Ssekabira Umaru - IDI, Uganda

Effectiveness of three models of providing post training support for capacity building in Pediatric HIV

management.

Presented by Dr Umaru Ssekabira- Training department of the Infectious Diseases Institute(IDI) Makerere University-Kampala Uganda.Presented at “The second HIV capacity Building Partner’s Summit-Birchwood Hotel and conference Centre Johannesburg, South Africa March 19-21, 2013”

Investing in the Future: Impacting Real Lives

Background information• Building and maintaining capacity for HIV patient mgmt.- is critical

given rapidly changing guidelines.

• Pre-service & In service training equips, refreshes HCW knowledge and skills.

• Post training support- vital for continuing professional development and knowledge & skills retention.

• Usual approaches (onsite F/up, mentoring and coaching) are costly

• Widespread use of mobile phones for SMS, Internet and phone calls.

• IDI compared the effectiveness of three models of providing post training support for pediatric HIV care in Uganda.


Description of context• Study was conducted in 18 HF in 6/9 IDI supported rural districts in

SW Uganda.

• Healthcare workers ( Medical officers, clinical officers, nurses & midwives) involved in Management of Pediatric HIV patients were recruited

• Good coverage with Mobile phone network

• Widespread use of mobile phones for SMS and phone calls, internet.

• Facilitation for field visits and presence of staffInvesting in the Future: Impacting Real Lives

Methodology• Baseline assessment in all health facilities including Technology

literacy and resources assessment.

• 5 day classroom based Pediatric ART Management course for 72 HCW

• Introduction to mobile phone based learning included

• Random allocation of facilities to three models; • blended- onsite and distance follow up support. 25 HCW• distance follow up- received weekly SMS quiz questions, reminder texts of

key messages from training and voice calls. 23 HCW• Onsite (control)- CMEs, case scenarios-24 HCW

• Post training support for three months • Access to assistance via the IDI toll-free line for patient

management problems.


Key interventions/Methodology


Assessment of Outcomes

Knowledge retention evaluated at 4 times using MCQ test

Comparison of scores at T2 and T4 using T test and Annova


Description of study participants


• Sex – 51 females and 21 males

• Cadre– 3 Doctors, – 18Clinical officers,– 25 Enrolled nurses/midwives,– 19 nursing officers – 7 others

• Equally distributed amongst intervention groups

Evidence of success and achievementsMean percentage scores with all included


Intervention Group T1 T2 T3 T4

Blended 51.45 71.74 64.49 68.12

Control 51.04 72.22 70.66 65.63

Distance 57.17 78.00 0.00 39.50

Overall 53.30 74.07 44.16 57.35

Mean percentage scores with absentees excluded


Intervention Group T1 T2 T3 T4

Blended 51.45 71.74 70.63 74.60

Control 55.68 72.22 77.08 78.75

Distance 59.55 78.00 n/a 75.96

Overall 55.62 74.07 73.93 76.47

Comparison of mean scores across interventions

Intervention Group

T2 T4

t-test (Including zero scores)

t-test (Excluding zero scores)

Blended 71.74 74.60Control 72.22 78.75Distance 78.00 75.96Anova (Including zero scores) p =0.171 p =0.008Anova (Excluding zero scores)p =0.171 p =0.741

P = 0.000 P = 0.128

Challenges• Staff Absenteeism/ trainee drop out.

• Heavy clinic days

• Participants reluctant to answer phone calls

• Funding for onsite support


Lessons learntShort text messaging - Participants disturbed by numerous SMS and callsSolutions: Proper orientation/communication; Use accountability partners based at each site; Visits to non compliant participants

Computer assisted learningIssues: Power failure; facility owned computer always engaged and not accessible; skills low for some staffOnsite SupportThings that are appreciated –CMEs; Discussion of case scenarios; presence and support of supervisors enhances HWs adherence to learning program


Conclusions• Results show no difference in knowledge

retention amongst the three arms

• Post training support using distance learning methods could be as effective as onsite

• Need for a randomized controlled trial with a bigger sample size to confirm findings


ACKNOWLEGEMENTS• Outreach services department• Extended Kibale Kiboga Project• Centers for Diseases Control-Uganda• The 6 District Health Teams• The 18 health facilities• Training department staff• Participants


Health & Medicine

Ssekabira Umaru - IDI, Uganda