Standardized Patients for HIV/AIDS Training in Resource-Poor Settings: The Expert Patient–Trainer

Abstract

This article presents a unique approach to HIV/AIDS training in resource-poor settings that incorporates the use of standardized patients (SPs). Integrated Management of Adolescent and Adult Illness (IMAI) is a World Health Organization health systems strengthening initiative with a strong emphasis on training health workers in the management of common diseases and conditions. In IMAI, SPs are called Expert Patient-Trainers (EPTs) to emphasize their role in the training of health workers. EPTs were first used in IMAI training in Uganda in 2004. Since then, the method has been adopted by a number of other countries in Africa, Latin America, and Asia. EPTs are usually recruited from groups of people living with HIV/AIDS. In the classroom, EPTs discuss living with HIV and help participants understand HIV as it affects patients. Course participants spend approximately two hours per day in "skill stations," multiple-station assessments consisting of one-on-one encounters with EPTs. In each encounter, the health worker interacts with an EPT portraying a standardized case. Instructions on how to portray each case provide only broad outlines of the major clinical and counseling points; the EPT is expected to use his or her own life experiences to fill in emotional details. Course facilitators noted that health workers were often initially skeptical about EPTs, but this generally turned to enthusiasm after participating in the skill stations. EPTs benefited from the sense of being part of the training team, the satisfaction of improving the skills of health workers, and learning more about their illness.

Involving expert patients in antiretroviral treatment provision in a tertiary referral hospital HIV clinic in Malawi

“…In relation to other health staff, previous studies describe that formal health workers may initially be skeptical about expert patients, but that their reservations tend to diminish over time [12]. We show that formal health staff perceived the expert patients’ clinical competency to be somewhat inferior to the standard of care they provide.…”

“…Task shifting may also be envisaged as a means of achieving Greater Involvement of People with HIV/AIDS (GIPA) as advocated by the WHO and scientists [9-12]. Although the involvement of individuals living with HIV was first articulated over a decade ago by AIDS activist groups and by UNAIDS in 1999, little research has been done to assess the extent of the adoption of this principle.…”

An Integrated Approach for Antiretroviral Adherence and Secondary HIV Transmission Risk-Reduction Support by Nurses in Kenya

“…Provider self-report of prevention health counseling practices may overestimate actual practice patterns. Future research could include nurse-patient interaction observation, perhaps using standardized patients (Carney & Ward, 1998; Seung et al, 2008), and should assess longer-term impact on HIV-infected patient behaviors, as well as the feasibility for scaling up such integrated counseling interventions in high-volume HIV clinics in resource-limited settings. Time motion studies could be conducted to ensure that the burden on already stressed health care providers does not increase substantially.…”

Impact of a Continuing Education Program on Pharmacists’ Knowledge and Attitudes toward Asthma Patient Care

“…This finding may be due to the life-threatening consequences of asthma exacerbation, and includes ethical debate about the mission of healthcare providers to save lives [25] . Another possible explanation may be the lack of patient involvement, such as expert/standardized patients or consumer educators, in the program [26,27] . Involving the patient in the education program is worth considering as it may affect pharmacists' attitudes toward patient autonomy [28] .…”