1. Assessment of in-service HIV training in Swaziland 7 th Dec, 2011 Zwane-Shabalala FS 1, Nxumalo-Magagula N 1, Mngadi P.T 1, Kamiru H.N 3, Bruce K 3, Schulman D.W. 3, Dlamini N 3, Simelane B 3, Vandelanotte J 3, McNairy M 3, Khumalo T 2, Dohrn J 3, Flam R 3 16 th INTERNATIONAL CONFERENCE ON AIDS AND STIs IN AFRICA, Addis Ababa Ethiopia 1.University of Swaziland (UNISWA), Faculty of health sciences 2.Ministry of Health, Swaziland 3. ICAP, Columbia university, Mailman school of public health

2. Outline Background Objectives of the study Methods Results Conclusions and recommendations

3. Background (1) Swaziland has the highest global population HIV prevalence 19% of (SDHS 2007) HIV sero-prevalence among Pregnant mothers 41% (Sentinel Serosurveillance Report MOH, 2010) 77,156 were in need of ART as of 31 st Dec 2010 55,296 (64.1%) people were actively on treatment the end of September 2010, (49,907 adults and 5,389 children) (M&E 3 rd Quarter Report 2010)

4. Background (2) Significant effort has been invested by government of kingdom of Swaziland and development partners in capacitating HCW’s on HIV Rapid expansion in the need for HIV prevention, treatment and care in the country. – creating a demand for skilled and competent health work force to ensure provision of high quality HIV services. It is unclear how much in-service training has been provided, and whether this had any impact on HCWs knowledge, self-efficacy, skills, and competences in HIV service provision.

5. Objectives To describe the type of HIV in-service training provided to HCWs in Swaziland To determine the impact of in-service training on HCWs’ knowledge of HIV, self-efficacy to provider HIV care, and clinical service provision To establish the criteria used for selecting candidates for in-service training

6. Methods (1)

7. Methods(2) Descriptive cross-sectional survey. 255 doctors, nurses, pharmacists and laboratory personnel working in 60 care health facilities from all four administrative regions. Participation of HCWs was voluntary with informed consent. Ethical clearance was obtained from all relevant institutions: SEC-MOH and Columbia University.

8. Methods (3): Questionnaire Self-administered questionnaire to collect – demographics, – in-service training, – HIV/AIDS knowledge (21 MCQ), – 16 item five-point Likert scale self-efficacy to provide HIV/AIDS care and treatment scale (not at all confident (1) to extremely confident(5)) – Type of services provided Self-reported knowledge of HIV/AIDS (HIV knowledge self-efficacy) Clinical skills observed check list on adults, pediatric, and maternity care Systems skills observed check list.

9. Results (1 ): demographics Categoryn(%) GenderMale205 (81) Female47(19) Missing3(1) CadreNurses220(81) Doctors14(6) Laboratory technicians 9(4) pharmacists5(2) Missing7(3)

10. Results (2 ): HIV/AIDS service provision Trainings provided to HCWs past 12 months

11. Results (3): Criteria used to invite HCWs for in-service training

12. Results(4): knowledge of HIV/AIDS Stratan % knowledge score (s.d) p-value Overall 24963.7(15.8) N/A Ever trained Yes23065.0(23.4) <0.00005 No1947.6(14.3) Trained in the past 12 months Yes18265.9(13.6) 0.0002 No6757.7(19.4)

13. Results(5): knowledge of HIV/AIDS Stratan % knowledge score (s.d) p-value Gender Male4463.8(21.6) 0.99 Female20263.8(17.6) Missing358.7(14.5) Cadre Doctors1474.5(10.8) <0.00005 Nurses17365.2(14.6) Nurse assistants4760.0(14.8) Pharmacists941.3(26.7) Lab technicians523.8(27.4) Missing733.3(34.8)

14. Results (6): knowledge of HIV/AIDS Stratan % knowledge score (s.d) p- value Nursing cadres Degree nurses5365.6(12.7) 0.72 Diploma nurses with Midwifery 9965.1(15.6) Diploma nurses1860.1(17.6) Certificate nurses4560.6(15.1) Missing4053.3(29.1)

15. Results(7): self-efficacy to provide HIV care Stratan Mean self-efficacy score p-value Crude 9263.6(14.0) Ever trained Yes23644.4(23.9) 0.02 No1930.7(22.6) Trained in the past 12 months Yes18446.8(23.6) 0.0002 No7134.3(23.1) Gender Male4735.6(25.3) 0.02 Female20544.9(23.4) Missing359(33) Cadre Doctors1439.9(18.1) 0.02 Nurses17347.1 (22.8) Nursing assistants4746.0 (20.6) Pharmacists96.8(11.9) Laboratory technician5N/A Missing716.5(22.2) Nursing cadresDegree nurses5344.2(22.2)0.26 Diploma and Midwifery9947.7(22.9) Diploma nurses1837.6(27.4) Certificate nurses4546.9(17.8) Missing4030.2(29.2)

16. Results (8): Nurses’ self-confidence to perform routine adult clinical examination % with % routinely undertaking the exam ADULT EXAM Low Confidence Moderate Confidence High Confidence Vital Signs -49620 General -237729 Skin 131689 Head, Neck, Mouth 233658 Breasts 433636 Extremities 531643 Abdomen 840527 Chest, Lungs 1552337 Cardiovascular 2847264 Neurological System 36451913

17. Conclusions Most health workers in Swaziland were exposed to HIV/AIDS in-service trainings in the past year. Receiving HIV/AIDS in-service training was associated with higher HCW knowledge of HIV/AIDS and self-efficacy to provide HIV care. Clinical mentorship is not uniformly provided following in-service trainings. Staffing shortages, shortage of equipment and supplies negatively affect HCWs ability to provider quality HIV services.

18. Recommendations A national HIV in-service training plan needs to be developed annually so that all cadres and health care workers are targeted for training. – In-service training coordinators have already been trained – Swaziland Nursing Council is working on a continuing nursing education system Continuous mentorship should be provided following training to ensure practical competencies are gained through practical implementation of theoretical information gained during training. – A technical working group to develop the framework and National Mentorship Curriculum has been formed

19. Acknowledgements University of Swaziland, Faculty of health sciences Ministry of Health, Swaziland ICAP, Columbia university, Mailman school of public health Funding partners: PEPFAR/CDC

20. Siyabonga