HIV education for health-care professionals in high prevalence countries: time to integrate a pre-service approach into training

Effectiveness of a Comprehensive 4-Week Course in HIV Medicine for Postgraduate Doctors at University of Nigeria: A Preservice Education Initiative

There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-limited settings. To strengthen preservice HIV training for postgraduate health care providers, University of Maryland’s Institute of Human Virology and Center for Clinical Care and Research Nigeria collaborated with University of Nigeria to plan and implement a comprehensive 4-week course in HIV medicine. The first course was piloted with 30 postgraduate doctors. Mean objective structured clinical examinations (OSCE), pretest, and posttest scores score were 51%, 53%, and 75%, respectively; follow-up examination at 6 months showed mean score of 74%. In multivariate regression analysis, pretest score was positively associated with posttest score (22.03, P < .001) and OSCE (0.29, P = .04), age negatively associated with pretest score (−0.94, P = .001), and female gender positively associated with OSCE score (6.15, P = .05). Six- and 18-month online surveys revealed trainees continued to apply knowledge and skills gained. North–south university collaborations to develop practicum-based preservice curricula offer a sustainable way to strengthen preservice evidence-based HIV medicine training with long-lasting retention of skills and knowledge.

Validation of the integration of HIV and AIDS related nursing competencies into the undergraduate nursing curriculum in South Africa

BACKGROUND

Being in its fourth decade, HIV remains an epidemic that requires combined efforts for the global fight. The strategies planned and implemented in the fight against HIV include reversing and halting the spread of HIV, increasing health care access, and strengthening the health care system. South Africa has made the fight one of its top priorities, and has developed plans to increase the role of nurses in the management of HIV, demonstrating its willingness, commitment and progress in the fight against HIV.

OBJECTIVE

This article presents the validation process conducted to confirm the integration and mapping of the HIV and AIDS related nursing competencies into the four-year Bachelor of Nursing programme at a university in South Africa.

METHODS

This study adopted a constructivist paradigm, using a qualitative approach, applyingthe design step of the process model of curriculum development, to validate the inte gration of the mapped HIV and AIDS related nursing competencies into the undergraduate nursing curriculum.

RESULTS

For each competency, outcomes were developed for each year. Participants confirmed completeness of outcomes and appropriateness of the mapping of the HIV and AIDS related outcomes into the nursing curriculum, as well as the feasibility and practicability of the integration.

CONCLUSION

Required resources for integration of HIV and AIDS related nursing competencies, such as human resources and nurse educators' continued personal development were identified, as well as barriers to integration, and measures to eliminate them were discussed. The importance of integration of HIV and AIDS nursing competencies into the curriculum was reiterated.

Promoting reproductive options for HIV-affected couples in sub-Saharan Africa

HIV-affected couples face unique challenges that require access to information and reproductive services to prevent HIV transmission to the uninfected partner and offspring while allowing couples to fulfil their reproductive goals. In regions of high HIV prevalence in sub-Saharan Africa, HIV-affected couples require multipurpose prevention technologies (MPTs) to enhance their reproductive healthcare options beyond contraception and prevention of HIV/sexually transmitted infections (STIs) to include assistance in childbearing. The unique characteristics of the condom and its accepted use in conjunction with safer conception interventions allow HIV-serodiscordant couples an opportunity to maintain reproductive health, prevent HIV/STI transmission, and achieve their reproductive goals while timing conception. Re-thinking the traditional view of the condom and incorporating a broader reproductive health perspective of HIV-affected couples into MPT methodologies will impact demand, acceptability and uptake of these future technologies.

Knowledge, attitudes and behaviours of health care workers towards clients of sexual health services in Fiji

A cross-sectional survey was conducted to identify the attitudes and behaviours of health care workers (HCWs) in health care settings (HCS) in Fiji involving 369 participants. Self-rated knowledge of HIV and sexually transmissible infections (STIs) varied depending on whether the HCS was divisional or sub-divisional, and varied between the various national divisions. HCWs with experience in HIV, reproductive health and antenatal clinics had higher self-rated HIV knowledge. A high proportion had a fear of catching HIV from HIV-positive clients. This study found high levels of negative attitudes towards clients from vulnerable groups with regards to the transmission and spread of HIV. Study participants also reported observing differential treatment by their colleagues if a client was known to have or was suspected of having HIV. There is a need for further HIV education of HCWs, with training focussed on occupational risk, and on reducing stigma and discrimination of those living with or vulnerable to HIV in Fiji.

Medical education in sub-Saharan Africa: a literature review

OBJECTIVES

This review synthesises research published in the traditional and 'grey' literature to promote a broader understanding of the history and current status of medical education in sub-Saharan Africa (SSA).

METHODS

We performed an extensive review and analysis of existing literature on medical education in SSA. Relevant literature was identified through searches of five traditional medical databases and three non-traditional or grey literature databases featuring many African journals not indexed by the traditional databases. We focused our inquiry upon three themes of importance to educators and policymakers: innovation; capacity building, and workforce retention.

RESULTS

Despite the tremendous heterogeneity of languages and institutions in the region, the available literature is published predominantly in English in journals based in South Africa, the UK and the USA. In addition, first authors usually come from those countries. Several topics are thoroughly described in this literature: (i) human resources planning priorities; (ii) curricular innovations such as problem-based and community-based learning, and (iii) the 'brain drain' and internal drain. Other important topics are largely neglected, including: (i) solution implementation; (ii) programme outcomes, and (iii) the development of medical education as a specialised field of inquiry.

CONCLUSIONS

Medical education in SSA has undergone dramatic changes over the last 50 years, which are recorded within both the traditionally indexed literature and the non-traditional, grey literature. Greater diversity in perspectives and experiences in medical education, as well as focused inquiry into neglected topics, is needed to advance medical education in the region. Lessons learned from this review may be relevant to other regions afflicted by doctor shortages and inequities in health care resulting from inadequate capacity in medical education; the findings from this study might be used to inform specific efforts to address these issues.

Task shifting in Mozambique: cross-sectional evaluation of non-physician clinicians' performance in HIV/AIDS care

BACKGROUND

Many resource-constrained countries now train non-physician clinicians in HIV/AIDS care, a strategy known as 'task-shifting.' There is as yet no evidence-based international standard for training these cadres. In 2007, the Mozambican Ministry of Health (MOH) conducted a nationwide evaluation of the quality of care delivered by non-physician clinicians (técnicos de medicina, or TMs), after a two-week in-service training course emphasizing antiretroviral therapy (ART).

METHODS

Forty-four randomly selected TMs were directly observed by expert clinicians as they cared for HIV-infected patients in their usual worksites. Observed clinical performance was compared to national norms as taught in the course.

RESULTS

In 127 directly observed patient encounters, TMs assigned the correct WHO clinical stage in 37.6%, and correctly managed co-trimoxazole prophylaxis in 71.6% and ART in 75.5% (adjusted estimates). Correct management of all 5 main aspects of patient care (staging, co-trimoxazole, ART, opportunistic infections, and adverse drug reactions) was observed in 10.6% of encounters.The observed clinical errors were heterogeneous. Common errors included assignment of clinical stage before completing the relevant patient evaluation, and initiation or continuation of co-trimoxazole or ART without indications or when contraindicated.

CONCLUSIONS

In Mozambique, the in-service ART training was suspended. MOH subsequently revised the TMs' scope of work in HIV/AIDS care, defined new clinical guidelines, and initiated a nationwide re-training and clinical mentoring program for these health professionals. Further research is required to define clinically effective methods of health-worker training to support HIV/AIDS care in Mozambique and similarly resource-constrained environments.

The Tanzania HIV/AIDS nursing education (THANE) preservice curriculum

The Schools of Nursing at Muhimbili University of Health and Allied Sciences and the University of California, San Francisco (UCSF) have been collaborating on a twinning partnership to develop an HIV nursing education preservice curriculum. The Tanzania HIV/AIDS Nursing Education (THANE) project was designed to increase the HIV education capacity of Tanzanian nursing schools by strengthening the knowledge and skills of the nurse educators. The THANE project includes three components: (a) development of 12 curriculum modules, (b) training of trainers, and (c) roll-out to all nurse educators in the eight zones of Tanzania and Zanzibar. The evaluation plan focuses on three main areas: (a) HIV knowledge, confidence in teaching, and thoughts about HIV, (b) participant satisfaction with the workshops, and (c) monitoring educators to assess implementation and dissemination of the THANE curriculum into existing curricula. To date, 300 nurse educators have been trained.

An assessment of interactions between global health initiatives and country health systems

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money, and outcomes in global public health, then these opportunities should not be missed.