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I-TECH Supports the Mental Health of Healthcare Workers and People Living with HIV in Ukraine Amid War

                 Image by Денис Марчук

Since the Russian invasion and onset of full-scale war in 2022,  the International Training and Education Center for Health (I-TECH) has been strengthening its capacity to provide support for healthcare workers (HCWs) in Ukraine. Key support programming has included a mental health project targeting both HCWs and people living with HIV (PLHIV), delivered as part of its national Pre-exposure Prophylaxis (PrEP) Program.

The Ukrainian population is experiencing high rates of post-traumatic stress disorder (PTSD) and other mental health disorders as a result of the war in Ukraine. One recent study found that 30.8% of its Ukrainian respondents met criteria for elevated risk of PTSD, with internally and externally displaced people showing significantly higher rates of risk.1 Another found that 52.7% of its Ukrainian sample aged 18 years or older showed symptoms of psychological distress, 46.8% of depression, and 12.1% of insomnia.2

“As time goes on, the greater the need for support for healthcare professionals becomes.”
Olena Frolenkova, counselor

These numbers include not only the general population, but also the physicians, nurses, and other HCWs who continue supporting their fellow Ukrainians amid the war. These professionals put their own safety and mental health on the line every day to provide compassionate care to their communities in a time of immense crisis.

“Our medical doctors and nurses remain on the frontlines of the humanitarian responses, dealing with unimaginable loss and trauma daily, both professionally but also personally,” says Anna Shapoval, EdD, Country Representative for I-TECH Ukraine.

By mid-2024, the growing team of I-TECH counselors has conducted 325 planned individual online supportive supervision, including counseling, sessions for HCWs. Out of those, 45% of sessions were requested by HCWs due to a complex psychological and emotional condition. Key topics for supervision sessions were the psycho-emotional conditions of medical providers, discussions of actual working cases, management of complex consulting cases, and team interactions.

At the same time more than 3,500 PLHIV were screened for depression, out of them around 10% were diagnosed with such and referred for specialized care as part of this project. I-TECH’s team also invests significant time and resources into strengthening the counseling capacities of the HCWs and sharing information on the importance of mental health and related services available in each region of Ukraine among patients of its PrEP Program.

In recent months, the I-TECH team in Ukraine has expanded mental health program activities within its PrEP Program and hopes to continue this expansion through enhanced mental health education, counseling, and supervision for HCWs, focus on additional target groups such as military, veterans and their family members, and other related activities in 2025.

“The I-TECH Ukraine team is immensely grateful to its funders – the U.S. Health Resources and Services Administration (HRSA) through the President’s Plan for Emergency AIDS Relief (PEPFAR) in Ukraine – for their proactive position in regard to the mental health needs of HCWs, PLHIV, and PrEP patients in Ukraine,” says Ms. Shapoval. “As a result, since 2022 I-TECH Ukraine has received additional funding and guidance from its partners that have enabled immediate tailored response and development of the mental health programming that now represents a vital part of our daily activities in Ukraine.”

Ongoing expansion is critical, says Ms. Shapoval, to meet the increasing needs of both HCWs and their patients. Natalia Tiuleneva, lead mental health counselor with I-TECH, agrees: “Currently, medical specialists in Ukraine see a large number of patients who come to their appointment not only with somatic problems, but also with emotional flooding due to the war,” says Ms. Tiuleneva. “With each patient, the doctor experiences an individual patient war each time. This is a big mental burden…. Doctors complain of fatigue and the inability to process so much mental pain.

“It is important for us to save each other,” she continues. “It is important to protect highly qualified specialists. People are capable of a lot when they have a place where their resilience will be noticed and preserved. This culture of professional support in the medical community is promoted by our program, and it is slowly taking root.”

A couple of these examples are below.

A mother, a daughter, and their doctor make progress

A PrEP patient arrived at her doctor’s appointment with her 13-year-old daughter, who had been raped by her HIV-positive stepfather. While the offender was under investigation by the police, he continued to live in their shared housing. After testing, the girl was found to have HIV.

The doctor provided highly professional, compassionate support and consultation, but after the appointment she noted that her personal psychological condition had worsened, and she could not sleep at night. She contacted an I-TECH psychologist for help.

During the session, the psychologist led the doctor through a series of breathing and grounding exercises to lower her stress level. Afterward, she outlined recommendations to be shared with the patient and her mother:

  • To ensure the safety of the girl, she and her mother should end all contact with the offender and find another place to live.
  • The mother should contact a psychologist for her daughter that specializes in sexual trauma.

At a follow-up appointment a month later, the doctor, mother, and child worked together on assimilating the daughter’s experience, a therapeutic method that has shown to decrease the intensity of symptoms.3 As a result of the doctor’s interventions, as well as the help of other specialists, the child is now receiving antiretroviral therapy (ART) and psychological counseling, and she and her mother were able to move to a shelter for survivors of violence.

“I am inspired by the strength in these stories. The power to be human, the power to help others, the power to overcome life’s challenges and trials, the power to become stronger.”
Diana Martyniuk, counselor

For her part, the doctor’s sleep has improved, and her stress levels have decreased. “Finally, I can consult [the mother and child] as my regular patients,” she says.

Empathy leads to overload, and a request for help

During a scheduled session with an I-TECH psychologist, a doctor reported that she was in a difficult emotional state due to the stress of war. The doctor was worried because she often woke up at night with an accelerated heartbeat and a feeling that something terrible was about to happen. Often, she could not fall asleep for a long time and felt overall depressed.

She then mentioned a challenging case from her clinical practice that had been weighing on her heavily.

A 50-year-old patient of hers had been in serious condition with COVID-19. Every day, the doctor was tasked with telling the woman’s son, who served in the military, that his mother’s condition was getting worse. Over time, providing quality support and feeling compassion for the patient and her son had led to emotional overload and exhaustion for the doctor. When her patient died, the son’s grief—and even his gratitude toward her—compounded the doctor’s mental overwhelm.

To address these issues, the physician turned to the I-TECH psychologist again, requesting an additional session. After practicing self-regulation exercises shared during the session, the doctor reported that her sleep stabilized, her well-being improved, and her mood fluctuations decreased.

In a follow-up text to her counselor, the doctor reported: “I started working again, tomorrow it is going to be two weeks…. I completed the activities we discussed. I feel better. I have a different mood, I feel calmer.”

“During the hostilities in Ukraine, the burden on all doctors has increased,” says counselor Nadiya Bruyaka. “In addition to the increase in the number of patients and the severity of their personal stories, other challenges have been added that they had no experience with before: blackouts, Internet outages, air raids, distance learning of one’s own children and anxiety for them during air raids, the presence of relatives and friends in the Armed Forces and increased anxiety for their lives, feelings of uncertainty and helplessness.

“It’s all exhausting,” she continues, “and it is during sessions that doctors and nurses have the opportunity to share their personal condition, understand it, and get support and practical recommendations.”


1 Ben-Ezra M, Goodwin R, Leshem E & Hamama-Raz Y. (2023). PTSD symptoms among civilians being displaced inside and outside Ukraine during the 2022 Russian invasion. Psychiatry Res. 2023 Feb:320:115011. doi: 10.1016/j.psychres.2022.115011. Epub 2022 Dec 17.
2 Xu W, Pavlova I, Chen X, Petrytsa P, Graf-Vlachy L & Zhang SX. (2023). Mental health symptoms and coping strategies among Ukrainians during the Russia-Ukraine war in March 2022. Int J Soc Psychiatry. 2023 Jun;69(4):957-966. doi: 10.1177/00207640221143919. Epub 2023 Jan 4.
3 Basto IM, Stiles WB, Rijo D, and Salgado J. Does assimilation of problematic experiences predict a decrease in symptom intensity? Clin Psychol Psychother. 2018 Jan-Feb; 25(1): 76–84.

Two Years of War in Ukraine: I-TECH and Healthcare System Resilience

Alyona Ihnatiuk, Strategic Information Lead at I-TECH Ukraine, discusses the areas of active Russian hostilities and shelling in Ukraine.

A version of this piece was first posted on the University of Washington (UW) Department of Global Health’s (DGH) website. Article adapted and re-posted with permission.

On March 28, 2024, the International Training and Education Center for Health (I-TECH), the UW Behavioral Research Center for HIV (BIRCH), and the UW Department of Global Health (DGH), hosted a conversation with two critical members of the I-TECH Ukraine team, Oksana Danylenko, MD, MPMA, and Alyona Ihnatiuk, MPH.

During Two Years of War in Ukraine: I-TECH and Healthcare System Resilience, Dr. Danylenko and Ms. Ihnatiuk presented on the impact of the war on critical infrastructure and I-TECH’s activities in Ukraine to address the impacts, including new challenges, needs, and new service delivery models, as well as calling upon action and support.

Dr. Danylenko has 20+ years’ experience working in HIV/AIDS prevention, treatment, policy, and guidelines and serves as a Strategic Clinical Lead at I-TECH in Ukraine. Ms. Ihnatiuk is a Strategic Information Lead at I-TECH Ukraine, focusing on developing public health interventions, M&E system frameworks, data analysis, and program evaluation.

The session recording can be found on the DGH YouTube channel.

Related Resources

I-TECH Presents at 2023 IAS Conference on HIV Science

The 2023 IAS Conference on HIV Science logo. Read the full background and inspiration behind the 2023 IAS Logo. Image credit: IAS

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.




I-TECH and Partners Fête Quality Improvement Teams in Côte d’Ivoire

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.”


HIV Pre-Exposure Prophylaxis (PrEP) in Ukraine

The Government of Ukraine prioritized pre-exposure prophylaxis (PrEP) as part of combination prevention for HIV in 2019.1 Since 2020, I-TECH has focused its programmatic efforts in Ukraine on improving PrEP services uptake and strengthening PrEP delivery at selected stat healthcare facilities.

Continue reading “HIV Pre-Exposure Prophylaxis (PrEP) in Ukraine”

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.

Empowering Young Mothers in Namibia

A young woman learning to weave a basket during the September 9-13, 2019 craft-skills training session.
A young woman learning to weave a basket during the September 9-13, 2019 craft-skills training session.

Young mothers enrolled in the DREAMS program in the Zambezi region of Namibia had the opportunity to learn the traditional art of basket weaving through a series of craft-skills trainings facilitated by the International Training and Education Center for Health (I-TECH) and the Integrated Rural Development and Nature Conservation (IRDNC).

The all day, weeklong trainings taught the young women the basics of basket weaving and also empowered them to create marketable items that could lead to greater economic independence. For the trainings, I-TECH and IRDNC invited a Master Weaver to teach women about the technique, the types of natural fibers and dyes, and the necessary tools used in the craft. All of the women who participated in a training made at least one basket by the end of the week.

“Basket weaving is a traditional craft in this area and it is often a source of income for families,” explains Sharon Zambwe, Program Lead for DREAMS Zambezi. “One of the best parts about this program is that it not only teaches women the skills needed for basket weaving but it also connects them to a market for their works, and with each other for ongoing support and encouragement.”

The baskets that the young women crafted were made available for purchase during an event marking the end of their training. The event was attended by representatives from the Society of Family Health; Zambezi Regional Council; and Regional Ministries of Health & Social Services, Education, Arts & Culture, and Youth and Sport. The special event provided attendees with a background of the DREAMS program and included a keynote address from the special advisor of the Zambezi Governor’s Office who presented the future vision of the DREAMS program.

A basket woven by one of the participants at the September 9-13 craft-skills training session.
A basket woven by one of the participants at the September 9-13 craft-skills training session.

I-TECH launched the DREAMS program in the Khomas region in February 2018 and expanded the program to the Zambezi region in June 2018. Since the launch, I-TECH has enrolled over 20,000 girls and young women aged 9-24 years old in the program. DREAMS is a PEPFAR-funded initiative that aims to give girls and women the tools to be Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS). The program not only addresses the HIV epidemic through prevention and treatment, but it also focuses on the structural drivers of the epidemic, such as gender-based violence (GBV) and poverty.

“The DREAMS program has been able to provide girls and young women with the mentoring and social support needed to help encourage them to make positive and healthy decisions in their everyday lives,” says Ellen MacLachlan, DREAMS Program Director for I-TECH. “The activities in Khomas and Zambezi have had a profound impact on the girls and young women in the program. Economic strengthening activities such as the basket weaving classes can directly empower women by giving them a way to make their own money so they are less dependent on a male partner, especially one who may put her at risk of HIV.”

Since the DREAMS program first launched in the Zambezi region, it has provided social and health services (such as pre-exposure prophylaxis, or PrEP) as well as HIV/GBV prevention education to girls and young women and in August 2019, the program expanded into the field of economic empowerment by providing craft-skills trainings. Since the beginning of the service expansion, I-TECH and IRDNC have trained 82 young mothers, aged 15-24, in the art of basket weaving.

While the craft-skills training program in Zambezi is still in its infancy, there are plans to expand the scope of the training to incorporate other crafts skills such as clay pot artistry, knitting, and needlework. In addition to expanding the scope, DREAMS Zambezi plans to partner with tourism organizations as a way for the women participating in future trainings to showcase and sell their wares.

“We have been impressed with the response from the women who have participated in the program over these past four weeks,” says Zambwe. “We can’t wait to expand this program to incorporate more skills that will benefit not only the young women and their families but the community.”

Aaron Katz

Aaron Katz is a principal lecturer emeritus of Health Services, Global Health (adjunct), and Law (adjunct) at the University of Washington School of Public Health where he teaches several graduate level courses in health policy. He also has an adjunct appointment at the University of Queensland (Australia) School of Public Health. Aaron has held numerous academic leadership positions, including his current role as faculty coordinator of the Health Systems and Policy Concentration of the Health Services Master of Public Health (MPH) program and was founding director of the Leadership, Policy, and Management track of the Global Health MPH program. He was director of the UW Health Policy Analysis Program from 1988 until 2003 and editor-in-chief of the School’s biannual journal, Northwest Public Health, from 1999 to 2008.

Aaron received the American Public Health Association’s Award for Excellence in November 2006 and the Outstanding Teaching Award from the UW School of Public Health in 2004. At the 2011 “State of Reform” Washington Health Policy Conference, Aaron received the Health Reform Leadership Award.

Aaron has developed a deep understanding of the U.S. health care system and its strengths and weaknesses during a career that has spanned 40 years and four “bouts” with health care reform. He has worked in health policy and planning in Washington state since 1978, serving as a health planner, policy and planning consultant, lobbyist, and political adviser. Aaron has directed numerous policy analysis and policy development projects for legislative bodies, state and local public agencies, and private sector clients, including work on health system reform, public health reform, managed care, rural access, HIV/AIDS, workers compensation, long term care, medical economics, and services for people with low incomes. Since 1999, Aaron has collaborated on policy development and advocacy projects with colleagues in various countries in southern Asia, sub-Saharan Africa, Latin America, and Japan.

Aaron has served as a peer reviewer of articles for the International Journal for Equity in Health, Health Affairs, Journal of Health Care for the Poor and Underserved, Global Health Action, and the American Journal of Public Health. He has served on numerous community boards, including the Washington State Budget and Policy Center, Northwest Health Law Advocates, Washington Physicians for Social Responsibility, and Health Alliance International.

Aaron received a bachelor of science degree from the University of Wisconsin – Madison in 1974 and a certificate [master] of public health degree from the University of Toronto in 1975.

Jeff Lane

Jeff Lane, JD, MPH, is Co-Director of the University of Washington’s (UW) International Training and Education Center for Heath (I-TECH) and an Assistant Professor in the UW Department of Global Health. He is also an affiliate faculty member with the UW Global Medicines Program and the UW Implementation Science Program.

Prior to joining UW, Jeff practiced health care regulatory law in Seattle, Washington where he was a partner in the firm’s health care practice group. During his career, Jeff has worked to strengthen health policy and regulatory environments in the United States and more than a dozen countries around the world, including Botswana, Cambodia, India, Jamaica, Kenya, Mozambique, South Africa, Tanzania, Trinidad & Tobago, Uganda, and Ukraine. Jeff’s research focuses on how health policy and law impact access to essential medicines and health workers around the world.

Some of his recent projects include:

  • Developing guidance for national medicine regulatory authorities on emergency use authorizations for medicines and vaccines
  • Evaluating the implementation of pharmacist-initiated HIV pre-exposure prophylaxis (PrEP) laws in the United States
  • Assessing the availability and affordability of medicines in the WHO Africa region
  • Strengthening capacity for HIV service delivery in India, Jamaica, Mozambique, Trinidad and Tobago, and Ukraine
  • Analyzing scope of practice laws affecting equitable access to cardiovascular health services in rural areas of the United States
  • Strengthening advanced HIV disease services in Mozambique

Jeff teaches Policy Development and Advocacy for Global Health (GH523) every spring and co-teaches Global Health Pharmacy: Medicines, Practice, and Policy every winter (GH543). He received his Juris Doctorate and Master of Public Health from UW.