I-TECH’s extensive experience in HIV prevention, care and treatment service delivery, particularly in supporting ART scale up and innovation, make us particular well-suited to support Treat All implementation and differentiated models of service delivery to improve impact. I-TECH recognizes that different clients have different needs and that patient-centered approaches are likely to result in better clinical outcomes and in turn lead to better retention, adherence, and viral suppression. I-TECH has already worked in many countries across PEPFAR to build and support health systems and develop and implement policy at all levels from Health Ministry to local ART centers, and has designed and delivered a broad spectrum of activities to improve service delivery. I-TECH is engaged in supporting Treat All scale-up and piloting DSD models in several countries.
Category: Scott Barnhart
Demand Creation
Demand creation is an evidence-based approach that tailors messaging and activities to specific geographic locations and communities for the most effective results. I-TECH works with the ministries of health in Mozambique, Namibia, and Botswana to scale up demand creation activities for HIV prevention, retention, and testing.
Program Highlights
Quality Improvement
I-TECH’s quality improvement approach emphasizes ongoing assessments of program aims and operations. Country projects apply continuous quality improvement (CQI) strategies targeting both programmatic and management activities. Small-scale, practical Plan-Do-Study-Act (PDSA) cycles are used to construct improvement goals, test proposed changes, and implement adjustments, leading to increased quality of operations, service delivery, and care.
Program Highlights
Integrating Research and Practice
Program Highlights
Monitoring & Evaluation
I-TECH’s monitoring and evaluation staff work to ensure the efficacy of health care training sessions and programs by applying their expertise in cost analysis, data collection, and measurement to rigorous evaluations of these interventions.
In addition to routine monitoring and evaluation (M&E) and continuous quality improvement (CQI), I-TECH designs and implements operations research (the application of research methodology to inform and improve program design and management) and special studies for both I-TECH country programs and our partners. These activities enable us to answer strategic questions concerning the selection and effectiveness of program interventions. The team analyzes and designs evidence-based solutions to increase relevance, access, and scope of HIV services.
Monitoring ongoing projects and programs allows for midstream corrections; key findings are communicated to managers and leaders to improve programmatic decision making. Results are disseminated through publication, when appropriate.
Additionally, I-TECH has significant capacity in the rapidly expanding field of health informatics for resource-limited clinical settings. I-TECH develops tools and systems—such as the Training System Monitoring and Reporting Tool (TrainSMART)—and provides technical assistance for electronic medical records, training management, and remote clinical diagnostic systems.
Program Highlights
Nursing/HCW Cadres
World Health Organization guidelines for placing all HIV positive individuals on antiretroviral treatment has intensified the demand for a competent and accessible global health work force that can accommodate 90-90-90 UNAIDS targets for testing, treating, and virally suppressing HIV patients. There is an urgent need to concentrate on effective, differentiated, and cost-efficient service delivery models that embrace high quality patient-centered HIV care as countries adopt and roll out Test and Start. Achieving 90-90-90 will require substantial shifts in how HIV services are staffed and delivered; different solutions, including task sharing, are still needed to reach targets. Over the past decade, a variety of non-physician cadres, such as nurse-midwives, clinical officers, and medical assistants, have contributed to growing evidence of task sharing’s positive contributions to HIV health outcomes in resource-limited settings.
Program Highlights
Human Resources for Health
The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated health care workforce, and sustainable systems to educate and train those workers. I-TECH uses a systemic approach to build the skills and knowledge of, and foster attitude changes in, health care staff and those who train and educate them.
The following model outlines I-TECH’s human resources for health-based approach to achieving comprehensive patient-centered care. Each component of the model, including a strong enabling environment, supports an optimized health workforce as the foundation of an effective service delivery system.
Program Highlights
Clinical Mentoring
Clinical mentoring is a critical component of I-TECH’s comprehensive approach to training, as it provides a bridge between didactic training and independent clinical practice. Clinical mentoring enables health care workers (HCW) to practice new skills in clinical settings with the support and guidance of a more specialized and experienced clinician. Intensive, practical training is especially important in HIV care and treatment given the diversity of illnesses associated with AIDS and the complexities of antiretroviral therapy (ART).
Typically, the clinical mentor is an experienced clinician-trainer who provides onsite training and consultation on complex cases; supports and enhances high level problem solving, diagnostic, and decision-making skills; leads case discussions; and addresses issues of quality assurance and continuing education. These mentoring activities take place in the context of an ongoing, two-way relationship between the mentor and the clinicians working at the site.
The I-TECH approach to mentoring includes five key components:
- Relationship building. The establishment of a trusting, receptive relationship between the mentor and mentee(s) that evolves and grows over the course of mentorship is the foundation of effective mentoring practice.
- Identifying areas for improvement. Observation and assessment of existing systems, practices, and policies leads to the identification of areas for improvement. I-TECH has developed a number of tools for use during the assessment phase. Information obtained during an assessment helps to inform the establishment of goals and objectives for the mentorship.
- Responsive coaching and modeling of best practices. Mentors must demonstrate proper techniques and model good clinical practice. Targeted activities with mentees may include demonstrating appropriate examination techniques, modeling proper infection control measures, and setting examples for establishing good rapport with patients.
- Advocating for environments conducive to quality patient care and provider development. This component relates to technical assistance in support of systems-level changes at a site. Mentors work with colleagues to enhance the development of clinical site infrastructure, systems, and approaches that can support the delivery of comprehensive HIV care.
- Data collection and reporting. Mentors support the utilization and integration of patient data into clinical practice by encouraging staff to adopt documentation practices that promote effective chronic disease management. Mentors can help demonstrate the utility of data collection and reporting to mentees during mentorship.
The ultimate goal of I-TECH’s clinical mentoring programs is to build the skills of local clinicians to become clinical mentors themselves. Ideally, as the pool of expert HIV/ART clinicians in each country expands, a network of local HIV clinical mentors will emerge to support and train other HIV clinicians with less experience.
Program Highlights
Laboratory Systems
Medical laboratories are a critical component of quality health care and provide essential data for patient care and treatment, disease prevention and control, and public health policy development. I-TECH recognizes laboratory strengthening as a core component of its work. I-TECH’s Laboratory Systems Strengthening (LSS) team’s mission is to improve laboratory operations for optimal patient care and treatment, disease surveillance and response, biosecurity, and policy development. The LSS team fosters the development of sustainable laboratory systems and laboratory capacity in multiple countries throughout the world and comprises staff at the University of Washington (UW) in Seattle, as well as locally based staff. The team leverages partnerships within UW and with external collaborators globally, and engages directly with Ministries of Health and funders to accomplish mutual objectives.
In addition to the highlights below, I-TECH also has had laboratory programs in Cambodia, Côte d’Ivoire, Lao PDR, the Middle East and North Africa, and Zambia.
Program Highlights
Layering Research and Practice in Haiti
The EMR iSanté enables research on population health in Haiti, including the implementation of Option B+. This work was presented at the International AIDS Society Conference in 2015 Continue reading “Layering Research and Practice in Haiti”