Effectiveness of Clinical Training for HIV Care in Sub-Saharan Africa—the Infectious Disease Institute (IDI) Training Evaluation
Background
A review of randomized controlled trials of training interventions for physicians in Europe and North America showed that didactic methods, such as lectures and presentations, were not effective at changing physician practice. Interactive methods, however, such as hands-on practice sessions, case discussions, and role plays, were effective in changing physician practice, and, in some cases, the health outcomes of patients. Didactic training methods predominate in much of sub-Saharan Africa, though there are notable exceptions, such as the Infectious Disease Institute (IDI) at Makerere University in Kampala, Uganda. The IDI offered a four-week course on comprehensive HIV care, including antiretroviral therapy (ART), to 25 physicians six times a year, and, as of May 2006, IDI had trained a total of 350 physicians. The program featured interactive training methods, such as case presentations and clinical rounds. Its objective was to build the capacity of physicians and other health care professionals in Africa—especially Uganda—to treat patients with HIV.
The objective of the evaluation was to determine the effects of the IDI’s course on four outcomes: (1) clinical skills, (2) clinical activities, (3) monitoring of HIV patients, and (4) training activities.
Methods
A 17-item clinical exam checklist was used to assess clinical skills at the beginning and end of the course, and at a follow-up session three to four months later. A telephone survey was conducted one month after the course to collect data on four areas: clinical activities, monitoring of HIV patients, case studies on initiation of ART, and training activities. Data on training activities were also collected at the follow-up session. Four cohorts of physicians in 2004 and 2005 participated (n=47).
Findings
Between the beginning and end of the course, participants’ clinical skills improved significantly in 11 of 17 areas (n=34). Between the end of the course and the follow-up, their skills improved significantly in 3 areas (n=14). Further, it was found that the trainees were practicing HIV care and training. The telephone survey (n=46) showed that 93% of trainees treated HIV patients, 35% provided training on HIV, and 47% monitored the weight of the last HIV patient treated (patient's weight was a clinical endpoint to measure health status). At follow-up, everyone provided training and trained an average of 20 people per month.
Conclusion
The evaluation found that the IDI course improved the clinical skills of the doctors who completed it, and that alumni were practicing HIV care and training. It could be possible to improve capacity for treating HIV-infected children, and practice for monitoring HIV patients in the future.
For an article based on this evaluation, see: Weaver MR, Nakitto C, Schneider G, Kamya M, Kambugu A, Ronald A, Lukwago R, McAdam K, Sande M. "Measuring the Outcomes of a Comprehensive HIV Care Course: Pilot Test at the Infectious Diseases Institute, Kampala Uganda." Journal of Acquired Immune Deficiency Syndromes 2006; 43(3): 292–303. The article can be accessed at http://faculty.washington.edu/mweaver/Weaver_JAIDS2006.doc.
