1. Physician Supervision and Mentorship to Improve the Capacity of Clinical Officers to Deliver HIV Care in Kenya Anthony Etyang, MBChB, MMed, 1 Samah Sakr, MBChB, 2 Maged Moussa, MBChB, 2 Grace C. John-Stewart, MD, PhD 1 and Michael H. Chung, MD, MPH 1 1 University of Washington, Seattle, USA, 2 Coptic Hospital, Nairobi, Kenya Issue The majority of 1.4 million HIV-infected Kenyans receive their care from public institutions HIV patients are seen primarily by Clinical Officers (COs) who are mid-level health workers with basic 3 year diplomas in Clinical Medicine COs may require supplemental on-site supervision and training to handle complicated HIV cases We set out to describe a physician-led mentorship program of Clinical Officers in an HIV treatment clinic in Kenya. Lessons Learned In an anonymous survey, COs reported: An improvement in their clinical skills leading to better patient care Physical presence of physician provided immediate on-the-spot support for challenging cases that was much better than telephone consultation Valuing open-ended nature of Q&A sessions which allowed free discussion and learning based on practical real-life cases Next Steps On-site physical clinical supervision and mentorship improves the clinical skills and knowledge of COs providing HIV care through continuous support Providing direct access for COs to physicians trained in HIV medicine and mentorship should be considered a component of HIV capacity-building, particularly as antiretroviral resistance and complicated treatment cases increase Setting Coptic Hope Center for Infectious Disease is an HIV clinic based in Nairobi, Kenya that provides free comprehensive HIV care The Hope Center has enrolled more than 9,000 patients, and put 6,000 on antiretroviral medications since 2004 At the Hope Center, 8 COs each see approximately 30 patients a day Description A physician (MBChB, MMed) was hired to work as a full-time, physically present mentor to teach and train the COs at the Hope Center. Clinical Supervision Four half-days a week, the physician saw patients side-by-side with individual COs COs learned by observing the physician and emulating his physical examination skills and techniques in acquiring medical history Physician taught COs by reviewing differential diagnoses, suggesting treatment options, and discussing complicated cases Case Conferences One hour case conferences were held three times a month CO prepared presentation of challenging cases he/she had seen Preparation with assistance from the physician included careful review of the medical history, physical examination findings, differential diagnoses, laboratory investigations, and treatment Cases were presented to fellow COs and facilitated by the physician to reinforce importance of differential diagnoses, appropriate use of laboratory tests, and careful patient management and follow-up Description (continued) Q & A Sessions One hour Question & Answer (Q&A) sessions were held twice a month Open forum where COs could field any question or concern to the physician Allowed physician to learn of and correct any misconceptions, myths, or knowledge gaps expressed by the COs or their patients Lectures One hour HIV lectures were presented by physician twice a month Physician gave didactic lectures that covered topics that required more in-depth attention than permitted by Q&A session Lectures given with PowerPoint slides, visual aids, and journal references Topics included management of lactic acidosis, antiretroviral resistance and treatment failure, and prevention of mother-to-child transmission