RTMI is highly experienced in the WASH (Water, Sanitation, and Hygiene) sector, focusing on implementing projects that are designed to address critical public health issues and the risks from waterborne diseases. The organization has operated in various intervention settings, particularly in high-risk and low-resource areas that struggle to access safe drinking water, sanitation, and hygiene practices. The foundation of RTMI’s work lies in thorough research and engagement with relevant communities, employing evidence-based Water Resource Hygiene to identify and address the root causes of WASH-related deficiencies. In collaboration with the Johns Hopkins Bloomberg School of Public Health, RTMI supports two core activities aimed at combating cholera: Cholera Prevention and Water, Sanitation, and Hygiene interventions.

The "Ring Water, Sanitation, and Hygiene Intervention to Reduce Cholera in Hotspots in Bangladesh" aims to reduce cholera transmission among high-risk populations in Dhaka by building on the CHoBI7 WASH intervention, which promotes handwashing with soap and water treatment through pictorial modules and mobile health messages. The project implements a ring-shaped intervention around cholera patients’ households, evaluating the efficacy of targeted WASH measures during the critical one-week high-risk period post-diagnosis through randomized controlled trials (RCTs), compared to standard messaging for diarrhea patients. Household members are recruited within 36 hours of the index cholera patient’s enrollment, with households visited at five time points (Days 1, 3, 5, 7, and 9) for clinical and environmental surveillance. Clinical surveillance includes reporting diarrhea or vomiting and collecting fecal specimens to test for Vibrio cholerae, while environmental surveillance involves testing household water sources and stored drinking water for Vibrio cholerae and free available chlorine. The primary outcome is cholera infection within one week, defined by a positive bacterial culture and/or a fourfold rise in vibriocidal antibody titer. Secondary outcomes over 12 months include diarrhea prevalence, child growth, handwashing with soap, Vibrio cholerae and chlorine levels in stored drinking water, and changes in WASH-related psychosocial factors. The hypothesis is that the CHoBI7 intervention will reduce cholera infections and other diarrheal diseases among those near cholera patient households and increase WASH behaviors.

The "Testing a Scalable Model of the Cholera Hospital-Based Intervention" project expands the CHoBI7 framework by addressing both urban and rural settings. This initiative aims to adapt and scale the CHoBI7 program for delivery in rural areas, tailoring the intervention to community clinics and district health facilities. Spanning the Dhaka, Narayanganj, Munshiganj, and Manikganj districts, the project includes research activities to assess feasibility and stakeholder engagement, followed by intervention implementation and evaluation. The scalable version of the CHoBI7 program is expected to provide only a soapy water bottle and chlorine tablets, encouraging households to construct handwashing stations and water vessels using items from their homes. The study is divided into two phases: (1) Formative Research Phase (12 Months): This phase tailors the CHoBI7 program for rural health facilities and tests the feasibility of providing a modified WASH package with only a soapy water bottle and chlorine tablets in both urban and rural settings through formative research and stakeholder engagement; (2) Intervention Implementation and Evaluation Phase (18 Months): This phase evaluates the effectiveness of delivering the CHoBI7 program in community clinics, district hospitals, tertiary hospitals, and sub-district health complexes in rural areas, focusing on increases in WASH behaviors and decreases in diarrheal disease through a randomized controlled trial (RCT).