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Abstract
BackgroundCurrent educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities.MethodsThe training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions.ResultsOf 258 initially active participants, 225 (225/258 = 87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200 = 85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001). The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001). A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills.ConclusionThis innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.
Highlights
Central America, which consists of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama, has been affected by the rapidly spreading HIV epidemic in Latin America
Pan American Health Organization (PAHO) recommendations for universal HIV screening of pregnant women, only 52% of pregnant women were HIV-tested in Latin America and the Caribbean [2,3] and only 36% of pregnant women diagnosed with HIV received antiretroviral therapy for the prevention of HIV mother-to-child transmission (PMTCT) in 2007 [3]
Needs Assessment and Baseline Evaluation A large need was identified in HIV testing, among pregnant women with only 52% of pregnant women being tested for HIV in the Latin America and Carribean (LAC) region, and even lower rates in the selected countries (Dominican Republic, 42%; Nicaragua, 20%; and Guatemala, 10%) [2,3]
Summary
Central America, which consists of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama, has been affected by the rapidly spreading HIV epidemic in Latin America. Lack of integration of HIV care into primary medical care in Central America leads to lost opportunities for HIV diagnosis and treatment, especially for rural or marginalized populations that may not have easy access to specialized HIV care at referral centers This affects quality and access to care and long term prognosis of HIV-infected individuals. Guidelines are developed and discussed between national authorities and HIV experts, many training activities target doctors at specialized care clinics or hospitals [4], whereas training programs designed to facilitate the implementation of these recommendations by primary health care workers (HCWs) at the community level are limited. Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities
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