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Category: HIV Counseling and Testing

I-TECH Supports Mental Health in Ukraine Amid War

Post categories: HIV Counseling and Testing Mental Health PrEP Ukraine
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                 Image by Денис Марчук

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.

New I-TECH Publication Shows Effectiveness of Index Testing Program in Ukraine

Post categories: HIV and STI Prevention HIV Counseling and Testing Implementation Science Index Testing/Partner Notification Ukraine Uncategorized
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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.”

  1. 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.

I-TECH Celebrates 20 Years

Post categories: Ann Downer Caribbean HIV and STI Prevention HIV Care and Treatment HIV Counseling and Testing Key Populations Malawi Nursing/HCW Cadres Pamela Collins Zimbabwe
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In 2008, I-TECH Mozambique celebrated I-TECH’s sixth birthday. “Sempre crescendo” = “always growing.”

On April 1, the International Training and Education Center for Health (I-TECH) celebrates 20 years since its founding. It has since grown into the largest center in the Department of Global Health (DGH) and one of the largest centers at the University of Washington (UW).

“We are proud to mark this milestone,” says Dr. Pamela Collins, Executive Director of I-TECH, Professor of Psychiatry and Behavioral Sciences, and Professor of Global Health at UW. “For 20 years I-TECH has helped to save lives through its support of public health systems in the Caribbean, Europe, Africa, and Asia. Over the years, our scope has broadened, but responsive partnerships with ministries of health, collaborating NGOs, and our donors have been central to the work.”

I-TECH comprises a global network, operating in 17 countries, that fosters healthier communities around the world through equitable partnerships in research, training, and public health practice. Its work is rooted in health care training and draws on a culturally rich community that includes UW faculty, global partners, and U.S. and global staff and students. This community of people with diverse backgrounds, experiences, and opinions encourages learning from one another while working toward high quality, compassionate, and equitable health care.

“COVID-19 has reminded me, and many of us, about the critical and life-saving role of health care workers, a group that often lacks proper support,” says Ivonne X. “Chichi” Butler, Associate Director at I-TECH. “At the same time, collectively, we have come to understand the urgent need for stronger and better prepared health systems to respond to the COVID crisis.

“At I-TECH, these concerns have been at the heart of our work for the past 20 years,” she continues. “We have invested–and continue to invest–in health workers and in the systems in which they work. I am proud to be part of a center that has transformed the delivery of HIV care and treatment in so many countries and that truly puts individuals and communities at the forefront to meet their particular needs.”

I-TECH began in 2002 with its first award, the International AIDS Education & Training Center (IAETC) grant. The IAETC was administered by the Center for Health Education and Research (CHER), within the Department of Health Services (now the Department of Health Systems and Population Health). This was one of CHER’s first forays into what would become known as “global health.”

“The IAETC award was the first of its kind at UW,” says Shelly Tonge-Seymour, Associate Director of I-TECH, who has been with the center for 20 years, “the first to translate lessons from the U.S. to improve the training of health care workers and delivery of care globally.”

With the advent of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, I-TECH’s portfolio expanded rapidly, reflecting the evolution of PEPFAR from “emergency” to a longer-term investment in health systems strengthening. I-TECH became an official UW center in 2008, a year after joining UW’s new Department of Global Health at the invitation of Dr. King Holmes, then-chair of DGH. “It became clear that we had grown so large that we needed our own administrative core,” says Tonge-Seymour.

Through its work with PEPFAR, I-TECH’s efforts have contributed meaningfully to the huge advancements in HIV prevention, care, and treatment seen across the globe, with a particular emphasis on groups that have been marginalized or stigmatized.

“One of the most powerful changes in the past 20 years in the Caribbean Region has been in the attitude toward key population groups,” says Natalie Irving-Mattocks, Executive Director of the Caribbean Training and Education Center for Health (C-TECH), one of I-TECH’s independent partner organizations. “Through the Key Populations Preceptorship Program, I-TECH has contributed significantly to better health in the Caribbean region by training healthcare workers to provide nonjudgmental, high-quality, comprehensive HIV care to men who have sex with men, transgender women, and sex workers.”

C-TECH is just one of the independent organizations I-TECH has helped to establish worldwide. Once operating as I-TECH Zimbabwe, the team at the Zimbabwe Technical Assistance, Training, and Education Center for Health (Zim-TTECH) has a long history of partnering with local organizations and community-based health care workers to increase access to care.

“I’ve been involved with I-TECH for its entire 20 years, and the most impactful thing for me has been the contribution I-TECH has made in Zimbabwe to supporting the development of lay cadres into primary counselors,” says Abisha Jonga, Senior Program Manager at Zim-TTECH. “This program created a career path for so many, made HIV counseling services more accessible to the general population, demystified HIV testing, and shaped the individuals’ lives.”

Dr. Batsi Makunike, Executive Director of Zim-TTECH, agrees that fostering local connection has been the key to success. “I am particularly proud of the fact that I-TECH has succeeded in nurturing local organizations,” says Dr. Makunike. “Providing full support without competition–that is huge. Without I-TECH, there would be no Zim-TTECH.”

Malawi has seen its health care landscape change dramatically in the past 20 years and is now close to meeting the UNAIDS 95-95-95 targets for the elimination of HIV. Since 2008, I-TECH has partnered with the Malawi Ministry of Health’s Department for HIV and AIDS and helped to generate pioneering policy initiatives such as the 2011 adoption of Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV. Option B+ provides universal, lifelong ART for pregnant and breastfeeding women. Based on Malawi’s documented success, the World Health Organization formally adopted Option B+ as a global policy in 2013.

“We truly believe that I-TECH has significantly contributed to the prevention of thousands of infant infections and AIDS deaths among children, adolescents, and mums and dads in Malawi,” says Dr. Andreas Jahn, Senior Technical Advisor with I-TECH Malawi. “We have walked this journey with a whole generation of Malawian HIV program colleagues, and we have learned a tremendous amount from each other.”

I-TECH’s funding has grown from $500,000 for its initial award in 2002 to a cumulative total of more than $1 billion. The center currently has 26 awards, harnessing UW technical expertise in multiple technical areas from mental health to electronic health information systems to global health security and emerging health threats.

As I-TECH has adapted to changing needs, at its core remains a commitment to creating equitable partnerships and facilitating knowledge sharing throughout the I-TECH network, which includes I-TECH’s own country offices, independent partner organizations fledged from I-TECH, ministries of health, academic institutions, community groups, and others.

“When I reflect on the success of I-TECH in reaching the age of 20, two observations keep coming up for me,” says Dr. Ann Downer, co-founder and former Executive Director of I-TECH and Professor Emeritus in the Department of Global Health. “One is about the power of unity. I believe that the ability of a diverse group of individuals and teams to hold a common vision and set of values generates resilience. This unity allows I-TECH to continue operating after 20 years with integrity and grace across enormous geographic, linguistic, and cultural borders and despite regular economic and social challenges.

“The other observation is about the importance of encouraging leadership from all parts of an organization,” she continues. “This requires us to embrace the value of humility and results in our ability to listen and learn. Both are critical actions for successful work anywhere but are essential for working ethically on a global stage.”

The I-TECH story continues to unfold. From a modest grant with limited staff to a vital, resilient, and animated worldwide network of more than 1,600 dedicated personnel, I-TECH will continue to work alongside its global partners in its commitment to stronger health systems and safer, healthier communities.

“There’s so much to celebrate and a wealth of lessons to light the way forward,” says Dr. Collins. “In this era of pandemic, war, and fractured communities, our vision for health is needed now more than ever.”

HIV Impact Assessment Shows Significant Progress in Malawi

Post categories: Gabrielle O'Malley HIV and STI Prevention HIV Care and Treatment HIV Counseling and Testing Integrating Research and Practice Malawi
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Tiwonge Chimpandule, I-TECH Malawi’s Strategic Information Officer, presents the results of the 2020/21 Malawi Population-based HIV Impact Assessment (MPHIA) to guest of honor Chrissy Kalamula Kantaso, Deputy Minister of Health (right). Looking on are Jeremy Neitzke, Deputy Chief of Mission, U.S. Embassy (center) and Dr. Rose Nyirenda, Director, HIV and AIDS Department in the Ministry of Health (left). Photo credit: I-TECH Malawi

On World AIDS Day, December 1, staff from the International Training and Education Center for Health (I-TECH) convened with the Ministry of Health (MOH), Columbia University’s ICAP, and other national stakeholders in Malawi to present the results of the 2020-21 Malawi Population-based HIV Impact Assessment (MPHIA). The commemoration, with the theme of “End Inequalities, End AIDS, End Pandemics,” was held at Bumba Primary School grounds in Rumphi District.

Preliminary results of the assessment, led by the MOH and ICAP, show that the national HIV testing program, supported by I-TECH, has achieved a significant increase in the awareness of status among HIV-positive adults—from 77% in 2016 to 90.9% in 2020-21.

Malawi has also made great strides toward reaching the UNAIDS 95-95-95 Fast Track targets, surpassing both the second 95 (results indicate that 98% of those who know their status are initiated on treatment) and third 95 (results indicate 97% of those on treatment are virally suppressed).

The assessment will be critical to informing future programming, says Dr. Rose Nyirenda, Director of the Ministry of Health’s HIV and AIDS Department. “The 2020-21 MPHIA has produced a wealth of information that will be critical for tailoring our services and to refine strategies for closing the remaining gaps,” says Dr. Nyirenda.

The HIV and AIDS Department also exhibited commodities (antiretroviral medications, testing kits, opportunistic infection (OI) and sexually transmitted infection (STI) medicines, condoms, voluntary medical male circumcision kits) that are procured and managed through the Supply Chain and Logistics Unit.

Correction: A previous version of this article misstated the organization that conducted the 2020-21 Malawi Population-based HIV Impact Assessment. This assessment was led by the Malawi Ministry of Health and Columbia University’s ICAP.

HIV Recency Surveillance in Malawi

Post categories: Gabrielle O'Malley HIV Counseling and Testing Malawi Monitoring & Evaluation Surveillance
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The International Training and Education Center for Health (I-TECH), in collaboration with the Malawian Ministry of Health (MOH) and the Centers for Disease Control and Prevention, began implementing recent HIV infection surveillance in April 2019. The project aims to establish a surveillance system among persons newly diagnosed with HIV infection by integrating point-of-care testing for recent infection into routine HIV testing services (HTS). A rapid test for recent infection is given to consenting clients 13-years-and-older who screen HIV positive within routine HTS across participating health facilities. Between April 2019-2020, I-TECH and MOH activated 485 testing points at 155 facilities in Malawi. All 155 facilities implemented recent HIV infection surveillance and reported data. The project has reached 11 of 28 districts to date.

These data allow the detection and characterization of recent HIV infection among newly diagnosed individuals and identify geographic areas associated with recent HIV-1 infection to inform geographic prioritization of HIV prevention and treatment strategies. The project has demonstrated high uptake and allowed characterization of recent infections according to socio-demographic and geographic factors. PEPFAR implementers in Malawi will collaborate with MOH to further investigate the reasons for high recent infection prevalence in identified clusters. Based on the findings of these responses, Malawi may focus on interventions such as youth-focused programs that aim to limit HIV acquisition and transmission among young people.

I-TECH Announces Launch of Independent Local Organizations B-TECH and C-TECH

Post categories: Botswana Caribbean Countries COVID-19 Differentiated Care HIV Care and Treatment HIV Counseling and Testing Key Populations Transition & Sustainability
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The B-TECH team implements innovative, high-yield testing approaches to increase HIV case identification and yield.

On October 1, the International Training and Education Center for Health (I-TECH) celebrated the launch of the local and independent Botswana Training and Education Center for Health (B-TECH) and Caribbean Training and Education Center for Health (C-TECH).

For more than 17 years, these teams have worked within the regional Botswana and Caribbean offices of I-TECH to respond to the health needs of individuals and communities infected and affected by HIV. B-TECH and C-TECH, as locally registered non-governmental organizations, will continue to build on those years of experience implementing innovative, locally driven HIV prevention, care, and treatment programs, as well as expand their work to tackle other pressing health issues within the Batswana and Caribbean communities.

As part of the I-TECH network, B-TECH and C-TECH are able to access the academic depth and regulatory structures of UW and, together with local and regional clinical and programmatic expertise, scale up best practices and strengthen health systems. As local entities, B-TECH and C-TECH will also be able to take advantage of expanded partnership opportunities.

The C-TECH team also has broad experience with clinical mentoring at HIV treatment sites.

Both teams have supported pioneering work in their regions to provide comprehensive, patient-centered care for the most vulnerable populations. The C-TECH team has implemented a groundbreaking preceptorship program to improve provider communication with key populations affected by HIV in Jamaica and Trinidad and Tobago. It has also implemented a successful telementoring program through a Project ECHO®-based platform and model, reaching 465 providers. The program connects groups of providers to form communities of practice throughout the region to facilitate clinical updates, case consultations, and strengthened practice in HIV treatment and care and, recently, COVID-19.

“We look forward to remaining within the I-TECH family,” said Natalie Irving-Mattocks, Executive Director of C-TECH. “But our team is equipped and ready to move into this next chapter, deepening our local relationships, expanding our reach throughout the Caribbean, and building on our commitment to support access to high quality health care for the region’s most vulnerable.”

For its part, the B-TECH team has made an enormous impact on the health systems of Botswana, enabling the policy environment for HIV clinical case management; developing and implementing an interoperable, standards-based health information system; and enhancing the capacity of the health workforce at all levels. The team has also implemented innovative, high-yield testing approaches to increase HIV case identification. Targeted HIV testing strategies include partner testing services; HIV self-testing; testing among presumptive tuberculosis cases; and the expansion of afterhours and weekend testing to target men.

“We are excited to begin this new endeavor to promote innovative, locally driven, and effective programs to respond to the HIV epidemic in Botswana,” said Dr. Odirile Bakae, Executive Director of B-TECH. “With a high level of technical assistance from I-TECH, combined with B-TECH’s boots-on-the-ground approach, we are a winning team. We look forward to a fruitful partnership with both I-TECH/UW and the Government of Botswana.”

I-TECH has worked closely with UW Global Operations Support over the past decade to inform the internal procedures and structures necessary for international office registrations. This work has promoted operational effectiveness by enabling a safe, compliant, and legal environment for conducting international work. I-TECH’s close work with Global Operations Support has also helped to create the administrative and policy structures necessary to enable the successful launch of B-TECH and C-TECH.

Over the past two years, three other I-TECH offices – in Haiti, India, and Zimbabwe – have launched local organizations, signaling I-TECH’s bedrock commitment to transition, sustainability, and country ownership.

“These new organizations reflect our shared goals of serving communities, building capacity, and supporting expert leadership across the I-TECH network,” said Dr. Pamela Collins, I-TECH Executive Director. “We look forward to continued strong collaboration that saves lives.”

Read more about the B-TECH and C-TECH leadership teams below.

Dr. Odirile Bakae, Executive Director, B-TECH

Dr. Bakae is a physician with over 15 years of clinical experience in providing services to people living with HIV, as well as a deep understanding of structuring health programs to optimize client outcomes. He has several years of experience practicing medicine in public health settings in Botswana, including the management of the Infectious Disease Control Centers (IDCC), specializing in ART failure clients, complicated TB and HIV cases, and cervical cancer patients.

In addition to his role as B-TECH Executive Director, Dr. Bakae is the Principal Investigator for the CDC funded Cervical Cancer (GH20-2009) and Strategic Information Services (GH20-2007) awards.

He joined I-TECH Botswana in 2015 and led one of the most successful HIV testing programs in the country, focusing on a client-centered approach. Under his leadership, the country program performed exceptionally well, in terms of quality of service delivery and in meeting donor targets and expectations.

Thulaganyo Kauta, Deputy Executive Director, B-TECH

Ms. Kauta is a seasoned operations management professional with over 20 years of experience across a wide range of industries. She joined I-TECH Botswana in April 2009 and, as the Deputy Executive Director for B-TECH, she oversees operations, finance, and human resources, and is responsible for design and implementation of internal controls and compliance oversight at all levels of the organization.

In her management role, Ms. Kauta provides planning and coordination of efficient and effective support services to enable delivery of quality work to B-TECH clients and stakeholders. A key function of her role is to identify solutions to address operational challenges within B-TECH as well as ensure the implementation and adherence to the organization’s operational systems, policies and procedures.

Natalie Irving-Mattocks, Executive Director, C-TECH

Ms. Irving-Mattocks is a public health program director with extensive experience in managing projects focusing on health systems strengthening. She is also a business development practitioner with 13 years of experience in the field of social development. Her expertise includes financial management, budget management, project proposal writing, program design/development, planning, implementation and monitoring, strategic planning, and institutional development.

To her role as C-TECH Executive Director, Ms. Irving-Mattocks also brings deep experience and a proven track record in mobilizing and managing grants from international funding agencies such as United States Department of Human Services Health Resources and Services Administration (HRSA), PANCAP Global Fund, United States Agency for International Development (USAID), Clinton Foundation and National Institutes of Health (NIH).

Dr. Clive Anderson, Board Chair and Technical Advisor, C-TECH

Dr. Anderson has 30 years of experience as a primary care physician, specializing in HIV and STI care and prevention, as well as dermatology. He comes to his role as Board Chair and Technical Advisor after serving as Country Director of I-TECH Jamaica for the past three years.

He remains Technical Advisor to I-TECH Jamaica, where his experience also includes extensive experience as Technical Lead of the Caribbean Quality Improvement Collaborative (CareQIC), Lead HIV Project ECHO® Facilitator and Mentor, and clinical mentor at HIV treatment sites throughout Jamaica.

Dr. Anderson is currently a Clinical Assistant Professor in the Department of Global Health, University of Washington.

Facility-Based HIV Testing Services in Namibia

Post categories: Gabrielle O'Malley HIV Counseling and Testing Namibia
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As a key component of I-TECH’s support to HIV care continuum strengthening in Namibia, I-TECH supports the Ministry of Health and Social Services in efforts to achieve the UNAIDS target of “90% of people living with HIV will have a known status.” I-TECH supports above-site HIV testing activities at region-and national-levels, as well as technical assistance and direct service delivery at the site-level across 78 facilities in 6 regions in Namibia.

I-TECH implements evidence-based HIV-testing strategies to maintain efficient programs while increasing HIV-positive yield including optimized provider-initiated testing and counseling (PITC) and index testing.

  • I-TECH’s clinical and technical teams place emphasis on offering PITC to high-risk populations including STI patients, clients attending family planning services, presumptive and confirmed TB cases, and patients attending in-patient hospital services. In addition, efforts will be made to increase testing among men through the above strategies, as well as encouraging more flexible hours for HIV testing through extended hours of operation.
  • I-TECH participates in the national-level index testing work group, helping to finalize paper tools and training materials for national deployment. At the site level, I-TECH strategic information staff ensure complete documentation of partner status of all enrolled patients, with testing offered to identified partners. I-TECH in Namibia is also working with I-TECH country offices across the network to leverage expertise in index testing training and monitoring and evaluation. I-TECH is currently supporting discussions at the national-level concerning the role of self-testing as an extension of services offered to facility-based clients, as another option for ensuring that more partners are tested.

I-TECH is currently supporting facilitation of stepped training for HIV recency testing in 5 high-volume districts in Namibia. Recency testing provides insight into the timeline of a client’s HIV infection. As Namibia approaches epidemic control, identifying, and targeting efforts and interventions to hard to reach populations most at risk for HIV acquisition will be essential.

I-TECH Ukraine Conducts In-Service Nurse Training Pilots for Achieving 90-90-90

Post categories: Clinical Mentoring HIV Care and Treatment HIV Counseling and Testing Nursing/HCW Cadres Ukraine Uncategorized
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Recent public health care reform in Ukraine has called for the growing role of primary health care, task shifting, and decentralization of HIV services while providing care and treatment for people living with HIV (PLWH). In June 2018, the International Training and Education Center for health (I-TECH) Ukraine conducted two back-to-back, five-day in-service training programs on HIV testing services for two cohorts of participants from twelve regions across Ukraine.

Dr. Serhii Rabokon facilitates a training on the role of nurses in achieving UNAIDS 90-90-90 targets.
Dr. Serhii Rabokon, Head of the Treatment Programs at the CPH of the MoH of Ukraine, delivers a presentation on the nurse’s role in achieving UNAIDS 90-90-90 targets. Photo source: I-TECH Ukraine.

The concept and design of these unique pilot training programs were influenced by the recent reform to actively involve general practice/primary care nurses into the process of achieving UNAIDS 90-90-90 targets in Ukraine.

A group of 10 national HIV and health care reform experts, I-TECH’s international consultant-nurse practitioner, and the I-TECH Ukraine training development team carefully designed the learning objectives and content of the training program with consideration of the specifics of the national HIV epidemic, participant backgrounds, as well as anticipated task shifting. Together, these experts synthesized and presented international and national clinical and nursing best practices in the area of serving PLWH.

Training participants included nurses from primary care facilities, specialized HIV clinics, as well as faculty of seven local nursing colleges, including I-TECH Ukraine’s national partners – Ternopil State Medical University and the Nursing College of Poltava Ukrainian Medical and Dental Academy.

The training programs outlined roles for general practice/primary care nurses in achieving UNAIDS 90-90-90 targets, taught HIV basics, helped develop skills for HIV testing services with rapid HIV test kits, and coached participants on conducting counseling for PLWH using a non-discriminatory, patient-centered approach.

Participants working in small groups at the June 2018 training.
Participants in the second pilot training work in small groups. Photo source: I-TECH Ukraine.

Facilitators used interactive training tools and approaches during the program to fully engage participants and strengthen the capacity of the nursing college’s faculty to teach up-to-date HIV content in an appealing and efficient way.

One of the central elements of the program was to educate the participating nurses about the challenges surrounding HIV-related stigma and discrimination with a major goal to overcome it in the nursing community and encourage respectful delivery of services for PLWH.

“[I-TECH Ukraine and its partners are] doing such a[n] important thing,” says Valentyna Borysova, lecturer of Zaporizhzhia Nursing College. “Educating nurses on HIV has been so much underestimated and under-invested in Ukraine.”

In addition to feeling as though this training addressed a critical gap in education, participants also provided positive feedback about the content and facilitation of the training, especially the parts of the training that were facilitated by the international and national peer nurses.

Participants attend a training about HIV fundamentals.
Participants in the first pilot training focus on a presentation about HIV Fundamentals. Photo source: I-TECH Ukraine.

“The knowledge on testing and post-exposure prophylaxis are badly needed at our clinic,” says Liudmyla Samolelis, Senior Nurse of the Psychiatric Clinic in Poltava, Head of Poltava Oblast Nurse Association. “I plan to conduct an on-the-job training for the nurses, using the materials from the training.”

Due to the success of the pilot trainings, I-TECH Ukraine intends to finalize training materials, institutionalize the course through its local partners, and develop a manual that could be used in different training formats, including state-owned colleges and medical universities. In addition, an ambitious regional rollout of the training program is anticipated during the next year of the project.

 

Differentiated HIV Service Delivery Models in Tanzania

Post categories: Ann Downer Differentiated Care Health Policy HIV Care and Treatment HIV Counseling and Testing Key Populations Quality Improvement Tanzania
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In October 2016, the Government of Tanzania adopted the World Health Organization’s (WHO) Treat All recommendations. The adoption of WHO recommendations, coupled with the Government of Tanzania’s acceptance of the UNAIDS 95-95-95 targets represents a significant commitment to the fight against HIV in Tanzania.

Continue reading “Differentiated HIV Service Delivery Models in Tanzania”

Gabrielle O’Malley

Gabrielle O'Malley, PhD

Gabrielle O’Malley, MA, PHD, is I-TECH’S Director of Implementation Science. Dr. O’Malley has worked as an applied research and evaluation professional for over 25 years. Her experience includes a wide variety of international and domestic programs including child survival, private agricultural enterprise, medical education, community technology, reproductive health, HIV prevention (PrEP), and care and treatment as well as applied research for private industry. Her research interests include innovative practices for program evaluation and improvement, formative research, qualitative methods, and the relationship of gender and health.

Dr. O’Malley received her PhD from UW, an MA from Johns Hopkins University and a BA from Smith College.

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