conducting international work. I-TECH’s close work with Global Operations Support has also helped to create the administrative and policy structures necessary to enable the successful launch of B-TECH and C-TECH.
Over the past two years, three other I-TECH offices – in Haiti, India, and Zimbabwe – have launched local organizations, signaling I-TECH’s bedrock commitment to transition, sustainability, and country ownership.
“These new organizations reflect our shared goals of serving communities, building capacity, and supporting expert leadership across the I-TECH network,” said Dr. Pamela Collins, I-TECH Executive Director. “We look forward to continued strong collaboration that saves lives.”
Read more about the B-TECH and C-TECH leadership teams below.
Dr. Odirile Bakae, Executive Director, B-TECH
Dr. Bakae is a physician with over 15 years of clinical experience in providing services to people living with HIV, as well as a deep understanding of structuring health programs to optimize client outcomes. He has several years of experience practicing medicine in public health settings in Botswana, including the management of the Infectious Disease Control Centers (IDCC), specializing in ART failure clients, complicated TB and HIV cases, and cervical cancer patients.
In addition to his role as B-TECH Executive Director, Dr. Bakae is the Principal Investigator for the CDC funded Cervical Cancer (GH20-2009) and Strategic Information Services (GH20-2007) awards.
He joined I-TECH Botswana in 2015 and led one of the most successful HIV testing programs in the country, focusing on a client-centered approach. Under his leadership, the country program performed exceptionally well, in terms of quality of service delivery and in meeting donor targets and expectations.
Ms. Kauta is a seasoned operations management professional with over 20 years of experience across a wide range of industries. She joined I-TECH Botswana in April 2009 and, as the Deputy Executive Director for B-TECH, she oversees operations, finance, and human resources, and is responsible for design and implementation of internal controls and compliance oversight at all levels of the organization.
In her management role, Ms. Kauta provides planning and coordination of efficient and effective support services to enable delivery of quality work to B-TECH clients and stakeholders. A key function of her role is to identify solutions to address operational challenges within B-TECH as well as ensure the implementation and adherence to the organization’s operational systems, policies and procedures.
Ms. Irving-Mattocks is a public health program director with extensive experience in managing projects focusing on health systems strengthening. She is also a business development practitioner with 13 years of experience in the field of social development. Her expertise includes financial management, budget management, project proposal writing, program design/development, planning, implementation and monitoring, strategic planning, and institutional development.
To her role as C-TECH Executive Director, Ms. Irving-Mattocks also brings deep experience and a proven track record in mobilizing and managing grants from international funding agencies such as United States Department of Human Services Health Resources and Services Administration (HRSA), PANCAP Global Fund, United States Agency for International Development (USAID), Clinton Foundation and National Institutes of Health (NIH).
Dr. Clive Anderson, Board Chair and Technical Advisor, C-TECH
Dr. Anderson has 30 years of experience as a primary care physician, specializing in HIV and STI care and prevention, as well as dermatology. He comes to his role as Board Chair and Technical Advisor after serving as Country Director of I-TECH Jamaica for the past three years.
He remains Technical Advisor to I-TECH Jamaica, where his experience also includes extensive experience as Technical Lead of the Caribbean Quality Improvement Collaborative (CareQIC), Lead HIV Project ECHO® Facilitator and Mentor, and clinical mentor at HIV treatment sites throughout Jamaica.
Dr. Anderson is currently a Clinical Assistant Professor in the Department of Global Health, University of Washington.
The ZimPAAC consortium collaborates with the Ministry of Health and Child Care (MoHCC) in Zimbabwe to meet the following primary HIV epidemic control objectives:
Diagnose 95% of all persons living with HIV through integrated testing
Ensure 95% of individuals diagnosed with HIV are initiated on antiretroviral therapy (ART), retained in care, and are virally suppressed using differentiated service delivery models
Using a Differentiated care model, a patient-centered model of service delivery designed to meet the diverse needs and expectations of all people living with HIV, ZimPAAC oversees activities such as:
facility and community-based HIV testing;
HIV self-testing, index case testing;
ART initiation; and
ART delivery through multi-month refills for stable patients, Family ART Refill Groups, and Community ART Refill Groups (CARGs). CARGs benefit group members—through decreasing health center visits, offering peer support, and allowing clients to take responsibility for their health—and staff, by decreasing workload and allowing greater time for patient care.
In addition to differentiated service delivery, ZimPAAC conducts site-level mentoring at health facilities to strengthen health service delivery towards the “95-95-95” UNAIDS targets by improving patient linkages between HIV testing, initiation on treatment, and retention in care rates. This is accomplished in part by several hundred dedicated HIV testers and nurses who support ART initiation and management of opportunistic infections alongside MoHCC staff.
ZimPAAC also supports index testing through community linkages activities that help clients access HIV testing, especially sexual partners and biological children of existing HIV-positive clients who present to the health facilities. In an effort to improve index testing within MoHCC health facilities, ZimPAAC has implemented an assisted partner service model, known as Enhanced Index Case Testing. This program emphasizes reaching clients recently diagnosed with HIV and those whose blood tests show a high HIV viral load. Quality Improvement activities are a key part of ZimPAAC’s approach to improving outcomes for index testing. In 2019, a “change package” describing the interventions that have improved index testing was developed by ZimPAAC for national scale-up of the model.
ZimPAAC program activities also support retaining people living with HIV in care. Programs engage community linkage facilitators who work with facilities and communities to identify patients who have defaulted from treatment and return them to services.
In addition to HIV care and prevention for adults, ZimPAAC supports increased access to services for children and adolescents through Africaid’s community adolescent treatment supporters (CATS). CATS are HIV positive 18-to-24-year-olds trained to provide peer support, conduct demand-creation activities, build community engagement, and mobilize targeted HIV testing and outreach activities to bring services to this hard-to-reach group.
In addition to the first two objectives, ZimPAAC collaborates with MoHCC towards two additional objectives:
Strengthen and expand access to cervical cancer screening and treatment of precancerous cervical lesions among women living with HIV
Increase uptake of pre-exposure prophylaxis (PrEP) services through training, technical assistance and direct client support
Under the direction of PZAT, ZimPAAC also works closely with the MoHCC to support key-population-friendly programming in the public health sector facilities in Harare. PZAT supports health worker training at selected facilities and builds demand and knowledge of these services through community champions and engagement with vulnerable populations and advocacy and civil society organizations. PZAT also works to promote PrEP services for adolescent girls and young women in Mazowe district and among key populations in Harare.