Category Archives: Uncategorized

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.

Kayla Cody-Lushozi Reflects on I-TECH’S Global Health Leadership Development Program

Kayla Cody-Lushozi

By Chelsea Elkins

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.

Despite COVID-19 Challenges, I-TECH Supports Progress Toward Cervical Cancer Elimination

The World Health Organization (WHO) Global Strategy to Accelerate the Elimination of Cervical Cancer, launched in November 2020, calls for a world where cervical cancer—which kills more than 300,000 women per year—is eliminated. To achieve this, the strategy proposes ambitious 90-70-90 targets over the next decade.

However, the COVID-19 pandemic has severely hindered critical work on cervical cancer interventions, including reduced clinic flow, training opportunities, and outreach.

Due to agile programs and dedicated staff, several teams within the International Training and Education Center for Health (I-TECH) network, despite the challenges presented by COVID-19, have continued to make strides toward the WHO cervical cancer elimination goal.

Record-breaking cervical cancer screening in Namibia

The I-TECH Namibia program focuses on cervical cancer screening services for women living with HIV (WLHIV). Namibia’s national antiretroviral therapy (ART) program has rapidly adjusted to COVID-19 and the need to decongest public health facilities through multi-month dispensing (MMD) of ART. While this has helped with ART access, it has significantly reduced opportunities for performing facility-based services, since the frequency of health facility visits by women on ART has declined rapidly.

In close collaboration with the Namibia Ministry of Health and Social Services (MoHSS), I-TECH is implementing enhanced facility-based screening campaigns to increase access and rapidly reach more women. For these enhanced screenings, clients within a district are mobilized and given paced appointment times at several facilities in-line with COVID-19 restrictions. Service providers are then assigned to the specific sites where they provide screening services.

From 8-12 February, 805 women were screened through visual inspection with acetic acid (VIA) or Pap smear, 95% of whom were women living with HIV (WLHIV). Of the 137 women screened VIA positive, 98% received treatment. This campaign broke national records by achieving the highest recorded number of women screened in a 5-day campaign, as well as the highest number of women screened in a single day (210).

“As the COVID 19 pandemic rages on, and preventative restrictions limit client screening, the downtime should be used in planning for catch-up screening activities,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Lead Physician in Namibia. “Resource and client mobilization are both key to prepare for any window of opportunity when COVID restrictions are relaxed to enable rapid mass screening.”

Mentoring and training continues in Mozambique via videoconferencing technology

In close collaboration with the Ministry of Health (MOH) and the University of Texas MD Anderson Cancer Center—a Project ECHO® “superhub” for oncology—I-TECH has continued its monthly cervical cancer ECHO sessions in Mozambique, with an additional focus on COVID-19 safety and risk reduction. An average of 40 participants attend each session, and topics have included cervical changes in older women; relevance of normal and abnormal colposcopic findings; and hygiene, disinfection, and asepsis of materials.

“Although the emergence of the COVID-19 pandemic was sudden, it was possible to adapt quickly using remote information and communication technologies,” says Dr. Ernestina David, Program Manager for the I-TECH Cervical Cancer Prevention Program. “The ECHO videoconference sessions made it possible to bring together providers across the country to address uterine cancer and diagnose and treat pre-cancerous lesions, using local cases and looking for ways to approach and treat them.”

In addition, the Mozambique team has continued its regional cervical cancer trainings in a blended format (both virtual and in-person components). I-TECH has implemented three trainings using a model spearheaded by MD Anderson, wherein a two-day LEEP and colposcopy training was adjusted so that trainers could join via Zoom in lieu of traveling to Mozambique.

While some participants join only the Zoom sessions, others are able to watch the sessions from a classroom setting and then work through skills-building demo stations, followed by practice on patients at a provincial hospital.

Access to services increase through health communication in Malawi

Despite the Malawi government indicating cervical cancer screening, care, and treatment as priority services, after the COVID-19 pandemic hit the country, most facilities did not include cervical cancer services on their priority lists. Facilities either completely suspended or heavily reduced screening and treatment. This, coupled with fears among targeted women about contracting COVID-19, marginalized access to services.

To combat these challenges, I-TECH delivered health talks within communities on how women can protect themselves as they access services (social distancing, hand washing, use of face masks, etc.). Those reached were encouraged to pass on information to others.

I-TECH also engaged district health officers and those in charge of affected facilities on the need to continue providing cervical cancer services, in line with MOH COVID-19 prevention guidelines. Presenters emphasized the burden of cervical cancer and how it would worsen should services be interrupted for the entirety of the pandemic. Discussion also touched on including cervical cancer providers on the rotation roster and ensuring that commodities were available.

In Malawi, 391 health facilities are currently providing cervical cancer screening services, and 80% of those health facilities are also providing treatment services. More than a quarter of a million women were screened between January 2020 and June 2021, 57% of whom were WLHIV.

Zimbabwe consortium takes measures to blunt the impact of COVID-19

I-TECH and its network partner the Zimbabwe Training, Technical Assistance and Education Center for Health (Zim-TTECH) implement cervical cancer screening and treatment via the local Zimbabwean consortium ZimPAAC.

By March 2021, ZimPAAC had achieved 53% of the annual target for the number of women on ART screened for cervical cancer. ZimPAAC implemented several measures to mitigate the impact of COVID-19 on continuity of cervical cancer screening services, including:

  • Training of all health care workers on COVID-19 safety and security, transmission, and prevention;
  • Support to ensure infection prevention and control (IPC) and triage at health facilities through training, procurement and distribution of personal protective equipment (PPE), hand washing stations/commodities, face masks for both staff and clients in need; and
  • Procurement and distribution adequate PPE for use by health care workers at facilities.

We Asked Women Leaders in the I-TECH Network: What Inspired Your Career?

The International Training and Education Center for Health (I-TECH) has a broad network of talented faculty and staff across the globe. We are particularly lucky to benefit from the knowledge, passion, and dedication of many women within our network leadership — both in our country offices and independent partner offices. We recently had the chance to ask just a few of the women leaders in our network, “What drew you to a career in public health?” The answers were as varied as they were inspiring.

Nadine Abiola, PhD, MS
Country Director, I-TECH Côte d’Ivoire

I am French native, with strong Cameroonian roots. I came from a Christian Presbyterian family. My father was the first medical pediatrician of Cameroon, and my mother was a nurse. I grew up with a culture and education of compassion, acceptance, and resilience. My parents were always trying to provide, with very little, a maximum of education and treatment for all.

My life as a toddler existed inside several outbreaks that affected children (cholera, kwashiorkor, meningitis, rubeola, polio). Observing my father treating more than 60 babies and children per day, with a great faith in God, undeniably inspired my career in public health.

Naturally, I chose to be pharmacist and medical biologist. I like the challenges–being on the front lines in Haiti, DR Congo, Tunisia, or Côte d’Ivoire in the battle against AIDS or Ebola is my passion.

Pamela Collins, MD, MPH
I-TECH Executive Director

When I entered medical school, I was drawn to psychiatry. I was also intrigued by the possibilities of preventive medicine and the challenge of problems that could not be solved in a doctor’s office.

Although I did not really know what the field of public health entailed, I was fascinated by the broad concept of culture and how culture, as well as social and political context, could support health or curtail help-seeking; how societies could systematically deny quality health care or adequate income and education to some groups—all of which affected health and wellbeing. I liked the idea that responses to these problems could benefit an entire population.

By the time I was a resident, I’d had some important experiences that confirmed my desire to study public health. In one example I sat with a group of South African nurses who were discussing how they might approach HIV prevention with their patients. They described cultural differences as tremendous barriers. They talked about how the threat of conflict with a spouse, or loss of a relationship, could influence health behavior and thus risk of disease. I listened to them, and I began to appreciate the complexity that public health must embrace in order to achieve its aims. That conversation led me to a public health research career with a central focus on HIV and mental health.

Natalie Irving-Mattocks, MBA
Executive Director, Caribbean Training and Education Center for Health (C-TECH)

About 17 years ago, a close relative of mine died of AIDS at the age of 24. She was a commercial sex worker in her community. After she was diagnosed with HIV, the health care workers in the community disclosed her status to her family members, and it quickly spread in the community that she was HIV positive. She continued to hide her status, which prevented her from accessing care and taking her medication. Her health deteriorated rapidly, and she later died of AIDS. I was very hurt by the way she was treated by her own family members as well as members in the community. Her story inspired me to start looking for opportunities to help the sick, particularly those with HIV.

I applied for my first job in public health, HIV prevention, care, and treatment in 2006. My plan has always been to support those who are most vulnerable, as well as those who have suffered because of stigma and discrimination. What drives me every day is my passion to see those women, children, men who have sex with men, as well as other members of the key population groups receive comprehensive, equitable, and quality health care. No one should be left behind because of their gender, sexual orientation, profession, or social status.

Anna Shapoval, MIR, MPA
Country Representative, I-TECH Ukraine

Back in 1996, I was in my second year at the School of International Affairs in Kyiv. I found myself surrounded by predominantly business-minded/profit-focused classmates. I majored in social policy studies and, soon, realized that I want to devote my life to something more meaningful than money-making.

That year, I volunteered for the Harm Reduction Program at Soros Foundation and, eventually, got hired. The program supported initial few harm reduction sites in country, where no antiretroviral therapy (ART) was available, and people with HIV were dying daily.

Back then, my life-long passion for social justice and public health started along with my professional career. This passion drives me to date.

 

I-TECH Develops COVID-19 Vaccine Registry in Botswana

In March, the Botswana Ministry of Health and Wellness (MoHW), launched an online self-registration platform to allow eligible citizens to register for COVID-19 vaccination. The registration portal was developed by the International Training and Education Center for Health (I-TECH), in conjunction with the MoHW and the National COVID-19 Task Force. Since the launch, more than 60,000 people have registered for vaccination through the platform, and more than 45,000 people have received their first dose of the COVID-19 vaccine.

Screenshot of the COVID-19 registration portal

I-TECH assisted the MoHW to develop the following modules for the platform:

  • A DHIS2 tracker module tracks vaccinated clients for a follow-up dose. I-TECH trained MoHW health informatics and M&E officers to provide remote and on-site support to frontline health care workers across the country on application use. An interactive and intuitive dashboard shows vaccination trends across age and gender bands, geographical area and clinics/health facilities. The tracker module sends automated SMS reminders to clients regarding vaccination date, location, and time. Clients also receive a post-vaccination acknowledgment message.
  • An adverse events tracking module records any adverse events (AEs) due to COVID-19 vaccines. The module also automates reports on AEs and the correlation between AEs and any underlying conditions as disclosed by the clients.
  • A stock management module tracks the vaccine stock at facility, district, and national levels. This module is particularly helpful in projecting the vaccine demands at the clinics and vaccine availability against the vaccination bookings. The MoHW team closely monitors daily opening and closing stocks, to ensure optimal supply. Automated data checks and validations are built in to alert the facility management of any misappropriations in the vaccine stocks.

Available reports within the COVID-19 registration portal

Currently, I-TECH is working on a scheduling application that will be integrated into the portal for online booking of vaccination appointments. This will considerably reduce the number of “walk-in clients,” increase efficiency, and assist frontline workers in managing the workload at vaccination sites.

I-TECH will continue supporting this initiative until the end of the current funding cycle, while simultaneously capacitating the MoHW to take over the day-to-day management and maintenance of the portal.

This online, DHIS2-based platform is available here.

I-TECH’s work in Botswana 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 authors’ 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.

I-TECH Says Goodbye to Longtime Executive Director Ann Downer

Dr. Ann Downer speaks at the I-TECH annual meeting in 2010.

On June 30, 2020, Dr. Ann Downer will retire from her post as the Executive Director of the International Training and Education Center for Health (I-TECH) at the University of Washington (UW).

Downer has had a 31-year career at UW; she founded I-TECH 18 years ago with a talented team of global health professionals at UW, along with her friend and colleague Dr. Michael Reyes, at the University of California, San Francisco. In that time, she has been the center’s trusted leader; a principal investigator for several awards; and a pioneering educator, mentor, and friend.

As is fitting for a hero’s journey, hers started on a boat.

After dropping out of University of California, Berkeley, as an undergraduate in the early ’70s, one semester shy of completing her degree, she worked as one of the only female commercial fisher-“men” in the Pacific Northwest for the lion’s share of her 20s.

Downer fishes in Neah Bay on the Makah Reservation in Washington, across the border from British Columbia.

“Mistake or not, [leaving UC Berkeley] set me on a path that school wasn’t setting for me at the time,” says Downer. “My experience fishing made me resilient, taught me how to work hard, and, above all, made me think about my future since I knew I couldn’t fish forever.”

But in order to finish school, she needed to set a new direction. On the advice of a female sailing instructor, she volunteered at Planned Parenthood Whatcom County in Bellingham, where she quickly secured a paying job.

“This one action — asking someone for advice — set my entire career in motion,” says Downer. “She prompted me to seek a new direction.

“And it was during my time as an education coordinator for Planned Parenthood that I gained the core skills that would serve me for the rest of my career,” she continues. “Teaching and instructional design, health education and curriculum development, comfort with discussing issues related to sexual health, and being in front of groups of people. Those years also solidified one of my core values — that people should have choice in regard to their own bodies.”

Downer finished her undergraduate degree while working at Planned Parenthood and then applied to the UW in Seattle. She went on to get a master’s degree in Health Education and Health Promotion at UW from a department (Kinesiology) that was later eliminated as duplicative with School of Public Health programs.

She again worked full-time during graduate school, exercising her entrepreneurial muscles helping to start a nonprofit program on prevention of child sexual abuse (the successful Committee for Children program has since expanded its work with parents and teachers to provide training on development of empathy and conflict resolution skills).

Downer and her team designed many of the first AIDS prevention campaigns in the state.

Following graduation and a year doing consulting work for clients such as the Washington State Office of the Superintendent of Public Instruction, Downer became the education coordinator in the mid-’80s for the first HIV/AIDS program at Public Health-Seattle and King County, where she and her team designed many of the first AIDS prevention campaigns in the state.

“I had learned by then that I really enjoyed working at the edge of emerging social issues,” she says.

Downer joined the UW faculty in the Department of Health Services in 1989. As a practice-focused educator working among researchers — and as a master’s-trained faculty member working closely with physicians, nurses, and PhDs — she had ample opportunity to call on the work ethic and tenacity she’d forged in the commercial fishing industry years earlier.

She eventually took the advice of her department chair, Dr. Bill Dowling, to continue her education. So, once again, she returned to school and worked full time while earning an advanced degree in educational leadership at Seattle University.

“The program wasn’t what I expected,” says Downer. “I thought it would concentrate on topics related to educational administration, like finance and law, but, while those topics were included in the curriculum, it was really a degree program focused on values-based leadership.

“I didn’t know it then,” she says, “but this was exactly what I needed in order to stay at UW and flourish.”

Values-based leadership became the foundation of two centers that Downer led at UW: the Center for Health Education and Research (CHER) and, later, I-TECH.

“I discovered that I could bring people together who shared certain values —  respect for others, belief in the power of education, maintaining an attitude of hope, the desire to integrate practice and research,” she says. “These were the core values that guided us at CHER and carried over to I-TECH.”

CHER’s programs were initially focused on domestic public health challenges but began to expand in the direction of global health, so Downer approached Dr. Stephen Gloyd, who led the International Health Program (IHP).

“With Steve’s help and encouragement, we aligned more closely with IHP and began to grow our global portfolio of projects” says Downer. “As new projects were funded, the metamorphosis into what would become I-TECH was rapid, but our values and principles always remained the same.”

Downer and mentor Dr. King Holmes, Chair Emeritus of the UW Department of Global Health, in 2017.

I-TECH was formally founded in 2002 and moved from Health Services into the newly created Department of Global Health (DGH) in 2007, at the invitation of Dr. King Holmes, the founding chair of DGH. Holmes was closely involved in I-TECH from its inception and has been instrumental in its success; he remains a mentor to Downer and I-TECH to this day.

Since 2002, I-TECH’s cumulative funding at UW totals nearly $1 billion. I-TECH currently has an international staff of 2,000, with 13 offices in low- and middle-income countries, several of which have now transitioned to become independent, local organizations.

I-TECH implements programs in more than 30 different technical areas that support strengthening of health care systems, including workforce development; HIV prevention, treatment, and care; laboratory systems strengthening; voluntary medical male circumcision; health information systems; health regulation and policy; and leadership and management.

Downer was recognized by UW in 2015 as the recipient of the “Distinguished Contributions to Lifelong Learning” award, in part because of her growing interest in promoting e-learning at UW. Downer’s pioneering 12-week online course, Leadership and Management in Health, had graduated 25,242 participants as of March 2020, with an 87% completion rate. More recently, partnering again with the DGH e-Learning Program (eDGH) on a second 12-week professional development course, Project Management in Health, graduated 6,197 participants in its first two offerings, with a completion rate of 88%.

“My work with eDGH has brought me back to my roots in education,” says Downer, “designing educational products that include content and voices from diverse cultural traditions and perspectives. This is critical learning for those working in public health systems throughout the world — and especially important for improving the leadership and management skills of people working in those systems.”

I-TECH staff past and present, as well as assorted friends and family, gather virtually to toast Ann’s career and retirement.

Though officially retiring on June 30, Downer, as an emeritus professor in DGH, will continue to work for a small amount of time from July through December 2020 in order to finish one global health project under way in Cambodia and two online courses before turning them over to others.

At the same time, Downer does plan to be a retired person and reports that she’ll be busy in her garden, as always, and returning to her early roots as she again takes up sailing. Her adventure began — and now continues, it would appear — on the vast waters of our beautiful Pacific Northwest.

Downer is truly excited to see I-TECH move into the next phase of its organizational life under the leadership of Dr. Pamela Collins, Professor of Psychiatry and Behavioral Health, Professor of Global Health, and Director of the Global Mental Health Program.

“We all welcome you, Pamela!” says Downer. “I believe with all my heart that you are the right person at the right time for I-TECH. You inherit one of the most competent, resilient, and ethical groups of people you will ever work with — and a vision, mission and set of operating principles that I know are consistent with your own.

“I-TECH has been one of the loves of my life,” she continues, “and I wish you the same sense of fulfillment and pride I have had working with this incredible team of people — past and present — at this incredible university of ours.”

We Stand in Solidarity

During the “Doctors for Justice” march on June 6, 2020, health care workers and others marched from Harborview Hospital to Seattle City Hall to protest police brutality.

Communities in the United States and globally continue to respond to the tragic murders of George Floyd and Breonna Taylor at the hands of police officers, as well as the death of Ahmaud Arbery, who was murdered by two White men, one of whom was a former police officer. We acknowledge the pain experienced by Black people and other communities of color. We acknowledge racism, police violence, and anti-Blackness as pervasive and systemic problems – and as barriers to the health and well-being of Black people and other communities of color. Racism and police violence are public health emergencies in the U.S., and we stand with Black communities in the fight against these public health and human rights violations.

Police violence against persons with black and brown skin is not new in the U.S. The United States were founded on racial violence – first through the mass destruction of indigenous communities and then again when the first ship bearing enslaved, captive Africans arrived in 1619. For hundreds of years enslaved people were bought and sold in the U.S. and, though slavery was officially abolished in 1865, the legacy of slavery lives on through the systemic racism, mass incarceration, and injustice that continue to impact our communities of color to this day.

I-TECH staffers and their families attend the “Doctors for Justice” march, which began outside of I-TECH headquarters.

I-TECH will continue to examine policies and procedures that foster safe workplaces for our colleagues of color, especially our Black colleagues; continuously examine and challenge our own biases; and strive to be purposely anti-racist in our actions. I-TECH remains committed to creating an environment where equity, diversity, and inclusion are core values and integral to our workplace and communities. We will hold ourselves accountable when those core values are not upheld.

Our thoughts are with Black members of the community, particularly the families of Mr. Floyd, Ms. Taylor, and Mr. Arbery and all of the other Black families who have lost loved ones to acts of racist violence. We will honor these individuals through our commitment to examining and reducing structural racism in our work.

If you would like to see how UW Health Sciences leadership have responded to these tragedies, read their message here.

Two-Way Texting Study Offers Innovative Model to Reduce Provider Workload while Preserving Patient Safety

The two-way texting research team.

This piece was first posted on the University of Washington Department of Global Health’s website.

Voluntary medical male circumcision (VMMC) safely reduces the risk of female-to-male HIV transmission by up to 60%. Few men have any post-operative VMMC complication. However, current practice in Zimbabwe and throughout most of sub-Saharan Africa requires VMMC patients to return for multiple, in-person post-operative visits. With low complication rates, and severe healthcare worker shortages, these required visits are a burden for providers and patients — threatening achievement of critical HIV prevention targets. A two-way texting model studied by University of Washington researchers in Zimbabwe offers a new way to address this barrier by reducing provider workload while also safeguarding patient safety.

“These visits can be a barrier to male circumcision uptake and expansion in countries with severe health care worker shortages, as well as negatively impacting patients who needlessly pay for transport, miss work, and wait for unnecessary reviews,” said Principal Investigator Caryl Feldacker, PhD, MPH, at the International Training and Education Center for Health (I-TECH) in the University of Washington Department of Global Health.

The study included 721 VMMC patients in two locations in urban Zimbabwe. In the study, patients communicated directly with a health care worker through interactive text messaging for the critical 13 days post-VMMC, rather than returning for required in-person visits. By giving men the option to heal safely at home, or return to care when desired or if complications arose, the method dramatically reduced in-person visits by 85%. Texting also reduced follow-up costs by about one-third while improving the quality of care.

As compared to routine in-person care, the study yielded twice the number of reported complications. “This increased identification and reporting is a positive result that is likely attributable to improved counseling and men’s engagement in care. Through texting, men were empowered to observe their healing and report potential issues promptly, before they worsened,” said Feldacker.

Currently, most text-based health care efforts blast pre-defined messages to many people simultaneously, removing patients’ ability to communicate back with health care workers. In contrast, two-way texting between providers and patients provides interactive care, and the short time frame heightened participation: in the study, 93% of men responded to texts. Both providers and clients reported confidence in the texting option, feeling safe and highly recommending it for scale.

“With the current system, Zimbabwe could perform millions of unnecessary follow-up visits over the coming five years. The workload burden for health care workers and time lost for patients who are healing without complication is a significant burden for health care workers and clients alike,” said Feldacker. “Potential gains in efficiency and reduced costs through using two-way messaging are large.”

With funding from the U.S. Centers for Disease Control and Prevention (CDC), and in partnership with the Society for Family Health, the model will soon be tested in urban South Africa. The new, field-based research will further test two-way texting in a different geographical and patient context to better inform the model for adaptation and widespread scale-up.

Feldacker added that “while our findings are grounded in studies on male circumcision, our results are largely attributable to the methods rather than to a specific disease or condition.

“With minimal adaptation,” she continued, “two-way texting could streamline other post-operative care contexts or be re-configured for other similarly acute, episodic conditions where continuity of care within a short period is critical for patients, such as short-course TB treatment, post-operative healing, post-natal care or early childhood illnesses — diarrhea, pneumonia, malaria — laying the foundation for generalizing to other diseases and contexts.”

For more on the study, see the paper pre-published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS):

Reducing provider workload while preserving patient safety: a randomized control trial using 2-way texting for post-operative follow-up in Zimbabwe’s voluntary medical male circumcision program

The study was led by Caryl Feldacker, and co-investigators are Vernon Murenje (International Training and Education Center for Health (I-TECH), Harare, Zimbabwe); Mufuta Tshimanga (Zimbabwe Community Health Intervention Project (ZiCHIRE), Harare, Zimbabwe); Scott Barnhart, Isaac Holeman, and Joseph B. Babigumira (Department of Global Health, University of Washington); Sinokuthemba Xaba (Ministry of Health and Child Care, Harare, Zimbabwe); and technology partner Medic Mobile (Nairobi, Kenya).

The Zimbabwe 2wT study was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW010583.

I-TECH Helps to Improve Health Regulatory Systems and Training Programs in Cambodia

Pictured are mannequins used at two regional training centers for nurses, midwives, and dental nurses in Kampong Cham and Battambang, Cambodia. I-TECH has supported the procurement of new mannequins to replace those that are old or broken, as well as new teaching tools that will expand the centers’ ability to conduct simulation training. Photo credit: Ann Downer/I-TECH.

The International Training and Education Center for Health (I-TECH) is working on a project led by FHI360, and funded by the U.S. Agency for International Development (USAID), to empower health care managers and national and provincial stakeholders to improve service quality, safety, and utilization, as well as strengthen overall health systems in Cambodia.

The project’s four objectives include:

  1. Improving policies, guidelines and standards for streamlined quality assurance.
  2. Increasing the efficiency and effectiveness of service delivery.
  3. Strengthening regulatory framework, implementation, and enforcement.
  4. Supporting pre-service public health training.

Given I-TECH’s deep experience in health workforce development, supporting the environments that enable strong health systems, and working with stakeholders at all levels, the team was a natural fit for Objectives 3 and 4.

In service of this critical work, I-TECH is supporting implementation of regulations among private and public health workers, as well as helping to lay the foundation for a sustainable accreditation program for public and private health facilities. I-TECH’s team also works with national stakeholders to develop the capacity of pre-service training institutions to deliver high-quality programs aligned with current evidence and national health priorities.

“We are excited to work with our partners to strengthen these critical components of quality health services in Cambodia,” said Jeff Lane, Principal Investigator and Assistant Professor in the Department of Global Health.

“By leveraging I-TECH’s broad experience in health policy, regulation, and workforce development,” he continued, “we can help Cambodia build an accreditation program to recognize high-performing hospitals, strengthen health professional councils to regulate health practitioners, and build sustainable pre-service training institutions that deliver competency-based education to train Cambodia’s health care workers of tomorrow.”

I-TECH Ukraine Initiates National Discussion on Performance-based Incentives Model in HIV

Participants of the national consultation on PBI model development discuss international best practices. Photo courtesy of I-TECH Ukraine.

In response to the need to quickly revitalize efforts to reach targets in Ukraine, CDC Ukraine has asked International Training and Education Center for Health (I-TECH) to support a performance-based incentive (PBI) model.

On March 28, 2019, I-TECH facilitated a high-level stakeholder workshop centered on PBI evidence and “best practices.” Participants from the U.S. Centers for Disease Control and Prevention (CDC) in Ukraine and the Public Health Center (PHC) of the Ministry of Health of Ukraine, and I-TECH gathered to discuss options for adapting proven methodologies to Ukraine’s HIV services.

PHC launched the model in December 2018 at five pilot sites across the country. In the pilot, monetary incentives were paid to individual doctors at the facilities to double efforts toward initiating new patients on ART.

PHC plans to expand the model to all 12 priority regions in the country. On the heels of COP ’19 discussions in South Africa, CDC Ukraine is looking for additional areas of the HIV cascade to which PBI could be applied to reach the FY2020 targets set by the U.S. Office of the Global AIDS Coordinator (OGAC).

The March meeting and the preceding preparatory meetings provided catalytic opportunities for identifying additional HIV services–including index partner testing, linkage to care, and loss-to-follow-up search–that could potentially benefit from the PBI model; discussing lessons learned from other PBI global initiatives; and utilizing evidence-based practices to design well-conceived and context-driven programs.

Marianne Holec, Senior Program Manager for I-TECH Zimbabwe’s voluntary medical male circumcision program; Efison Dhodho, Results-based Financing Health Specialist from the Programs Coordination Unit of the Ministry of Health of Zimbabwe; and Charbel El Bcheraoui, PhD, Assistant Professor at the Institute for Health Metrics and Evaluation (IHME) were keynote speakers at the event.

These working meetings resulted in meaningful exchanges between the guest speakers and Ukrainian experts about the successes (e.g., an increase in short-term achievement of targets and the opportunity to identify and target largest areas of need) and challenges (e.g., workplace friction, dissatisfaction with incentives, lack of teamwork, and reduced quality of care) of PBI implementation globally and in Ukraine to date.

Meeting participants appreciated the practical advice given by the guest speakers on designing effective, intentional, and sustainable PBI models for the longer term for HIV services. Experts advised developing a well-designed program that is adapted to local context; starting at a few sites and try different strategies to see what works best; gathering input from the providers as to what will work best; building in health competition between sites; and having a strong M&E framework.

With input from local stakeholders and international experts, I-TECH Ukraine has accepted the challenge of incorporating the key outcomes from the series of PBI meetings to structure the Ukrainian PBI model for HIV services. This narrative will include an outline of additional technical assistance required around its implementation.

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.