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Patel-Larson A, Ledikwe JH, West T, Cheever L, Hauck H, Andrews G, Lipita F, Gugsa S, Life T, Perlman J, Wilson A, Phillips HJ, Haddad C. Looking back to see forward: multidirectional learning between the US Ryan White HIV/AIDS Program and the US President's Emergency Plan for AIDS Relief. BMJ Glob Health 2024; 8:e013953. [PMID: 38395451 PMCID: PMC10897372 DOI: 10.1136/bmjgh-2023-013953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/28/2023] [Indexed: 02/25/2024] Open
Abstract
To end the HIV epidemic as a public health threat, there is urgent need to increase the frequency, depth and intentionality of bidirectional and mutually beneficial collaboration and coordination between the USA and global HIV/AIDS response. The US Health Resources and Services Administration (HRSA) is uniquely positioned to showcase bidirectional learning between high-income and low-income and middle-income countries (LMICs) in the fight against HIV. For 30 years, HRSA has successfully administered the Ryan White HIV/AIDS Program (RWHAP), the largest federal programme designed specifically for people with HIV in the USA. Further, HRSA has developed and delivered innovative, cost-effective, impactful HIV programmes in over 30 countries as an implementing agency for the US President's Emergency Plan for AIDS Relief (PEPFAR). When PEPFAR was authorised in 2003, HRSA rapidly developed systems and infrastructures to deliver life-saving treatment, initiated workforce development programmes to mitigate health worker shortages, and laid the path for transitioning PEPFAR activities from US-based organisations to sustainable, country-led entities. As global programmes matured, lessons learnt within LMICs gradually began strengthening health services in the USA. To fully optimise synergies between RWHAP and PEPFAR, there is a critical need to build on successful initiatives, harness innovation and technology, and inculcate the spirt of multidirectional learning into global health. HRSA is promoting bidirectional learning between domestic and international HIV programming through documenting, sharing and implementing strategies, lessons learnt, best practices and effective models of care to accelerate achievement of HIV epidemic control and support country-led, sustained responses to public health threats.
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Affiliation(s)
| | | | | | | | | | - Gail Andrews
- Republic of South Africa Department of Health, Pretoria, Gauteng, South Africa
| | - Faless Lipita
- Meharry Medical College School of Medicine, Nashville, Tennessee, USA
| | | | | | | | - Amber Wilson
- National Institutes of Health, Bethesda, Maryland, USA
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Kitema GF, Laidlaw A, O'Carroll V, Sagahutu JB, Blaikie A. The status and outcomes of interprofessional health education in sub-Saharan Africa: A systematic review. J Interprof Care 2024; 38:133-155. [PMID: 36739570 DOI: 10.1080/13561820.2023.2168631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/07/2023] [Indexed: 02/06/2023]
Abstract
The increasing burden of chronic diseases, and shortage of health care workers especially in Low and Middle Income countries (LMICs) requires greater collaborative working between health professions. There is a growing body of evidence that interprofessional education (IPE) and interprofessional continuous education (IPCE) can improve collaborative practice thus strengthening health care delivery in low resource settings. The World Health Organization (WHO) promotes this educational strategy in these regions as part of wider programs to improve health care. The purpose of this systematic review was to summarize IPE and IPCE activities in sub-Saharan Africa (SSA) and its outcomes; including practice, service and patient outcomes. Standard guidelines for conducting and reporting systematic reviews were followed. The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct. The Kirkpatrick model was used to classify IPE outcomes reported from literature. Following full text screening, 41 articles were selected for data extraction. It was found that IPE/IPCE is still a relatively new concept in SSA with 93% of studies published after 2012. Furthermore, IPE is concentrated predominantly in undergraduate institutions and mainly implemented to improve collaborative practice and address important public health concerns. Positive reaction and outcomes of IPE/IPCE were reported in terms of change of attitude and perception toward collaborative practice as well as knowledge and skills acquisition. Few studies in SSA sought to understand and measure the outcomes of IPE/IPCE relating to health care practice. More work in this important potential outcome of IPE/IPCE is recommended.
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Affiliation(s)
| | - Anita Laidlaw
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
| | | | - Jean Baptiste Sagahutu
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Andrew Blaikie
- School of Medicine, University of St-Andrews, Scotland, UK
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Kiguli-Malwadde E, Forster M, Eliaz A, Celentano J, Chilembe E, Couper ID, Dassah ET, De Villiers MR, Gachuno O, Haruzivishe C, Khanyola J, Martin S, Motlhatlhedi K, Mubuuke R, Mteta KA, Moabi P, Rodrigues A, Sears D, Semitala F, von Zinkernagel D, Reid MJA, Suleman F. Comparing in-person, blended and virtual training interventions; a real-world evaluation of HIV capacity building programs in 16 countries in sub-Saharan Africa. PLOS Glob Public Health 2023; 3:e0001654. [PMID: 37486898 PMCID: PMC10365303 DOI: 10.1371/journal.pgph.0001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/05/2023] [Indexed: 07/26/2023]
Abstract
We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p<0.001). Nursing and midwives constituted the largest learner group overall (1145 [37.9%] vs. 949 [43.3%] vs. 107 [20.5%]). Across all domains of HIV knowledge and self-perceived confidence, there was a mean increase between pre- and post-course assessments, regardless of how training was delivered. The greatest percent increase in knowledge scores was among those participating in the in-person course compared to VW or OC formats (13.6% increase vs. 6.0% and 7.6%, p<0.001). Gains in self-reported confidence were greater among learners who participated in the in-person course compared to VW or OC formats, regardless of training level (p<0.001) or professional cadre (p<0.001). In this multi-country capacity HIV training program, in-person, online synchronous, and blended synchronous/asynchronous strategies were effective means of training learners from diverse clinical settings. Online learning approaches facilitated participation from more women and more diverse cadres. However, gains in knowledge and clinical confidence were greater among those participating in in-person learning programs.
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Affiliation(s)
- E Kiguli-Malwadde
- African Center for Global Health and Social Transformation, Kampala, Uganda
| | - M Forster
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - A Eliaz
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - J Celentano
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - E Chilembe
- Kamuzu College of Nursing, University of Malawi, Kamuzu, Malawi
| | - I D Couper
- Department of Global Health, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - E T Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - M R De Villiers
- Department of Global Health, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - O Gachuno
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - C Haruzivishe
- Faculty of Health Sciences, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - J Khanyola
- University of Global Health Equity, Kigali, Rwanda
| | - S Martin
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - K Motlhatlhedi
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Botswana
| | - R Mubuuke
- School of Medicine, Makerere University, Kampala, Uganda
| | - K A Mteta
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - P Moabi
- Scott College of Nursing, Morija, Lesotho
| | - A Rodrigues
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - D Sears
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, United States of America
| | - F Semitala
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Botswana
| | - D von Zinkernagel
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - M J A Reid
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, United States of America
| | - F Suleman
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Dassah ET, Dzomeku VM, Norman BR, Gyaase D, Opare-Addo MNA, Buabeng KO, Adu-Sarkodie Y. Attitudes of health care professionals towards interprofessional teamwork in Ashanti Region, Ghana. BMC Med Educ 2023; 23:319. [PMID: 37158859 PMCID: PMC10165774 DOI: 10.1186/s12909-023-04307-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Interprofessional collaboration ensures that high-quality health care is provided leading to improved health outcomes and provider satisfaction. Assessing the attitudes of health care professionals towards teamwork in Ghana is novel. OBJECTIVE To examine the attitudes of health care professionals towards interprofessional teamwork and assess specific attributes influencing these attitudes in the Ashanti region, prior to implementing an in-service interprofessional HIV training programme. METHODS A cross-sectional pre-training online survey using a modified Attitudes Toward Health Care Teams Scale was conducted among health care practitioners undergoing a two-day interactive interprofessional HIV training in Kumasi and Agogo from November 2019 to January 2020. Trainees were diverse health professional cadres selected from five hospitals in the Ashanti region of Ghana. Data was summarised using the mean and standard deviation for continuous variables, and frequencies and percentages for categorical variables. An exploratory factor analysis was conducted to categorise the 14 items of the modified attitudes scale. The Wilcoxon rank-sum (Mann-Whitney) and Kruskal-Wallis tests were used to test the mean attitude difference among the demographic characteristics. Statistical significance was set at p < 0.05. RESULTS Altogether, 302 health professionals completed the survey. The ages ranged from 20-58 years, mean age 27.96 years (standard deviation 5.90 years). Up to 95% of the trainees agreed with the 14 statements on the modified attitudes scale. Three factors were identified; "quality of care", "team efficiency", and "time constraint" with Cronbach's alpha measures of 0.73, 0.50, and 0.45 respectively. The overall mean attitude score was 58.15 ± 6.28 (95% CI, 57.42-58.88). Attitude of health care professionals towards interdisciplinary teams for patient care varied significantly by age (p = 0.014), health profession cadre (p = 0.005), facility (p = 0.037), and professional experience (p = 0.034). CONCLUSION Strengthening in-service interprofessional training for health practitioners especially early career professionals in the Ashanti region would be valuable.
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Affiliation(s)
- Edward T Dassah
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Veronica M Dzomeku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Betty R Norman
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Gyaase
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mercy N A Opare-Addo
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame O Buabeng
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kiguli-Malwadde E, Forster M, Martin S, Chilemba E, Couper I, Motlhatlhedi K, Celentano J, Haruzivishe C, Sears D, Budak JZ, Khanyola JN, Von Zinkernagel D, Molwantwa M, Semitala F, de Villiers M, Reid M, Kazembe A. Evaluating the impact of a multicountry interprofessional training programme to improve HIV knowledge and clinical confidence among healthcare workers in sub-Saharan Africa: a cohort study. BMJ Open 2022; 12:e060079. [PMID: 35858724 PMCID: PMC9305810 DOI: 10.1136/bmjopen-2021-060079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the impact of an interprofessional case-based training programme to enhance clinical knowledge and confidence among clinicians working in high HIV-burden settings in sub-Saharan Africa (SSA). SETTING Health professions training institutions and their affiliated clinical training sites in 12 high HIV-burden countries in SSA. PARTICIPANTS Cohort comprising preservice and in-service learners, from diverse health professions, engaged in HIV service delivery. INTERVENTION A standardised, interprofessional, case-based curriculum designed to enhance HIV clinical competency, implemented between October 2019 and April 2020. MAIN OUTCOME MEASURES The primary outcomes measured were knowledge and clinical confidence related to topics addressed in the curriculum. These outcomes were assessed using a standardised online assessment, completed before and after course completion. A secondary outcome was knowledge retention at least 6 months postintervention, measured using the same standardised assessment, 6 months after training completion. We also sought to determine what lessons could be learnt from this training programme to inform interprofessional training in other contexts. RESULTS Data from 3027 learners were collected: together nurses (n=1145, 37.9%) and physicians (n=902, 29.8%) constituted the majority of participants; 58.1% were preservice learners (n=1755) and 24.1% (n=727) had graduated from training within the prior year. Knowledge scores were significantly higher, postparticipation compared with preparticipation, across all content domains, regardless of training level and cadre (all p<0.05). Among 188 learners (6.2%) who retook the test at >6 months, knowledge and self-reported confidence scores were greater compared with precourse scores (all p<0.05). CONCLUSION To our knowledge, this is the largest interprofessional, multicountry training programme established to improve HIV knowledge and clinical confidence among healthcare professional workers in SSA. The findings are notable given the size and geographical reach and demonstration of sustained confidence and knowledge retention post course completion. The findings highlight the utility of interprofessional approaches to enhance clinical training in SSA.
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Affiliation(s)
- Elsie Kiguli-Malwadde
- Director of Health Workforce and Development, African Centre for Global Health and Social Transformation, Kampala, Uganda
| | - Maeve Forster
- Institute of Global Health Sciences, UCSF, San Francisco, California, USA
| | - Shayanne Martin
- Institute of Global Health Sciences, UCSF, San Francisco, California, USA
| | - Evelyn Chilemba
- College of Nursing, Kamuzu University of Health Sciences, Kamuzu, Malawi
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Keneilwe Motlhatlhedi
- Faculty of Medicine, University of Botswana Faculty of Health Sciences, Gaborone, Gaborone, Botswana
| | - Jessica Celentano
- Institute of Global Health Sciences, UCSF, San Francisco, California, USA
| | - Clara Haruzivishe
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Harare, Zimbabwe
| | - David Sears
- Medicine, UCSF, San Francisco, California, USA
| | - Jehan Z Budak
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Judy N Khanyola
- School of Nursing, University of Global Health Equity, Kigali, Gasabo, Rwanda
| | | | - Mmoloki Molwantwa
- Faculty of Medicine, University of Botswana Faculty of Health Sciences, Gaborone, Gaborone, Botswana
| | - Fred Semitala
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marietjie de Villiers
- Division of Family Medicine and Primary Care, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | | | - Abigail Kazembe
- College of Nursing, Kamuzu University of Health Sciences, Kamuzu, Malawi
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Eichbaum Q, Sam-Agudu NA, Kazembe A, Kiguli-Malwadde E, Khanyola J, Wasserheit JN, Kilmarx PH, Nachega JB. Opportunities and Challenges in North-South and South-South Global Health Collaborations During the COVID-19 Pandemic: The AFREhealth-CUGH Experience (as Reported at the CUGH 2021 Satellite Meeting). Ann Glob Health 2021; 87:90. [PMID: 34567982 DOI: 10.5334/aogh.3440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Sustainable and equitable partnerships and collaborations between the Global North and Global South (as well as within the Global South) have been aspirations (if seldom achieved) of the “global health” endeavor over the past couple of decades. The COVID-19 pandemic led to global lockdowns that disrupted international travel and severely challenged these partnerships, providing a critical space for self-reflection on global health as a discipline. One major global north-south partnership is that between the African Forum for Research and Education in Health (AFREhealth) and the Consortium of Universities for Global Health (CUGH). This article reports on a recent Satellite meeting of the AFREhealth-CUGH Working Group (ACWG) at the CUGH 2021 virtual conference in March 2021 that provided insights on North-South and South-South global health partnerships, against the backdrop of the COVID-19 pandemic. The authors describe challenges and opportunities for research and education in these partnerships (as discussed at this ACWG Satellite meeting), and implications for the field of global health going forward as we emerge from the pandemic.
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