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.
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.
The Extension for Community Healthcare Outcomes (ECHO) Project® was developed by the University of New Mexico to improve care for underserved populations using a hub-and-spoke approach of knowledge-sharing by video-conferencing technology. The Lighthouse ECHO project provides a platform for sharing critical, timely, and life-saving information and data with health care workers (HCWs) located in different locations and facilitates peer-to-peer interactions among local, regional, and international experts using real-time, video-conferencing technology.
Lighthouse, a long-standing I-TECH implementing partner, is a World Health Organization-recognized clinic for integrated HIV prevention, treatment, and care in Malawi, serving approximately 60,000 antiretroviral therapy patients across the country. Lighthouse is an established HIV education site and has been involved in capacity building in pre- and in-service trainings for staff from the Ministry of Health as well as non-governmental organizations and implementing partners for many years.
Since April 2020, Lighthouse’s Project ECHO has conducted 67 sessions and has served 4,150 participants on COVID-19, HIV, and tuberculosis topics.
The International Training and Education Center for Health (I-TECH), in collaboration with the Namibian Ministry of Health and Social Services (MOHSS) and with funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), has launched a campaign to raise awareness of the importance of screening for and treatment of cervical pre-cancer in women aged 20–49.
This awareness campaign is the most recent expansion of the Namibian Cervical Cancer Screening and Treatment Program, which was rolled out in 2018 following the adoption of national cervical cancer guidelines by the MOHSS in March 2018.
MoHSS Health extension worker and data clerk capturing data for the National Cervical Cancer Program.
The rollout of this awareness campaign and expansion of the program has been especially important during the COVID-19 pandemic because patients may be less likely to visit their health care provider for preventive care, including cervical cancer screening and treatment.
“This campaign will bring a much-needed awareness to not only screening but also the different treatment options that are available,” says Dr. Laura Muzingwani, I-TECH’s Cervical Cancer Prevention Lead Physician in Namibia. “We want to ensure that all women, particularly HIV-positive women, are empowered to take action and get screened for cervical cancer. We also want to inform women that they can still be safely screened despite the ongoing COVID-19 pandemic.”
Screening and treatment are available to anyone who needs it, but the I-TECH program has focused its efforts on HIV-positive women. Women living with HIV are five to six times more likely to develop cervical cancer than HIV-negative women, even if they are on antiretroviral therapy (ART). Currently, the I-TECH program supports screening and treatment at 31 MOHSS health facilities and 11 outreach sites in seven regions across Namibia. As of August 2020, the program had performed more than 14,000 screenings and 1,700 treatment procedures for HIV-positive women.
“The cervical cancer program has achieved a lot of success within a short period,” says Dr. Laimi Ashipala, MOHSS Chief Medical Officer HIV/AIDS and STI Control subdivision. “With these additional outreach and awareness efforts, we hope to reach 100,000 HIV-positive women in the next two years.”
As part of the campaign’s outreach efforts to reach HIV-positive women, I-TECH is contacting women receiving ART to offer cervical cancer screenings during their routine medication pick-up visits. The team is also reaching out to community-based ART refill groups as a way to bring screening services to HIV-positive women at community meeting points.
Expanding and Adapting the Health Care Provider Training Program
VIA provider providing VIA services.
In addition to awareness and outreach, the program has expanded cervical cancer screening and treatment training for health care providers (e.g., doctors, registered and enrolled nurses).
“Key aspects of the program have been the training and uptake of our health care providers,” explains Dr. Ashipala. “We are scaling up our efforts to train and certify health care providers in using VIA and ablative treatments throughout the country. In addition to VIA and ablative treatments, we have also expanded training and certification to include LLETZ and cervical biopsies, which allows us to treat patients who may not be eligible for ablative treatments.”
The COVID-19 pandemic has led to adjustments in the way trainings are provided for the safety of facilitators and participants and to aid in pandemic control efforts. In response, I-TECH supported a virtual MOHSS VIA (visual inspection with acetic acid or VIA) screening training for nine, newly recruited cervical cancer screening health care providers. Since the program began in 2018, I-TECH and MOHSS have trained 249 health care providers.
Creating a Suite of Informational Materials
This Cervical Cancer Prevention brochure is one of several pieces in a suite of materials created by I-TECH.
I-TECH, in collaboration with stakeholders, has developed a suite of materials—flyers, brochures, and posters—for patients and providers to complement the outreach and training efforts.
The materials highlight the importance of screening, encourage women to make an appointment, explain the method of screening, and provide information about the treatment options that are offered through the program.
The materials will be used by health care providers during health education sessions with patients, distributed to women when they visit their health care facility or ART clinic, and following screening and/or treatment appointments. Some of the materials will also be displayed at health facilities and referral hospitals to advertise screening availability.
“We applaud the Ministry for highlighting the need for cervical cancer prevention, screening, and treatment despite the ongoing COVID-19 pandemic and taking action by collaborating in the development of resources, adopting guidelines for providers, and supporting training for health care providers,” says Dr. Muzingwani.
The ZimPAAC consortium has supported high-quality health care worker (HCW) knowledge and skills in Zimbabwe with technologies such as applications with clinical resources for clinicians, tablet-based data collection, and self-study modules. Through the use of self-study courses, HCWs complete learning activities using case scenarios in either prevention of mother-to-child transmission client retention, HIV testing services for children and adolescents, or viral load testing. ZimPAAC also uses WhatsApp messaging groups as a training intervention during self-study for peer-to-peer learning and support. Tablet-based data collection has now become the norm for most sites.
ZimPAAC also continually works to strengthen its program monitoring systems, such as the deployment of TrainSMART as the national training database. Recently, ZimPAAC developed and introduced the ZimPAAC Data Improvement Plan (ZDIP)—a new system of electronic data collection tools that will improve reporting and give facility and district staff better access to data. The new digital forms in ZDIP offer built-in data quality checks, the ability to view graphs, and provides faster feedback to sites so they can use the data for facility-based improvements.
I-TECH facilitates an HIV ECHO® program, a distance-based tele-mentoring program for providers and clinics across the region. Weekly sessions provide access to brief HIV clinical updates along with an opportunity to present and receive consultation on challenging or unusual clinical care issues from a team of multi-cadre HIV experts as well as from other members of the community of practice. In response to an identified need, the program added a monthly mental health and HIV session.
In 2019, I-TECH began supporting the Medical Research Foundation to initiate a similar HIV/STI ECHO® program that will target HIV and STI care and treatment sites in Trinidad and Tobago as well as with in other countries in the region.
The Kuunika Project: Data for Action was a four-year program implemented by a consortium of organizations, including the International Training and Education Center for Health (I-TECH), that began in 2016 to improve healthcare service delivery through the effective use of data. Consortium activities aimed to improve data systems, data use, and data governance in five districts throughout Malawi. I-TECH’s main focus was to build the capacity of healthcare workers (HCWs) to access, manage and use health data in high-burden HIV/AIDS facilities and communities.
I-TECH conducted an HCW training needs assessment with support from the Ministry of Health (MOH) in 2017. Using the assessment data, I-TECH collaborated with MOH, district health teams, local university representatives, and subject matter experts to design and develop a training curriculum that was piloted in 2018.
In January 2019, I-TECH rolled out a national training comprised of seven-day, in-person workshops and complementary eLearning modules with the goal of establishing a culture of data use, a strong base of high-quality data, and improve the availability of high-quality information to decision makers with the ultimate goal of improving health outcomes. The eLearning program, Building Effective Health Information Systems, is comprised of seven modules that introduce frontline healthcare workers and managers to health information systems. The modules include:
Introduction to Health Information Systems
Health Information Systems: Data Management Concepts
Using EMR Data for Decision Making
Improving and Maintaining the Quality of EMR System Data
Logic Models and System Classification
Overview of System Architecture
Introduction to Interoperability at the Facility Level.
An average of 150 HCWs per district were trained for an overall total of more than 800 HCWs trained across the country.
In May 2019, I-TECH launched a mentorship program designed to bridge the gap between training and practice, and to help participants apply their newly gained knowledge on the job. By the end of Phase 1, the I-TECH team had oriented over 100 district mentors to the mentorship program and tools. I-TECH’s role in the consortium concluded in August 2019 when Phase 1 of the Kuunika Project ended.
Liz Blanton, M&E advisor at I-TECH, presents her poster at MetaECHO.
On March 13-16, Liz Blanton, Monitoring and Evaluation Advisor at the International Training and Education Center for Health (I-TECH), joined more than a thousand clinicians, funders, academic leaders, government officials, and public health experts for the MetaECHO™ conference in Albuquerque, New Mexico. The University of New Mexico’s Project ECHO® model aims to bring specialized health care and expertise to rural and underserved communities in the U.S. and worldwide.
Blanton presented a poster titled “An Evaluation of Pilot Project ECHO in the Republic of South Sudan and Implications for Implementation in Fragile States.” The evaluation, still in its early stages, will assess the feasibility and acceptability of the model, which is implemented by Columbia University’s ICAP and is the first of its kind in a fragile state.
It will also gauge the impact of the ECHO model – based on telementoring and case presentation from a panel of experts – on providers’ sense of self-efficacy and professional satisfaction, as well as assess outcomes at the facility and systems levels.
“It’s the outcomes piece that really interested people,” said Blanton, pointing out that most of the outcomes studies to date have been fairly small. “It’s something a lot of people at the conference were talking about: how effective is Project ECHO at improving health outcomes?”
In light of this year’s theme of “Infinite Possibilities,” there were also deep discussions about the evolution of the model and how it might be adapted to improve communication between providers and patients, not just among providers. “There were several ‘ECHO Talks’ – TED-style talks – that were really moving,” said Blanton. “Some of the best were by patient advocates,” who highlighted the need for patient-centered care.
A fireside chat with keynote speaker Dr. Don Berwick, President Emeritus and Senior Fellow at the Institute of Healthcare Improvement, underscored the question: how can ECHO teams best deliver what patients need?
Today, Project ECHO operates more than 220 hubs for more than 100 diseases and conditions in 31 countries. The MetaECHO community encompasses all those dedicated to reaching the collective goal of touching 1 billion lives by 2025.
Project ECHO at I-TECH
Several programs at I-TECH utilize the Project ECHO model as a mentoring tool and force multiplier:
The first I-TECH-supported ECHO program in the Caribbean was established in January 2018, with the hub site in Jamaica. In that initial year, 41 ECHO sessions were provided, with participation by nearly 300 health care workers. Topics centered on viral load suppression and also included a series on TB prevention, diagnosis, and treatment in people with HIV; tenofovir toxicity; and HIV and lymphoma. During an I-TECH assessment, it was found that the majority of complicated cases presented during ECHO sessions in the Caribbean involved patients with mental health and substance use disorders that negatively impact their ability to adhere to medication and care. Plans are under way to include a psychiatrist/mental health specialist on the ECHO expert panel, and one Wednesday per month will be focused on HIV/mental health co-morbidities. The Jamaica Ministry of Health has also requested that I-TECH include an additional 20 HIV care and treatment sites, as well as a small group of private practitioners, in the current HIV ECHO program community of practice. In service of this request, I-TECH will support the development of a second ECHO program based in Trinidad, which will be launched this month.
I-TECH is implementing ECHO to build the capacity of laboratory staff and improve the quality of lab services in Côte d’Ivoire. Sessions include up to 17 laboratories and nearly 30 participants apiece; topics have included management of non-conformities in laboratories. laboratory equipment preventive maintenance, best practices in HIV serology, and external quality assurance.
In Malawi, I-TECH supports Project ECHO in partnership with the U.S. Centers for Disease Control and Prevention (CDC), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and Lighthouse Trust. The program has more than 40 participants from five different sites, and case presentation topics have ranged from tuberculosis to HIV encephalitis to Kaposi’s sarcoma. Benefits of the program include not only increased engagement of providers to discuss difficult cases, but also an improved referral system between clinics.
ECHO is installed and supported by I-TECH at 41 sites in Namibia, and monthly participation reaches up to 400 subject matter experts and staff. Dozens of topics were discussed during the pilot period (November 2015 to September 2016) alone – the most widely attended were on HIV disclosure to children, PMTCT Option B+, and presentation of tuberculosis. In an evaluation of the Namibia pilot, nearly 80% of participants cited that access to the expertise of HIV specialists and inter-disciplinary consultation was a major area of need for them and their clinics. Ninety-three percent of the participants reported that the presentations during the pilot ECHO sessions provided them with useful, up-to-date knowledge.
Representatives from the International Training and Education Center for Health (I-TECH) attended the fourth international African Society for Laboratory Medicine (ASLM) conference in Abuja, Nigeria, on 10-13 December 2018.
The theme this year focused on the role of laboratories in preventing and controlling the next pandemic. I-TECH had seven abstracts accepted at the conference that highlighted the laboratory systems strengthening work done by I-TECH in Cambodia, Côte d’Ivoire, and Zambia. The full abstracts presented by I-TECH can be found in the ASLM 2018 Conference Abstracts Conference Book.
Below is a summary of I-TECH presentations:
I-TECH Laboratory Systems Strengthening Team at ASLM 2018. Pictured (L to R): Sitting – Lucy Perrone, Felicity Golopang, Larissa Koffi; Standing – Sylvestre Kone, Nayah Ndefru, Siew Kim Ong.
Oral Abstracts
Siew Kim Ong, I-TECH Cambodia Project Coordinator, was lead author and presenter for the “Improved Laboratory Compliance to Quality Standards in Cambodian Laboratories through On-site Trainings.” This abstract reviewed the effect of training in 12 I-TECH-mentored laboratories in Cambodia on laboratory processes (Page 27).
Poster Sessions
Nayah Ndefru, I-TECH Seattle Laboratory Strengthening Specialist, presented an abstract titled, “Effectiveness of Using a Mixed Approach of On-site Mentoring and Tele-mentoring for Improving Laboratory Quality Management Systems: Lessons From Cambodia.” The presentation looked at the lessons learned in the implementation of a Quality Management System (QMS) in 12 national hospital laboratories throughout Cambodia and the 2018 pilot approach to addressing the QMS gaps identified in an earlier baseline survey (Page 55).
Larissa Koffi, I-TECH Côte d’Ivoire RTCQI Specialist, presented two posters: One titled, “Analysis of EQA HIV Serology Data in Côte d’Ivoire Reveals Gaps in Quality Testing.” The second poster was “Analysis of HIV Point of Care Testing Sites in Côte d’Ivoire Reveals Gaps in Tester Competence.” The posters displayed the results of a retrospective study that can inform strategies and interventions for improved quality at HIV testing sites (Page 200).
Sylvestre Kone, I-TECH Côte d’Ivoire Laboratory Quality Specialist, presented a poster titled “Improving Quality and Capacity of the Laboratory System in Côte d’Ivoire.” The poster detailed the work the team is doing to train and mentor laboratory staff in hospital laboratories towards achieving international quality standards (Page 242).
Felicity Gopolang, I-TECH Laboratory Mentor Consultant, presented a poster titled, “Implementation of a Professional Development Program in Laboratory Leadership and Quality Management in Zambia from 2016-2018.” The poster outlined the impact of the Program on quality improvement (Page 206).
Pat Sadate-Ngatchou, I-TECH Seattle Senior Laboratory Advisor, was lead author on the poster titled “Improvement of Quality Practices within HIV Point-of-Care testing (POCT) Sites in Côte d’Ivoire Through Implementation of the Rapid Test Continuous Quality Improvement (RTCQI),” which explored the impact of the implementation of RTCQI in POCT site audits (Page 246).
About ASLM The mission of ASLM is to improve clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks. Based on five strategic pillars, ASLM serves the community of laboratory professionals and promotes the value of strong medical laboratories to key stakeholders such as the Ministries of Health, research laboratories, and universities. ASLM is an independent, non-profit organization endorsed by the African Union and headquartered in Addis Ababa, Ethiopia.
I-TECH India PL has worked with stakeholders to develop national training curricula for health care staff on delivering HIV care and treatment services. In addition, it has:
Planned and implemented training programs for various cadres of clinical and program staff;
Participated in medical officer training programs at the national level;
Designed and conducted five regional continuing medical education (CME) courses in North, South, West and Northeastern regions on “Invigorating HIV Care” for ART center medical officers;
Designed and conducted four workshops in two weeks reaching 164 ART counselors for improving care support and treatment services provided to key population clients accessing ART centre services in Maharashtra;
Conducted National Distance Learning Seminars (webinars)—an average of 25 sessions per year on clinical- and program-related topics for the past five years reaching over 50% of ART Centers in India, with average participation of 1000 per session. These sessions are recorded and are available on YouTube channel “I-TECH India.”
Conducted Regional Distance Learning Seminars (webinars)—an average of 60 sessions per year through 15 HIV/AIDS Centres of Excellence in more than six languages during the last five years reaching over 50 % of ART Centers in India, with average participation of 50 per session; and
Coordinated certificate courses from UW on Leadership and Management in Health, Principles of STD (Sexually Transmitted Diseases) and HIV Research, Introduction to Epidemiology for Global Health, Clinical Management of HIV, and Fundamentals of Implementation Science for over 500 individuals during the past five years.
Medical Research Foundation of Trinidad and Tobago (MRFTT) HIV/STI Project ECHO® Series: In April 2019, I-TECH supported 
