Alex Greninger, MD, PhD, MS, MPhil, is the Larry Corey Endowed Professor in the Department of Laboratory Medicine and Pathology at the University of Washington Medical Center, assistant director of the clinical virology labs, and director of the clinical trials and Retrovirology lab.
Dr. Greninger is interested in building laboratory capacity to support global health initiatives for everything from quality management systems to bioinformatics for pathogen genomics and metagenomics for pandemic preparedness.
The Integrated Next-generation Surveillance in Global Health: Translation to Action (INSIGHT to Action) project is a five-year cooperative agreement with the ... Read More
On June 17, the International Training and Education Center for Health (I-TECH) and the U.S. Centers for Disease Control and Prevention (CDC) South America Office, in collaboration with the Ministry of Health in Peru (MINSA), launched the Informatics and Data Science for Health (IDASH) fellowship in South America. The program was first implemented in the Eastern Europe and Central Asia with support from WHO EURO, with the first cohort graduating in April 2024, and adapted to the South American context.
The 12-month training will focus on developing a health workforce that is well-trained in digital health and understands health informatics and data system requirements to support public health functions. Thirty-four fellows from government agencies from Brazil, Colombia, Ecuador, Paraguay, and Peru are together in Lima, Peru, for two weeks for the first in-person workshop.
During the opening ceremony, Peru’s Vice Minister of Health Ricardo Peña Sánchez and Secretary of Government and Digital Transformation César Vílchez Inga reaffirmed the importance of this initiative to support advancing digital strategies for health in Peru, including interoperability of information systems. The development of a skilled workforce in health informatics and data science is also aligned with PAHO’s efforts to advance digital health in the region, as highlighted by Sebastian García, Director of the Evidence and Intelligence for Health Action Department of the Pan American Health Organization (EIH/PAHO) during the opening.
During the second week of the in-person workshop, fellows will be joined by mentors from each participating country. The support from experienced mentors will enhance their learning experience and the application of the knowledge and skills acquired during the program.
Valdirene Montalvão, Information Systems Technician at the Brazilian Ministry of Health, has high expectations for her participation in the program. Through IDASH, “I will be able to learn and expand my skills to contribute more effectively to the process of monitoring, managing and evaluating for public health decision-making,” she says.
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.
The event included a final in-person workshop and a certificate ceremony, celebrating 12 months of intensive learning and collaboration. The fellowship program included in-person workshops, mentorship, and communities of practice to support applied learning, as well as completion of capstone projects that aligned with respective countries’ health priorities.
“IDASH has been a novel training approach to bridge the gap between public health informatics and data science to improve population health,” says Jennifer Gilvydis, INSIGHT Project Director. “The fellowship is a unique blend of applied learning and supports multidisciplinary workforce development.”
The final workshop covered topics such as evaluating surveillance system performance, public health informatics communication, developing effective poster presentations, and maintaining connections with fellow program graduates. Fellows presented their capstone projects, showcasing the application of newly acquired skills and knowledge.
Each interdisciplinary country team included members from Ministry of Health (MOH) units responsible for digital health and disease surveillance and response, such as mid-senior level epidemiologists, informaticians, data scientists, IT specialists, and public health policy personnel. This diverse mix of disciplines was integral to the fellows’ experience and the success of their capstone projects.
“What was unique [about this fellowship] was that this scholarship included the integration of systems as well as public health and technology,” says Nuraiym Zhumakunova, a fellow and epidemiologist with the Department of Disease Prevention and State Sanitary-Epidemiological Surveillance in Kyrgyzstan. Her team was working on a unified platform for disease surveillance data analysis.
“Overall, [the program] was good because we understood the work as analysts and as IT specialists,” she continues.
Stacey Lissit, Senior Technical Advisor for the IDASH fellowship, agrees that collaboration across disciplines was key to the program’s success: “The fact that IDASH brought together professionals from disciplines that may not typically collaborate and communicate with each other – public health/epidemiologist and IT/Data scientists – was an integral part of the fellowship,” she says. “It enabled fellows to get out of their silos and understand the priorities, needs, and ‘language’ of their colleagues, and see how communication and collaboration are so vital to achieving the desired public health outcomes. The relationships and community that was built among the fellows from different countries was an invaluable component of the program.”
The fellowship not only enriched the participating professionals but also had tangible benefits for their agencies and organizations. “We trained health workers on how to maintain quality data,” said Farhod Akbarov, First Deputy CEO at IT-Med LLC under the MOH of Uzbekistan, whose team was working on reporting, mapping, and forecasting of infectious disease. “These are already new skills for us. We can already filter, sort, and show better quality data.”
As the COVID-19 pandemic has demonstrated, robust information systems that can collect, analyze, interpret, and act on high-quality data are critical to public health. The IDASH fellowship program aims to close knowledge gaps in the global public health workforce, better preparing regions for future health threats.
The fellowship program is set to launch in five countries in South America this June, expanding its reach and impact on global health initiatives.
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.
Migrating waterfowl from Asia, Africa, and Europe intersect in Georgia, which increases the potential for novel avian-origin influenzas to emerge. I-TECH, through the INSIGHT project, is working with the Centers for Disease Control and Prevention Georgia, the Georgia National Food Agency, and the Georgia Ministry of Environmental Protection and Agriculture, through September 2024 to assess biosecurity and influenza outbreak readiness on commercial poultry farms in Georgia, and support capacity building for and development of a national wild bird surveillance strategy. Activities include a farm biosecurity survey and peri-domestic wild bird capture, sampling, and testing, as well as training in genomic surveillance and design of surveillance programs.
At a February 5-8 meeting in Bogotá, the International Training and Education Center for Health (I-TECH) convened with global health leaders from 5 countries to inform the adaptation of the Informatics and Data Science for Health (IDASH) training program to South American contexts.
IDASH–part of I-TECH’s Integrated Next-generation Surveillance in Global Health: Translation to Action (INSIGHT) project–is a training program for current and future leaders in public health that aims to strengthen regional capacity to use public health information and data systems to improve health outcomes at the population level, detect and respond effectively to threats to public health, and promote health equity.
The objectives of the intensive, weeklong Executive Committee meeting included identifying priorities and key capabilities; adapting the structure of the IDASH course to local needs as well as government priorities and initiatives; and identifying government and academic resources to support teaching.
IDASH South America Director Fernanda Freistadt addresses the participants on Day 1 of the meeting. Photo courtesy of Maíra Pessoa/FVS-RCP.
In a a website post of IDASH partner Fundação de Vigilância em Saúde do Amazonas – Dra. Rosemary Costa Pinto, INSIGHT Regional Director for South America Fernanda Freistadt said: “This initiative has the potential to create health professionals who have advanced knowledge in both epidemiology and information technology, an area in which there is a great lack today. Furthermore, IDASH can strengthen technical relations and collaborations in the area of surveillance between countries.”
The Executive Committee Meeting included representatives from Colombia, Brazil, Paraguay, Peru, and Ecuador, as well as international partners including Georgia’s National Center for Disease Control and Public Health (which has been an important partner in the IDASH training program for Eastern Europe/Central Asia). It is anticipated that the South America expansion implementation to happen later this year.
Despite establishing COVID-19 monitoring measures within the existing routine national surveillance system and significant efforts to conduct testing, contact tracing, and case investigations, Government of Malawi institutions at both the national and district levels faced many challenges in mounting an effective response to the COVID-19 pandemic. The existing COVID-19 surveillance system relied on retrospective data and it struggled to establish the magnitude of community transmission or identify emerging variants.
In June 2022, in collaboration with the Public Health Institute of Malawi and support from the US Centers for Disease Control and Prevention, I-TECH began sentinel surveillance monitoring of COVID-19 in seven sites. The COVID-19 sentinel surveillance system in Malawi was able to quickly detect changes in positivity rates and the emergence of variants. Read more about key findings and methods in I-TECH’s Sentinel Surveillance program brief.
The theme of this year’s World AIDS Day is “Let Communities Lead.” This is not only a call to action, but also a recognition of the irreplaceable contribution of community members in the success of global programs and their critical role in their own health care.
We had the honor of capturing a brief interview between two of our wonderful I-TECH colleagues in Trinidad and Tobago–Alana Lum Lock Cardinez, Program Advisor, and Conrad Mitchell, Program Manager. Here, Alana asks Conrad for his perspective as both a community member and project lead, as well as about the lessons learned when communities aren’t engaged (4:15).
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.
