LESSONS FROM THE ROLLOUT OF AN INNOVATIVE POST-GRADUATE, DIPLOMA-LEVEL PROGRAM IN CLINICAL HIV/AIDS MANAGEMENT FOR DOCTORS AND NURSES IN SOUTH AFRICA Sandy Pillay Kalavani Moodley Terence Nair Prinesh Gounden Umesh Lalloo Enhancing Care Initiative, UKZN

BACKGROUND South Africa (SA) remains the country with the highest HIV+ population in the world The public ARV program in SA started as late as 2003 – therefore, the majority of health workers have had no formal training in HIV care The body of HIV knowledge together with treatment guidelines are continuously changing There has been an urgent need in SA to skill up health workers with as little disruption to services as possible Short term programs for this purpose were found not to provide sustainable knowledge

HISTORY OF POST GRADUATE CLINICAL HIV MANAGEMENT PROGRAM Faced with the urgency, the Nelson Mandela School of Medicine of the UKZN developed a part time clinical HIV management program at a diploma level in 2004 The program was adapted to be delivered to doctors, nurses and pharmacists The program was adapted to a video-conferenced program and an IT platform was extended to the far reaches of the province of KZN

STRUCTURE OF PROGRAM The course was developed as a 2 year part- time program run over 8 weekends per year 16 modules required 80 hours each of contact and self-directed learning Each module was stand alone – health workers could access individual modules The teaching method consisted of didactic, case-based, problem-based and self directed learning

MODULES YEAR 1 MODULE NAME SEMESTER 1 Introduction to Clinical Aspects of HIV in Adults Introduction to ART in Adults Introduction to Clinical Aspects of HIV in Children Introduction to ART in Children SEMESTER 2 Introduction to Virology Introduction to Epidemiology and Prevention of HIV HIV and Women Palliative Care

MODULES YEAR 2 MODULE NAME SEMESTER 1 Advanced Clinical Aspects of HIV in Adults Advanced ART in Adults Advanced Clinical Aspects of HIV in Children Advanced ART in Children SEMESTER 2 Sexually Transmitted Infections HIV and Ethics HIV and TB Special Issues in HIV

VIDEO CONFERENCING In order to reach the furthest rural centres and to limit disruption to services, an IT infrastructure was developed and extended into rural KZN The program was conferenced to 3 distant sites Each site was staffed with academic facilitators and IT and admin support The program was adapted to include site based discussions/tasks and plenary type lectures and feedback

PROGRAM OUTCOMES 289 health workers have successfully completed the course 85 students are currently registered There has been a 95% pass rate The discipline breakdown: – 37.6% doctors – 40.7% nurses 16 students have opted to proceed with a masters program

EVALUATION An evaluation of the program demonstrated that the acceptability was very good at parent and distant sites There was no significant difference in the pass rate for students in the parent and distant sites

CONCLUSIONS A part-time, post-graduate program for doctors and nurses was successfully developed to rapidly skill them up in a sustainable manner Video conferencing is effective in disseminating such teaching widely, reducing service disruption A modularised course allows health workers to complete their program over time and to take modules which are most urgent early