Evaluation of National HIV Training Program in Tanzania
Background
In 2007, it was requested that I-TECH conduct an evaluation of Tanzania's national care and treatment training program. The goal of this evaluation was to gather data that would help inform the rollout of Tanzania's national antiretroviral drug (ARV) program through effective, decentralized training, which would increase the effectiveness of the national HIV/antiretroviral therapy (ART) training program.
The government of Tanzania began the care and treatment training program in July 2004 to support the provision of comprehensive HIV care and treatment services, including ARVs, by October of that year. International implementing partners and World Health Organization (WHO) representatives in the country collaborated to develop a standardized, PowerPoint-based curriculum, which was based predominately on source materials from Family Health International (FHI) and work done in Botswana by Harvard University, with input and content from other implementing partners.
The care and treatment training is delivered to multidisciplinary teams composed of clinicians, treatment nurses, pharmacists, lab technicians, counselors, and home-based care providers. This standardized national care and treatment curriculum was used to train the staff of 96 large regional and district hospitals in 2004–05, so they could begin providing care and treatment services. In the subsequent year, an additional 104 hospitals trained staff to initiate care and treatment services, with the goal of providing services to 100,000 patients.
The I-TECH training program evaluation was designed to answer the following questions:
- How well does the national ART curriculum facilitate effective teaching and learning?
- What is the National AIDS Control Program's (NACP) training strategy, and how is it implemented? Are there standards or quality assurance measures in place, and are they being met?
- Are participants acquiring adequate knowledge and skills in ART to provide safe and effective treatment?
- What are the recommendations for quality improvement for the national training program?
- The intended audience for this evaluation was the Ministry of Health and the partners involved in funding and implementing HIV care and treatment in Tanzania.
Methods
A variety of methods were used to obtain a comprehensive picture of the national training program. The components of the evaluation included:
- Desk review of the national care and treatment curriculum
- Observations of care and treatment trainings
- Interviews with U.S. government implementing partners
- Interviews with facilitators, training participants, and facility managers
- Interviews with other stakeholders
- Service delivery observations
Interviews were conducted with 119 clinicians (physicians, nurses, pharmacists, and counselors) from eight regions. In addition, 117 clinicians were observed while providing patient care. Observers were themselves ART-experienced clinicians who used a structured observation tool to document clinical practice.
The evaluation resulted in a set of recommendations for strengthening the curriculum, training delivery, and quality improvement systems.
