Pediatric Primary Care Provider's Knowledge of HIV/AIDS Care

Abstract

To respond to the difficulties that community-based providers face in keeping abreast of the rapid changes in HIV-related care, an intensive pediatric HIV mentoring program (Pediatric HIV Miniresidency [MR]) was developed, linking a regional AIDS Education and Training Center (AETC) with an urban children's hospital HIV outpatient care site. The purpose of this study was to evaluate HIV-related knowledge and perceived skills, abilities, and willingness of community-based primary care pediatric providers and providers completing the MR. A convenience sample of community-based primary pediatric practitioners and those participants in the MR program completed a three-part mailed survey. The survey assessed practice characteristics, knowledge of pediatric HIV clinical care, and perceived skills, ability, and willingness (PSAW) to provide HIV-related care. The main outcome measures were overall knowledge and PSAW scores. One hundred nineteen community-based practitioners (NMRs), 20% of those surveyed, completed the instrument, as did 19 of 20 MR participants. NMRs exhibited low knowledge scores in key areas relating to the identification and evaluation of HIV-exposed children. Fewer than half of these respondents correctly answered questions related to HIV antibody incidence in HIV-exposed newborns and recommended diagnostic testing of such infants. Providers completing the MR scored significantly higher on the knowledge survey (15.2 vs. 8.8, p < 0.001), and had higher PSAW scores (45.8 vs. 33.9, p < 0.001). Although the generalizability of our study is limited by the low response rate, community-based physicians completing the survey demonstrated a lack of knowledge we believe necessary to provide pediatric HIV-related care (as defined by Public Health Service practice guidelines). Physicians completing the MR program had substantial HIV-related knowledge and expressed a willingness to provide care to HIV-exposed/infected children. An effective MR program provides a mechanism for developing a network of dedicated community-based physicians who are willing and capable of providing care to HIV-infected or exposed infants and children.

Evaluation of the effectiveness of an outreach clinical mentoring programme in support of paediatric HIV care scale-up in Botswana

“…Along with training and supervision, clinical mentoring by providers skilled in HIV management has been identified as a cornerstone of scaling-up antiretroviral treatment in Africa (Zolfo et al, 2010), including for children, and is part of many national scale-up approaches(Cameron et al, 2012; Rustein et al,1998; Morris et al, 2009; Scherzer et al, 2010; Tolleet al,2008). While evidence of a direct effect of clinical mentoring on clinical outcomes is lacking, there is ample evidence for improved HIV outcomes in cohorts of patients managed by specialized or more experienced providers compared to those with less HIV-specific training and experience (Landon et al, 2003; Stone, Mansourati, Poses & Mayer, 2001; Wood et al, 2003), including for nurse-managed cohorts (Callaghan, Ford & Schneider, 2010; Sanne et al, 2010).…”

Diffusion of Positive AIDS Care Messages Among Service Providers in China

“…Previous studies have demonstrated that an HIV/AIDS stigma reduction intervention for service providers could increase knowledge and awareness of the disease and change attitudes by reducing fear of HIV transmission through everyday contact and increasing level of comfort, confidence, motivation, and willingness to provide care to PLWHA (Buskin et al, 2002;Lalonde et al, 2002;Rutstein et al, 1998;Sowell, Seals, Wilson, & Robinson, 1998). These studies also highlighted the high importance of training service providers in working with HIV/ AIDS and of incorporating HIV/AIDS intervention activities into their routine activities (Buskin et al, 2002;Wu et al, 2002).…”

Changes in service delivery following HIV/AIDS education of medical and mental health service providers: Results of a one-year follow-up.

“…Attitudinal, behavioral, psychological, and neuropsychiatric factors are of the utmost importance in every phase of the illness process, from the pre-infection risk of contracting the virus through the various clinical disease stages and their effects on the brain (Castellon, Hinkin, & Myers, 2001;Hinkin, Castellon, Atkinson, & Goodkin, 2001), likelihood of co-occurring hepatitis B and hepatitis C (Essock et al, 2003), ice delivery (Knox, Friedrich, Gaies, & Achenbach, 1994;Satriano, Rothschild, Steiner, & Oldham, 1999). Specific educational interventions have been shown to increase providers' knowledge of clinical symptoms and treatment protocols (Lewis, Gallagher, & Gelbier, 1996;Rutstein et al, 1998), increase comfort in working with HIV+ individuals (Panter et al, 2000;Riley & Greene, 1993), decrease provider anxiety (Atkinson, Grant, Lewis, & Sherval, 1996;Highriter, Tessaro, Randall-David, & Quade, 1995;Sowell, Seals, Wilson, & Robinson, 1998), increase skills and abilities (Campbell, Weeks, Walsh, & Sanson-Fisher, 1996;Farquhar, Stein, & Wagner, 1995), and increase willingness to provide treatment (Crawford et al, 1991;Knox et al, 1994;Martin & Murphy, 1997).…”