A Training Needs Analysis of Health Workforce Competencies in HIV Care and Treatment Services in Rwanda (L305) Presented by: Dr. Peter Memiah Presented by: Dr.. Peter Memiah

Objectives Identify the existing and emerging capacity gaps among medical health care providers currently in practice in health care Assess the current clinical practice in managing HIV/AIDS patients at health facility level Identify the type of trainings, offered and mechanism for ongoing professional development for HIV

Study Design Cross-sectional survey 30 randomly selected health facilities 5 provinces 20 health centers 10 hospitals High volume and low volume sites Methods:  Training needs Assessment self-reported (gap analysis)  Medical Chart review Sampling Proportionate to size 2 Referral hospitals 8 district hospitals 19 Health Centers 1 NGO

Self Administered Questionnaire People interviewed  Medical officer in charge of clinical supervision/mentorship (DH)  Head of ART clinic, nurse prescriber  Head of VCT/PMTCT service ( HC)  Laboratory technologist/technicians  In charge of pharmacy People involved directly in provision of HIV Services

Study Criteria Self Administered Questionnaire Staff from DH and HC which provide the full range of adult and pediatric HIV Care, treatment and prevention including VCT and PMTCT Able to provide consent Medical Record Review Medical Charts for Patients who have been on ART >6months inclusive of terminated/dropped out patients

Findings: Self- Administered Questionnaire

Health Care Providers Gender Distribution 107 responses 73% response rate

Professions 107 responses 73% response rate Years of Experience

Number of different health professionals versus the time when they provided care last for PLHIV

Training in the past year

HIV/AIDS Knowledge MO scored higher while counselors and lab had low scores all across

Summary of findings Guidelines were available in about ¾ of the facilities and utilization was at 79% Nurses care for 4 times as many patients as compared to physicians 8% of Nurses provide care without any HIV training 32% of nurses claimed not to know the significance of CD4 counts- drug resistance- VL Most nurses had responsibilities of training other staff- 40 %

Findings: Peds Chart Abstraction

Pediatric Patients Gender 112 Peds

Summary of findings 81% VL of < 1000copies/ml – Gender disparity (pvalue= 0.037) Males were initiated on trx earlier than Females (99 vs 135) Diagnosis: Rapid test (83%) and was the most used method for HIV test Majority (94%) of children were above 5 years Neonatal prophylaxis and maternal prophylaxis/treatment was mostly missing in patient chart 80% had exclusive breastfeeding Diarrhea (wasting) was the leading Opportunistic Infection

Findings: Adults Chart Abstraction

Demographics 832 patients The median age for adult patients was 41.5 years

Summary of findings 89% VL of < 1000copies/ml – Gender disparity (pvalue= 0.001) 11% had trx failure and only 2% were put on 2 nd line- up to 6 months of repeat testing for failing patients Age baseline CD4 and (D4T)current regimen were significantly associated with VL failure Females were initiated on trx earlier than Males (265 vs 339) There was a significant CD4 increase (av 137) between baseline and recent CD4 (pvalue=0.001)

Cross-Cutting Issues Poor documentation- role of CQI teams?

Lesson Learnt / Way forward Mentorship and supervision- gaps Task Shifting (and multi-tasking) Utilization of National guidelines Competency based Pre/In-Service Training – Cadre specific Documentation is crucial – Enriching the Tracplus system More in-depth analysis …Upcoming publication JAIPAC….

Co-Authors: Prof. Baribwira Cyprien; Dr. Kiromera Alphonse; Dr. Sebeza Jackson, Dr Riedel David;..IDI- Uganda ….CDC….RBC….HCP at all the facilities