ITECH Presentation

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I-TECH Building Human Capacity for AIDS Care and
Treatment

• E. Michael Reyes, MD, MPH,
• I-TECH CoDirector (UCSF)

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Background

• I-TECH founded April 2002 at University of
  Washington in Seattle
• Joint project with University of California San
  Francisco
• Cooperative agreement with HRSA as the
• International AETC

• Additional funds from USAID since 2003 for work
  in the Caribbean
• Human and institutional capacity development for
  improving the care and treatment of people living
  with HIV/AIDS

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Background

• Principal Investigator King K. Holmes, MD, PhD
• 8 offices Botswana,Haiti, St. Lucia, Ethiopia,
  India, Malawi, Namibia and Mozambique

• 2 offices with partners Guyana through FXB,
  Jamaica through UWI/CHART
• 100 partnerships and vendors
• Work in 25 countries

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Countries

• Botswana
• Caribbean (Antigua, Bahamas, Barbados, Dominica,
  Grenada, Guyana through FXB, Haiti, Jamaica,
  St. Kitts Nevis, St. Lucia, St. Vincent
  Grenadines, Surinam, Trinidad Tobago)
• Ethiopia
• India
• Kenya (through Coptic Hospital)
• Malawi
• Mozambique
• Namibia
• South Africa
• Tanzania
• Thailand
• Vietnam
• Zimbabwe

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I-TECH Mandate

• Increase human and institutional capacity for
  effective care and treatment of HIV/AIDS by
• Increasing human capacity in program management,
  clinical care, instructional design, information
  management, monitoring and evaluation
• Promoting transfer of learning from classroom to
  practice through clinical mentoring and long-term
  decision support
• Providing support for implementation of
  continuous quality management practices
• Building infrastructure for long-term delivery of
  effective training and health care services

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Handicaps of HIV Training1

• Absence of measurable objectives
• Poor trainee selection/turnover of trainees
• Curricula rarely custom-made and not linked to
  needs assessment
• Lack of training materials
• Absence of pre/post training evaluation
• Insufficient supervision and follow-up training
• 1 UN Population Fund, UNFPA, Evaluation Report,
  1999

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Core Capacity

• Assessing needs and capacity for training and
  clinical care
• Strengthening of clinical management and
  workforce training systems
• Infusing principles of adult learning into
  existing training programs

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Core Capacity (contd)

• Supporting knowledge transfer through
  instructional design and on-site mentoring
• Measuring impact of training on quality care
• Strengthening organizational capacity through
  program management and strategic planning

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Training Framework
Levels of Training - Adapted from U.S. AETCs
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Clinical Training

• Clinical Mentoring Initiative
• Development of the Clinical Mentoring Toolkit
• Compilation and expansion of tools for measuring
  impact of clinical mentoring activities
• Web page devoted to HIV CM support

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Knowledge Management

• www.go2itech.org includes
• Program information about
• our model and approach
• Country program profiles
• Consultant registry and
• employment listings
• Clinical training materials database
• Database has more than 1,200 materials in
• multiple languages
• A widely used resource
• March 2006 10,511 users 6,669 file downloads
• April 2006 9,829 users 7,154 file downloads

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Resource Database
Materials in database by type (audience and
language)
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Lessons from the AETC Experience

• Linking education/instructional expertise with
  HIV clinical expertise.
• Training efforts require resources and
  infrastructure. 
• Workplans should be based on targeted HIV
  clinical training needs assessment data.

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Lessons from the AETC Experience

• Utilize a systems approach to affect
  organizational change.
• Development of training infrastructure that
  allows for rapid dissemination of evolving
  clinical information.
• Expert clinical consultation as a post-training
  safety net

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Lessons from the AETC Experience

• Develop local thought leaders to lead HIV
  care
• HIV requires a multidisciplinary team approach.
• Staff turnover requires ongoing training
  efforts and enduring materials.

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Lessons from Abroad

• Stigma as a driver of the HIV epidemic
• Move quickly from the classroom to the clinic
• The Rapid Testing experience
• Program Management as a foundation
• Measuring impact and outcomes
• Bringing cultural lessons back to the US
• The importance of including PLHA in program
  planning and implementation
• Initial introduction of quality management

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Challenges in Scaling Up ART

• Need to
• Optimize or establish systems for identifying,
  referring, and retaining HIV persons in care
• Optimize or establish clinical lab services
• Define referral and consultative relationships
  between health centers and referral hospitals
• Establish strong links between TB and HIV
  treatment systems (joint conferences, cross
  training, complementary data collection systems)
• Create referral links to PMTCT programs to engage
  HIV mothers in follow up care

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Challenges in Scaling Up ART

• Need to
• Define and establish functional patient
  information systems that feed into data
  collection (ME)
• Identify and establish needed synergies with
  other international and local NGO resources to
  complete a continuum of medical care and support
  services
• Integration of prevention strategy, especially
  prevention with positives

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Summary Observations

• Long-term strategies address barriers to change
  at political, social, institutional and
  organizational levels.
• Short-term strategies alleviate workforce burden
  and create the time and goodwill for longer-term
  change to succeed.

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Summary

• Training is not sustainable or effective without
  addressing institutional and organizational
  barriers to change.
• Training is only one strategy in an overall human
  capacity development effort
• The appearance of duplication of effort in
  curriculum development does not necessarily mean
  its occurring. Many countries want tailored
  products, but we dont start from scratch.

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Summary

• Recruitment of the right trainees and transfer of
  learning to the worksite are the two hardest
  components of effective training.
• We need to be explicit that the role of all staff
  and consultants is to mentor and train local
  staff with the goal of exiting.
• Its important for purposes of continuity to send
  technical experts for long term assignments or
  send the same consultant back repeatedly.

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Summary Observations

• Relationship building is the basis for successful
  capacity development work.