Abstract
BackgroundThe Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy.MethodsMoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes.ResultsKnowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2–23.5%) and 22.3% (95% confidence interval 13.2–31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV.ConclusionsSimilar to other Project ECHO evaluation results in the United States of America, Namibia’s Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.
Highlights
The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016
Most participants were nurses (53.8%), who demonstrated the largest increase in knowledge (11.7 percentage points; 22.3% improvement)
Increased capacity Our evaluation showed that healthcare worker knowledge about clinical management of HIV increased after the Project ECHO sessions, with nurses having the most significant knowledge increase, and that increases in knowledge led to increased feelings of self-efficacy
Summary
The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. The Namibian Ministry of Health and Social Services (MoHSS), in collaboration with the US President’s Emergency Plan for AIDS Relief (PEPFAR) Namibia, implemented an acceleration plan to rapidly scale-up HIV care and treatment interventions starting in 2015 [1]. Namibia needs innovative interventions that expand clinical capacity, increase professional satisfaction and retention, and strengthen decentralization and task sharing to expand HIV clinical services to achieve HIV epidemic control [1]. Continuing medical education delivered through virtual strategies including telehealth, telementoring, and vertically integrated learning such as virtual communities of practice have been shown to facilitate peer communication and knowledge sharing, reduce isolation, and increase intention to continue work in remote areas in both low- and high-resource settings [6, 7]
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