STRENGTHENING THE COMPETENCIES OF MID-LEVEL CLINICIANS DURING PRE-SERVICE TRAINING TO IMPROVE THE CARE AND TREATMENT OF HIV+ PATIENTS IN MOZAMBIQUE

Background:
With the upsurge of HIV cases in Mozambique in the early 2000s and given the dearth of Mozambican physicians, the government authorized the task-shifting of HIV clinical care to mid-level practitioners, called Técnicos de Medicina (TM). HIV and related diseases was not included in the TM’s pre-service training, therefore, in 2009, the Ministry of Health (MoH) and I-TECH initiated the implementation of 4-week pre-service courses for all TM students prior to their graduation. The course was based on the knowledge and skills gaps identified in a national study of TM providing HIV care and revision of their competencies with the MoH.

Methods:
As the pre-service training institutes’ teaching faculty did not have experience in teaching HIV-related content, they were trained first. In addition to receiving a clinical update on HIV and related diseases, they were trained on how to use the I-TECH /MoH-developed teaching materials and methodologies. The faculty, with I-TECH support, implemented the TM-student trainings, which focused on clinical case discussions, the use of algorithms for differential diagnoses, direct clinical observations, and structured practicum.

Results:
Since its initiation and until the new curriculum, also developed with I-TECH's support, was initiated in all training institutes, 86 teaching faculty and 749 TM students from 28 cohorts have been trained in the 4-week course. Pre and post-test evaluations of the students have demonstrated an average of 23% improvement in HIV knowledge and competencies of TM students. All cohorts from the 10 pre-service training institutes graduating students were trained before being appointed to their assigned posts.

Although the training institute faculty were not considered to be a direct target group, their levels of HIV-related knowledge and skills have reportedly improved significantly, which they claim to be helpful for their other clinical teaching duties, besides being an asset to recently approved HIV task-shifting for other cadres in the country.

Conclusions:
HIV-focused, practical training for TMs prior to pre-service graduation can improve their knowledge and skills and better prepare them for their roles in HIV diagnosis, care and treatment. As an alternative implementation strategy for task shifting, strengthening the competencies of mid-level clinicians during pre-service also simplifies the logistics and diminishes the per diem costs involved once TMs leave the institute to their appointed posts in districts around the country.