The tool facilitates communication between clients living with HIV and their healthcare providers in between their care visits, through a digital case management system and two-way text messaging services. The tool gives clients anytime access to a text-message-based health library and the ability to ping their care team for telemedicine services. This digital health intervention seeks to strengthen the therapeutic alliance and enhance patient medication adherence.
This digital health intervention is made possible through funding and support from the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) via a sub-award granted to the Caribbean Training and Education Center for Health (C-TECH) and DIGI through the International Training and Education Center for Health (I-TECH).
IDASH fellows engage in group work during an October workshop in Almaty, Kazakhstan. Photo credit: Jamey Gentry/CDC.
Last month, the International Training and Education Center for Health (I-TECH), in collaboration with the U.S. Centers for Disease Control (CDC) and with support from the World Health Organization (WHO), facilitated the second of three in-person workshops for the Informatics and Data Science for Health (IDASH) fellowship.
Held in Almaty, Kazakhstan, the workshop marked the mid-point of the 12-month fellowship—and a chance for participants to come together to advance their ability to apply public health informatics and data science concepts and approaches.
“This workshop included a lot of hands-on practical exercises, and it was fun to observe how engaged the participants were with these activities and with the learning in general,” said Stacey Lissit, MPH, MS, Senior Technical Advisor for the IDASH program.
Content included all things data (quality, cleaning, analysis, visualization, governance, security, privacy, and confidentiality); interoperability; project management; business process analysis; and systems architecture. Sessions were a mix of didactic lecture, small group activities to practice application of skills and concepts, peer feedback, and guided hands-on learning in R and PowerBI. Over the course of the two weeks, participants collaborated to develop a data dashboard, a database schema, and a data quality workplan.
The first cohort of the IDASH fellowship, with I-TECH instructors. Photo credit: Jamey Gentry/CDC.
The current fellowship, launched in April 2023, comprises a cohort of four participants each from Georgia, Kazakhstan, Kyrgyzstan, Ukraine, and Uzbekistan—a total of 20 fellows. Each four-person team includes a mix of mid-senior level epidemiologists, informaticians, data scientists, IT, and public health policy personnel.
Fellow Zhanibek Yerubayev, Director of Public Health Emergency Operations at the Kazakhstan Ministry of Health’s National Center of Public Health, says the team mix is an integral part of IDASH’s impact. “[IDASH] connects people from the public health side with people from the IT side,” he says. “These people have a lot of projects to do [together], but they are not always well connected, and they do not always understand each other well.”
“It was exciting to see the relationships and community that are being built through the IDASH Fellowship – both within the country teams where fellows can collaborate closely with colleagues outside of their typical ‘work silos,’ and across countries within the region,” said Lissit. “That peer learning element is such an important part of the fellowship.”
And all efforts were made to ensure multi-directional collaboration. The Ukrainian team did not receive permission to travel to the workshop, so I-TECH made arrangements for them to participate via Zoom. A location was identified in southwest Ukraine where the team could attend the workshop together remotely, experience fewer daily safety issues related to the war, and avoid the distractions of being in their own workplace. A simultaneous translator for the Ukrainian language was provided on the Zoom call.
While remote participation is not ideal, the Ukraine team was able to attend and hear most of the workshop sessions and engage in the group work in meaningful ways. “A lot of effort went into setting up the technology that enabled this participation,” said Lissit. “At one point the Ukraine team was participating in a peer feedback activity with two country teams in Almaty—there were live cameramen, screen sharing, Zoom translators…and it worked mostly seamlessly!”
Fellow Durbek Aliyev, Deputy CEO at IT-Med LLC, which works under the Uzbekistan Ministry of Health, was especially appreciative of the chance to learn from a wide range experts across the region. “The digitalization of health care cannot be done by only one country itself,” said Aliyev. “The advantage of IDASH over other programs is that it brings [together] specialists from neighbor countries. We are talking to each other….We are learning from each other directly.”
And these relationships will be a lasting benefit of the program, he continued. “IDASH is a place where we can establish very good networking with other countries,” said Aliyev. “Any time I can contact them and learn from their expertise.”
IDASH is a project within the Integrated Next-Generation Surveillance in Global Health: Translation to Action (INSIGHT) program. In addition to acquiring new skills and knowledge in public health informatics and data science, IDASH country teams are developing and will implement a collaborative team project that demonstrates key competencies and is aligned with their country’s needs and priorities.
Index testing is a is a key strategy to identify and support those most at risk of acquiring HIV.1 Within the index testing framework, exposed contacts (i.e., sexual partners, biological children and anyone with whom a needle was shared) of an HIV-positive person (i.e., index client), are elicited and offered HIV testing services.
From 2019 to 2021, the I-TECH team in Ukraine provided increased technical assistance for 39 state healthcare facilities in 11 high HIV-burden regions to advance assisted partner notification/services and index testing.
In a recently published study in BMJ Open, the I-TECH team—along with representatives from the Public Health Center at the Ukrainian Ministry of Health—describe the success of this scaled program in index testing.
“Index case testing is crucial in reaching out to exposed contacts of individuals living with HIV, notifying them, and offering HIV testing,” said Anna Shapoval, I-TECH Ukraine Country Representative. “This approach is particularly important and effective in the context of Ukrainian national HIV response where, despite numerous successes, we still struggle to close HIV testing gap and reach out to people living with HIV earlier rather than later with proper treatment and support.”
I-TECH developed exhaustive standard operating procedures for index testing; thoroughly trained healthcare teams on the index testing algorithm; as well as provided consistent and regular methodological support as part of its index testing program.
The study includes clients enrolled in index testing services in 2020, who had with both recent (<6 months) and previously established (≥6 months) HIV diagnoses. Ukraine’s physician-led model involves a cascade of steps including voluntary informed consent, partner elicitation, selection of partner notification method and follow-up with clients to ensure partners are notified, tested for HIV, and linked to HIV prevention and treatment services, as needed.
“Ukraine’s index testing services were rolled out as a standard part of Ukraine’s HIV service package at the targeted governmental health facilities, and carried out by existing physicians,” said Alyona Ihnatiuk, Strategic Information Lead for I-TECH Ukraine and lead author of the study. “At each supported facility, one or two staff members were designated as focal persons for case management and follow-up. This integrated, physician-led model was streamlined to target index cases with both recent and established HIV diagnosis, to arrive at a high number of new cases of HIV identified.”
There were 976 new cases of HIV identified through the study period, representing a yield of 19.3%, and 1,408 people living with HIV (PLHIV) have been identified throughout the two-year index testing program.
Of 14,525 index clients offered index testing, 51.9% accepted, of whom 98.3% named at least one sexual partner, injection partner, or biological child. Clients named 8,448 unique partners; HIV case finding was highest among clients with recent HIV diagnosis and among people who inject drugs (PWID), and lower among clients with established HIV diagnosis. More than 90% of all partners with new HIV diagnoses were linked to care.
“The BMJ Open study confirms that comprehensive assisted partner notification services and index testing are highly effective in identifying people living with HIV,” says Ms. Shapoval, “as well as tracing previously diagnosed partners and supporting their linkage to care. I-TECH was honored to contribute to the design and implementation of this vital intervention in Ukraine early on and see it gradually rolled out across the country with multiple partners successfully implementing it now.”
Golden M, et al. Partner notification for sexually transmitted infections including HIV infection: an evidence-based assessment. Sexually transmitted diseases. 4th edn. McGraw-Hill; New York, NY: 2007.
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.
In 2019, I-TECH conducted an on-site assessment at Trinidad and Tobago’s largest HIV treatment site. The findings of that assessment led to the establishment of an integrated psychosocial program at this site that has yielded favorable results. This further inspired the need for expansion of this psychosocial approach to other HIV treatment and care sites.
In 2022, I-TECH collaborated with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH) to conduct a similar rapid assessment throughout the national treatment and care sites. The results reflected that there was a need for specialized staff to identify and treat common mental health and psychosocial concerns, as well as a standardized approach. Therefore, I-TECH is supporting the HACU to lead the expansion and strengthening of mental health and psychosocial (MHPS) service delivery for persons living with HIV at HIV treatment and care sites in Trinidad and Tobago. Goals include the standardization of psychosocial assessments to support the early identification of psychological distress, symptoms of co-morbid mental illness and psychosocial issues; as well as the standardization of the procedures for making interventions.
Activities include:
Developing a draft MHPS Protocol to include screening and intervention tools and psychosocial standard operating procedures (SOPs)
Establishing a standardized referral system
Training and supporting psychosocial team members in the use of the SOPs and all screening and assessment tools. Training will address areas of intimate partner violence, gender-based violence, and mental health challenges that are frequently encountered within the client population
Training and supporting psychosocial team members in data collection and reporting requirements
Training and capacity -building of psychosocial team members of the Psychosocial Coordination Unit being established by the HACU
I-TECH partners with the HIV/AIDS Coordinating Unit (HACU) of the Ministry of Health (MOH), the National AIDS Coordinating Committee (NACC) of the Office of the Prime Minister, and other local organizations to make accessible learning and capacity-building opportunities for all cadres of health care workers.
Learning Management System (LMS): I-TECH and the University of Washington Department of Global Health’s eLearning Program (eDGH) collaborated to adapt an LMS for Trinidad and Tobago from the Jamaica LMS. The LMS for Trinidad and Tobago will support ongoing, standardized capacity-building of an increased number of health care providers in a cost-effective way. The LMS will also function as a monitoring and evaluation tool for training and skill building. I-TECH will support, develop, and adapt HIV course material and provide local administration and coordination support.
Key Populations Preceptorship Web Modules: I-TECH is currently developing self-paced, eLearning training modules to improve providers’ knowledge, skill, and comfort in providing respectful and gender-affirming care for gay and bisexual men, other men who have sex with men, people of transgender experience, and people engaging in sex work. This module will be an adaptation of the innovative in-person Key Population Preceptorship (KPP) Program for Clinicians and will be made accessible on the I-TECH/eDGH LMS that is being developed. The modules will incorporate video recordings featuring local community members, modeling of best practices, and show interactive exercises.
UW eDGH Online Courses: I-TECH, through eDGH and in collaboration with HACU and the NACC Office of the Prime Minister, provides online certification courses to health care providers in Trinidad and Tobago. Courses include: Clinical Management of HIV; Leadership and Management in Health; Fundamentals in Global Health Research; Policy Development and Advocacy for Global Health; Project Management in Global Health; Monitoring and Evaluation in Global Health; Fundamentals of Implementation Science; Wellbeing for Healthcare Professionals; and Global Mental Health.
Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported MRFTT, the HIV treatment site with the largest adult population in Trinidad and Tobago, to become an ECHO® hub site. The hub provides virtual clinical consultation support as well as brief didactic sessions for healthcare workers in Trinidad and Tobago on a range of medical/clinical and psychosocial topics, as well as those relevant to HIV care, treatment and support. Healthcare workers (HCWs) who have benefitted from the series not only include those from Trinidad and Tobago, but also HCWs from Haiti, Barbados, Bahamas, St. Vincent, Grenada, and Florida, USA.
Management of HIV Infections Diploma Course: In 2014, I-TECH partnered with the University of the West Indies (UWI) – St. Augustine campus in Trinidad and Tobago to develop a blended eLearning course that enables HCWs to provide high-quality clinical management of patients living with HIV. This ten-month post-graduate diploma program is delivered through a series of online, self-paced courses taught by UWI faculty, and is augmented by synchronous virtual classroom discussions and hands-on, clinical practicum experiences. In recent years, I-TECH worked with the UWI to integrate extensive care and treatment content specifically focused on comprehensive care for key populations affected by HIV. The course is offered annually to healthcare workers from PEPFAR priority sites in the region. Course graduates include health care workers from Trinidad, Jamaica, Suriname, and Barbados.
Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider and a preceptorship trainer (PT), who is a member of a key population group, with the observation of a training facilitator. The PT takes on the role of a mock patient and uses a pre-scripted scenario as a guide to interact with the provider-in-training, giving feedback after each scenario. The KPP builds the provider’s capacity to provide comprehensive and nonjudgmental care to key population groups including gay and bisexual men, other men who have sex with men, persons of trans experience, and sex workers.
The KPP was adapted based on Jamaica’s KPP for clinicians in 2016 for physicians in Trinidad. In 2017, it was adapted for nurses and was delivered in-person over the course of a two-day period. In response to COVID-19 protocols, the KPP for social workers, which was adapted in 2020, was delivered virtually.
I-TECH Trinidad and Tobago collaborates with local organizations to implement programs focused on supporting the health and wellness of people living with HIV (PLHIV), including:
• National HIV Helpline: The COVID-19 pandemic highlighted the need for virtual support and information on HIV testing, care, treatment, and support, and an increased need for guidance and psychosocial support for PLHIV. This prompted the need for a central line for communication and connection to the HIV/AIDS network. For World AIDS Day 2021, the National AIDS Coordinating Committee (NACC), Office of the Prime Minister, in collaboration with the HIV AIDS Coordinating Unit (HACU) of the Ministry of Health and I-TECH, launched the national HIV helpline. I-TECH provides technical assistance, training, and capacity building support to the HIV Helpline Coordinator and Active Listeners and is supporting efforts to raise the social media profile to increase caller volume.
The NACC website has a new dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable to support health and treatment for PLHIV.
•Patient Health and Literacy: In collaboration with the National AIDS Coordinating Committee (NACC), Office of the Prime Minister and a technical working group comprised of PLHIV and non-governmental organization (NGO) representatives, I-TECH developed content across nine topic areas aimed at improving PLHIV health and treatment literacy. The content was integrated into the inaugural NACC website in a dedicated section titled “It’s All About U:” Identifying the Key Steps to a Healthier U, along your path to becoming Undetectable. Topic areas were focused on promoting and encouraging U=U with content titled: U and Your Dream Team; A healthy U; All about U and HIV; What U may get wrong; Your journey to U; U and your Partner; U in the future – HIV and Aging; U and your Baby – HIV and Pregnancy; HIV and COIVD-19 . The website is expected to facilitate wider access and reach to the PLHIV community and is the first content of its kind to provide consolidated, standardized and culturally appropriate material on HIV and AIDS treatment, care, and support in Trinidad and Tobago.
Trinidad and Tobago
Since 2005, I-TECH has been partnering with the local health ministry, national programs, and local organizations in Trinidad and Tobago to provide technical assistance and capacity building in support of the national response to HIV and AIDS. I-TECH Trinidad and Tobago is currently funded by the Health Resources and Services Administration (HRSA), through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and aims to support sustainable health systems, build healthcare worker capacity to provide comprehensive HIV treatment and care and strengthen self-advocacy for people living with HIV.
Trinidad and Tobago is part of I-TECH’s Caribbean Regional Program and collaborates with the Caribbean Training and Education Center for Health (C-TECH) to share, adapt and consolidate materials and efforts. The program also, where possible, includes participants from other Caribbean countries in its capacity-building activities.
The Center for Stewardship in Medicine (CSiM) has joined the International Training and Education Center for Health (I-TECH) Network as a partner, operating within the University of Washington’s Department of Global Health. CSiM is a collaborative of over 80 rural hospitals across nine states in the U.S. working together on stewardship challenges through education, quality and process improvement, and mentoring.
I-TECH and CSiM will mutually benefit from collective decades of experience tackling rural health challenges – including workforce shortages, staff who wear “many hats,” and disparities in services – in the U.S. and around the world.
“CSiM is a collaborative of physicians, nurses, laboratory professionals, and pharmacists working to bridge bi-directional knowledge gaps between academic medical centers and rural health care facilities,” said John Lynch, MD, MPH, co-director of CSiM. “Like I-TECH, we value collaborative, anti-hierarchical work that honors expertise and experience at all levels of the health care system, and from all sectors.” Dr. Lynch leads the center with Chloe Bryson-Cahn, MD, and Zahra Kassamali-Escobar, PharmD.
The CSiM team with guest speakers at the center’s conference in Spokane, WA, May 2023. Photo courtesy of CSiM.
CSiM works in antimicrobial stewardship and infection prevention, building sustainable quality improvement programs, and providing customized, long-term technical assistance to rural health facilities. The center’s main activities include leading the UW Tele-Antimicrobial Stewardship (TASP ECHO®) project, a telementoring program; coordinating Intensive Quality Improvement Cohorts; and providing resources and tools to support facilities in reaching their goals and improving the quality of healthcare.
“I-TECH and CSiM share a dedication to finding innovative and local solutions to provide ongoing education and mentoring to health care workers in resource-limited settings,” said Pamela Kohler, BSN, PhD, I-TECH co-director. “We are incredibly excited about the opportunity to learn from each other.”
Currently, CSiM has projects in Arizona, Idaho, Illinois, Louisiana, Maine, Montana, Oregon, Utah, and Washington and is exploring opportunities to extend its model globally.
“CSiM’s inclusive, team-based approach results in work that really matters to communities in need – particularly those in underserved, hard-to-reach, rural areas,” said Ivonne Ximena “Chichi” Butler, MPH, I-TECH co-director. “This approach makes it a perfect fit within the I-TECH Network.”
Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported 
Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV. The Key Populations Preceptorship (KPP) program is a simulated one-on-one patient-provider training program that brings together a health care provider and a preceptorship trainer (PT), who is a member of a key population group, with the observation of a training facilitator. The PT takes on the role of a mock patient and uses a pre-scripted scenario as a guide to interact with the provider-in-training, giving feedback after each scenario. The KPP builds the provider’s capacity to provide comprehensive and nonjudgmental care to key population groups including gay and bisexual men, other men who have sex with men, persons of trans experience, and sex workers.
