Improved HIV and TB Knowledge and Competence Among Mid-level Providers in a Cluster-Randomized Trial of One-on-One Mentorship for Task Shifting

Naikoba, Sarah; Senjovu, Kaggwa D.; Mugabe, Pallen; McCarthy, Carey; Riley, Patricia L.; Kadengye, Damazo T.; Dalal, Shona

doi:10.1097/qai.0000000000001378

Cited by 20 publications

(51 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In post-mentoring feedback, MLP appreciated the mentoring relationship and reported that it improved their con dence in managing HIV and TB cases. This was demonstrated in the results from the cluster-randomized trial, which showed that mentored MLP handled 50% of HIV clinic consultations compared to 27% by their non-mentored peers, with an improvement in HIV and TB indicators at the facility level such as the proportions of patients who had been offered an HIV test (11). An on-site mentorship approach thus had a cascade effect on clinical practice, patient care, and overall facility performance.…”

Section: Discussionmentioning

confidence: 98%

“…We describe a 12-month observational study on knowledge, competence and clinical practice among MLP that completed a cluster-randomized trial of one-on-one clinical mentoring. The detailed methods for the cluster-randomized trial are described elsewhere (11) but brie y, the intervention comprised of one-on-one, on-site clinical mentoring of MLP on HIV and TB care from a trained, randomly assigned mentor for 8 hours a week, every 6 weeks, over a nine-month period at each of ve intervention sites; no intervention was provided in control sites.…”

Section: Methodsmentioning

confidence: 99%

“…In order to improve clinical mentorship in public health facilities, it is essential that the most effective and sustainable approaches of mentoring are identi ed and disseminated. A cluster-randomized trial described elsewhere (11) demonstrated the effectiveness of a one-on-one, on-site, clinical mentorship program on individual MLP knowledge and competence. This follow-up study, continues from the end of the intervention of the cluster-randomized trial and reports on follow up 6 and 12 months after the end of intervention to determine if the gains seen at the end of the intervention were sustained over time once mentored providers returned to their routine practice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Knowledge and Competence Retention Among Mid-Level Health Providers After Intensive One-On-One Clinical Mentorship in TB and HIV Management

Dk¹,

Naikoba²,

Mugabe³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction : Clinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain. Methods : The midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8 hours a week, every 6 weeks over 9 months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm.Results: At the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6 months (0.6% [95% CI -1.4, 2.6]) or 12 months (-2.8% [95% CI: -5.9, 0.3]) while scores in the control arm significantly increased at 6 months (6.6% [95% CI: 4.4, 8.9]) and 12 months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6 month (2.8% [95% CI: -1.8, 7.5] and 12 months (3.7% [95% CI: -2.4, 9.8]) while in the control arm, a significant increase was seen at 6 months (5.8% [95% CI: 1.2, 10.3] and 12 months (11.5% [95% CI: 7.6, 15.5]).Conclusions : Mentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care.Trial Registration : The study received ethics approvals from 3 institutions – the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board “JCRC’s HIV/AIDS Research Committee” IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Knowledge and Competence Retention Among Mid-Level Health Providers After Intensive One-On-One Clinical Mentorship in TB and HIV Management

Dk¹,

Naikoba²,

Mugabe³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Training and supervision with feedback occurring alone or together have been shown as interventions that improve health worker performance especially in lower resource settings 27–32. Specifically, studies have looked at the benefits of training on how to write referral notes33 and the use of standard templates to improve quality of such notes from different categories of health workers.…”

Section: Discussionmentioning

confidence: 99%

Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods

et al. 2019

View full text Add to dashboard Cite

ObjectiveTo assess the completeness of obstetric referral letters/notes at the district level of healthcare.DesignAn implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data.SettingThree (3) districts in the Greater Accra region of Ghana.ParticipantsPregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses.InterventionAn enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms.OutcomeCompleteness of obstetric referral letters/notes.ResultsProportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons.ConclusionsMost obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.

show abstract

“…Numerous studies show that task shifting can have this cost-saving effect [ 23 , 24 ]. There is also some evidence that the synergistic interaction between supervision/mentorship and task shifting can produce facility-level performance improvement [ 25 ]. This is the first study to the authors’ knowledge to examine this interaction as it relates to efficiency in the public sector.…”

Section: Discussionmentioning

confidence: 99%

Explaining the heterogeneity in average costs per HIV/AIDS patient in Nigeria: The role of supply-side and service delivery characteristics

et al. 2018

View full text Add to dashboard Cite

ObjectiveWe estimated the average annual cost per patient of ART per facility (unit cost) in Nigeria, described the variation in costs across facilities, and identified factors associated with this variation.MethodsWe used facility-level data of 80 facilities in Nigeria, collected between December 2014 and May 2015. We estimated unit costs at each facility as the ratio of total costs (the sum of costs of staff, recurrent inputs and services, capital, training, laboratory tests, and antiretroviral and TB treatment drugs) divided by the annual number of patients. We applied linear regressions to estimate factors associated with ART cost per patient.ResultsThe unit ART cost in Nigeria was $157 USD nationally and the facility-level mean was $231 USD. The study found a wide variability in unit costs across facilities. Variations in costs were explained by number of patients, level of care, task shifting (shifting tasks from doctors to less specialized staff, mainly nurses, to provide ART) and provider´s competence. The study illuminated the potentially important role that management practices can play in improving the efficiency of ART services.ConclusionsOur study identifies characteristics of services associated with the most efficient implementation of ART services in Nigeria. These results will help design efficient program scale-up to deliver comprehensive HIV services in Nigeria by distinguishing features linked to lower unit costs.

show abstract

Improved HIV and TB Knowledge and Competence Among Mid-level Providers in a Cluster-Randomized Trial of One-on-One Mentorship for Task Shifting

Abstract: One-on-one on-site mentorship improves individual knowledge and competence, has a downstream effect on facility performance, and is a simple approach to training MLPs for task shifting.

Cited by 20 publications

References 15 publications

Knowledge and Competence Retention Among Mid-Level Health Providers After Intensive One-On-One Clinical Mentorship in TB and HIV Management

Knowledge and Competence Retention Among Mid-Level Health Providers After Intensive One-On-One Clinical Mentorship in TB and HIV Management

Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods

Explaining the heterogeneity in average costs per HIV/AIDS patient in Nigeria: The role of supply-side and service delivery characteristics

Contact Info

Product

Resources

About