A Training Needs Analysis of Health Workforce Competencies in HIV Care and

Treatment Services in Rwanda (L305)

Presented by:Dr. Peter Memiah

Presented by: Dr.. Peter Memiah

Objectives

• Identify the existing and emerging capacity gaps among medical health care providers currently in practice in health care

• Assess the current clinical practice in managing HIV/AIDS patients at health facility level

• Identify the type of trainings, offered and mechanism for ongoing professional development for HIV

Study Design• Cross-sectional survey

• 30 randomly selected health facilities• 5 provinces

• 20 health centers• 10 hospitals

• High volume and low volume sites • Methods:

Training needs Assessment self-reported (gap analysis) Medical Chart review

• Sampling Proportionate to size 2 Referral hospitals8 district hospitals19 Health Centers1 NGO

Self Administered Questionnaire

• People interviewed Medical officer in charge of clinical

supervision/mentorship (DH) Head of ART clinic, nurse prescriber Head of VCT/PMTCT service ( HC) Laboratory technologist/technicians In charge of pharmacy

People involved directly in provision of HIV Services

Study Criteria

Self Administered Questionnaire

• Staff from DH and HC which provide the full range of adult and pediatric HIV Care, treatment and prevention including VCT and PMTCT

• Able to provide consent

Medical Record Review• Medical Charts for Patients

who have been on ART >6months inclusive of terminated/dropped out patients

Findings: Self- Administered Questionnaire

Health Care Providers Gender Distribution

Females65%

Males35%

Percentage

• 107 responses• 73% response rate

Professions

Nurses54%

Lab Per-

sonel16%

Counselors15%

Social Work

ers6%

Pharmacy Personel6%

Medical Doctors3%

• 107 responses• 73% response rate

<1 year8%

1-5 years49%

6-10 years38%

11-15 Years5%

Years of Experience

Number of different health professionals versus the time when they provided care last for

PLHIV

Training in the past year

HIV/AIDS Knowledge

MO scored higher while counselors and lab had low scores all across

Summary of findings

• Guidelines were available in about ¾ of the facilities and utilization was at 79%

• Nurses care for 4 times as many patients as compared to physicians

• 8% of Nurses provide care without any HIV training• 32% of nurses claimed not to know the significance

of CD4 counts- drug resistance- VL• Most nurses had responsibilities of training other

staff- 40 %

Findings: Peds Chart Abstraction

Pediatric Patients

Active90%

Care ended10%

Male49%Female

51%

Gender112 Peds

Summary of findings• 81% VL of < 1000copies/ml– Gender disparity (pvalue= 0.037)

• Males were initiated on trx earlier than Females (99 vs 135)

• Diagnosis: Rapid test (83%) and was the most used method for HIV test

• Majority (94%) of children were above 5 years• Neonatal prophylaxis and maternal prophylaxis/treatment

was mostly missing in patient chart• 80% had exclusive breastfeeding• Diarrhea (wasting) was the leading Opportunistic Infection

Findings: Adults Chart Abstraction

Demographics

Female63%

Male37%

832 patients

The median age for adult patients was 41.5 years

Summary of findings• 89% VL of < 1000copies/ml– Gender disparity (pvalue= 0.001)

• 11% had trx failure and only 2% were put on 2nd line- up to 6 months of repeat testing for failing patients

• Age baseline CD4 and (D4T)current regimen were significantly associated with VL failure

• Females were initiated on trx earlier than Males (265 vs 339)

• There was a significant CD4 increase (av 137) between baseline and recent CD4 (pvalue=0.001)

Cross-Cutting Issues

• Poor documentation- role of CQI teams?

Lesson Learnt / Way forward

• Mentorship and supervision- gaps• Task Shifting (and multi-tasking)• Utilization of National guidelines• Competency based Pre/In-Service Training– Cadre specific

• Documentation is crucial– Enriching the Tracplus system

• More in-depth analysis• …Upcoming publication JAIPAC….

Co-Authors: Prof. Baribwira Cyprien; Dr. Kiromera Alphonse; Dr. Sebeza Jackson, Dr Riedel David;

..IDI- Uganda ….CDC….RBC….HCP at all the facilities