Human Capacity Development in Cote d’Ivoire: A Collaboration for Pre-Service Training in HIV, TB and Malaria between

the Elizabeth Glaser Pediatric AIDS Foundation and the University of Abidjan

• Presenter: Dr Tanoh Anthony

• Collaborators: Dr Joseph Essombo, Alexandre Guebo, Dr Attiah Joseph, Jocelin Koffi

Background

• EGPAF is the largest PEPFAR implementing partner in Cote d’Ivoire with 65% of all patients on ARVs (25,384) as of December 31, 2007

• 77 sites in 9 health regions out of 19 (31 health districts total) and at all levels of the health care system

• The implementation model is flexible and there are partnerships with numerous institutions (public, private, faith-based, NGO)

• To obtain the program objectives, the program trains more than 1,000 health care workers on topics related to care and treatment (VCT, PMTCT, ART, supply chain management and monitoring and evaluation) through in-service training

Rationale - 1

• All trainings are given to health care workers already providing services, but that had not been trained in HIV

• Trainings are expensive and there is no guarantee that the individual will implement HIV care and treatment activities once trained

• Continuous absences of health care workers for off site trainings disrupts health services

Rationale - 2• Medical schools historically did not include HIV

care in training

• Current approach of in-service training responds to the immediate need to offer services, but does not ensure long term sustainability of service provision

• For all of these reasons, EGPAF signed an agreement with the Medical School and the School of Social Work to develop a pre-service training program for doctors and social workers

Objectives

• General : Assist students in the final year of training to obtain a practicum in HIV, TB and malaria

• Specifics :– Acquire theoretical knowledge of the HIV, TB and malaria– Give students an appreciation of the impact of HIV/AIDS

on the health system– Participate in clinical activities to manage HIV, TB and

malaria– Train students in good clinical practices based on

national guidelines– Enhance vocational training

Implementation - 1

• First Step: Theoretical Training (15 days)

– Epidemiologic data– Physio-pathology– Care and treatment of HIV patients– National and international guidelines

• Second Step: Immersion in clinical services at university hospital setting (40 days)

– Participate in HIV, TB and malaria clinical activities in university hospital setting

Implementation - 2

• Third Step: Training in peripheral center under the supervision of a medical professor (6 months)

– Practical on-site training at a site supported by the Foundation, with participation in all activities, under supervision of medical professor

• Fourth Step: Presentation of thesis on one of the three diseases

– Based on experience at site

Successes to Date• 19 student doctors and 50 student social workers received

theoretical training

• 19 student doctors and 50 student social workers are currently in practical placements at Foundation-supported sites

• 2 supervision visits conducted by professors

• 14/19 (73%) theses are under development and will be presented in the coming months

• A final evaluation is planned by the University

Lessons Learned• The students and faculty are enthusiastic about the program.

Initially 15 medical students were anticipated, but program accommodated 19.

• High demand for program - students and faculty have requested that the program become permanent.

• The health facilities find the program a pertinent solution to human resource shortages. They benefit from the enthusiasm of young doctors and health care workers

• Students will have a better understanding of the burden of HIV and other diseases on the health care system

• Some students envision a career in HIV care and treatment

Recommendations• Extend the program to pharmacists and other

cadres of health professionals

• Progressively integrate HIV guidelines into pre-service curricula

• Document the experience

• Propose the program as a best practice to the Ministry of Health