Category Archives: Key Populations

I-TECH Celebrates 20 Years

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I-TECH Remembers Transgender Activist and Leader Brandy Rodriguez

Brandy Rodriguez gives feedback to a clinician during the pilot training of I-TECH’s Key Population Preceptorship program in Trinidad & Tobago. Photo credit: Lauren Dunnington/I-TECH.

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.

Staff at I-TECH are honored to have worked with Ms. Rodriguez, who served as a patient-trainer for I-TECH Caribbean’s Key Populations Preceptorship program in Trinidad & Tobago.

“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.

To learn more about the impact Ms. Rodriguez’s work, see these tributes at Trinidad and Tobago Newsday and UNAIDS.org.

I-TECH Announces Launch of Independent Local Organizations B-TECH and C-TECH

The B-TECH team implements innovative, high-yield testing approaches to increase HIV case identification and yield.

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.

The C-TECH team also has broad experience with clinical mentoring at HIV treatment sites.

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.

Thulaganyo Kauta, Deputy Executive Director, B-TECH

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.

Natalie Irving-Mattocks, Executive Director, C-TECH

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.

Expanding HIV Care and Treatment in Zimbabwe

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.
I-TECH Zimbabwe Care and Treatment Sites and Districts

A map of I-TECH’s Care and Treatment Sites and Districts in Zimbabwe.

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

In 2019, ZimPAAC began the expansion of cervical cancer screening for women living with HIV, beginning with a situational analysis to identify sites for implementation of a program serving women with visual inspection with acetic acid and cerviography.

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.

Strengthening Health Service Delivery in India

  • I-TECH India PL has successfully designed and implemented four differentiated ART service delivery models, including models for key population clients, in collaboration with other stakeholders in states of Maharashtra, Nagaland, Manipur and Mizoram to develop a proof of concept for the national level scale up;
  • Improved delivery of health services through onsite technical mentoring and supervison of health care staff in 9% of the ART centers of the country in the last three years;
  • Technically assisted successful implementation of newer initiatives such as treatment of TB through the ART centers, the “Treat All” initiative, and routine viral load monitoring at 48 ART centers; and
  • Conducted/participated in health service delivery assessments of facilities such as the national HIV/AIDS Centers of Excellence, ART Centers, Link ART Centers, and other care and support centers for the NACO.

HIV Positive Teens in Namibia Gather for Weekend of Fun and Support

HIV-positive teens gathered at B2Gold’s Otijikoto Mine Nature Reserve for a weekend of team-building exercises, support, and discussions about the importance of adherence to treatment.

All teens need consistent opportunities to build self-worth, explore their gifts, and feel the support of peers and adults. For teens who are HIV positive, the everyday pressures and fears of adolescence (rejection, bullying, gossip) can be amplified, making these opportunities especially important. In Namibia, adolescents and young people, especially girls and young women, continue to be disproportionately affected by HIV.

In response to these realities, in late August, a three-day Teen Club Retreat was organized by the Katutura Hospital Paediatrics Communicable Disease Clinic (PCDC) team, in collaboration with B2Gold, Champions for Life, and the International Training and Education Center for Health (I-TECH).

Fully funded by B2Gold and hosted at its Otjikoto Mine Nature Reserve, the retreat included 49 teens from the clinic (31 girls and 18 boys), who were joined by clinic doctors, nurses, and counselors as well as facilitators from Champions for Life, a psychosocial-spiritual program for children, adolescents, and young adults with the challenges of being infected or affected by HIV.

Through team exercises, game drives, inspiring films such as “Hacksaw Ridge” and “The Soul Surfer,” lectures, and small group sessions, the retreat aimed to:

  • strengthen bonds and networks;
  • create enthusiasm about the future;
  • develop self-respect;
  • instill the values of a healthy environment, teamwork, and responsibility; and
  • keep teens engaged in care.

“I enjoyed the movies, as they motivated me. I realized that I am not the only one facing challenges. When I courageously tackle my challenges, I remain strong even if I may not win them all.” – Teen Club member

I-TECH Namibia’s Sharon Mambo, an HIV Pediatric Expert Nurse, served as a chaperone and as one of the key organizers of the retreat. Mambo led a discussion on the importance of treatment adherence and viral load suppression. In addition, she tasked one of the teens with facilitating a discussion on “transitioning,” the process during which adolescents move from paediatric HIV care to more independent adult care. At Katutura hospital, this means accessing health services at an adult ART clinic.

Addressing the teens’ fears of waiting too long for services and meeting unfamiliar faces, Mambo assured the group that a specific health worker has been assigned to work with them and they would be “fast tracked.”

“It’s a matter of changing consultation rooms when you transition to the adult clinic,” said Mambo. “You will still meet the happy, friendly staff on the other side, so lay your worries aside.”

Teen Club members enjoyed a tour of the B2Gold facility, as well as nature and wildlife walks.

Highlights of the retreat also included a tour of the B2Gold mine and a game drive, where the kids were thrilled to see reserve animals including giraffes, springboks, wildebeests, and zebras at close range. “I got to see some of these animals for the first time,” said one teen. “I never knew that some animals could be as clever as human beings.”

The team from Champions for Life also held a full-day seminar titled “NICHE,” focused on self-image, identifying gifts and abilities, and creating one’s vision for the future. This was done through music, dance drama, group presentations, and poetry.

 “I enjoyed the team-building activities because we got to work as a group and had the opportunity to come up with ideas together as a team.” – Teen Club member

“A major success of this trip was the close bond, mutual respect, and trust that developed between the staff and adolescents during the three days,” says Mambo. “The shared experience and willingness of the staff to participate fully in all sessions of the program really lowered some of the barriers and discomfort that normally exist between teens and adults.”

Mambo has also been working with teen leaders from the group to support other facilities in Windhoek to establish their own Teen Clubs.

Innovative Training Models in Tanzania

I-TECH Tanzania has implemented many pre- and in-service training initiatives and materials, as well as adopted TrainSMART. Continue reading »

Differentiated HIV Service Delivery Models in Tanzania

In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania.

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Improving HIV Care and Treatment across the Caribbean

I-TECH supports a variety of activities aimed at improving HIV care and treatment in the Caribbean region, such as on-site clinical mentoring, development of training curricula, and providing clinical support materials to improve care and treatment for HIV/AIDS in the Caribbean region.
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eLearning Programs in the Caribbean

I-TECH has partnered with universities and ministries of health (MoH) in the region to develop accessible in-service training opportunities for HIV providers using distance and blended learning.

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