Transcript Training Methods

IMAI Training
Training Methods
No PowerPoint; no specialists
 Skills-based learning

Patient monitoring forms
 Patient education materials

Exercises and drills
 Expert Patient-trainers

Active training with cases,
interaction, clinical team building
What is the Expert Patient-Trainer?




A person living with HIV/AIDS (PLHA) and/or on
ART
Trained to role-play a patient in specific HIV
cases that were often (but not necessarily)
similar to their own life experience
Trained to assess the important skills that the
health worker should acquire from the clinical or
aid training courses
Trained to give appropriate feedback to the
health worker after the role-play, which allowed
the health worker to practice these skills
Role of the Expert Patient-Trainer
in IMAI



Worked in the skill stations as patients in a clinical
encounter related to Chronic HIV Care/ART where the
health workers would interact with them through their
cases and practice important skills.
Simulated role-plays with the course facilitators in the
classroom, so health workers could learn training
material and important clinical health worker - patient
interactions through the demonstrations
Shared personal experiences with HIV/ART with the
course participants pertaining to topics discussed within
the classroom environment
CASE 8

You are a 47 year-old man, who tested
HIV+ two years ago. You are a very heavy
drinker and do not go to the clinic
regularly. You come to the clinic today
because you want ART. This is your first
visit.
IF ASKED:





You are not taking any medications
Clinical Review: You do have a pain in your
mouth when eating. You do not have any
problems swallowing. You also have an itching
rash around your nose and eyes. You do have a
poor appetite and problems with sleeping.
You do not practice safer sex
You do not work but are able to do some things
at home when you are motivated
You feel very lonely. Your wife and baby boy
died last year, and you are living with friends.
________CUT HERE________

Physical Exam: Current weight 65kg (last
visit 8mo ago-77kg); Patient has white
patches in his mouth which when checked
can be scraped off and 1-2 mouth ulcers
which are not deep or extensive. He also
has a scaly rash around his nose and
eyes.
Case #8
Observer:
Health Worker:
GENERAL
Respectful
Simple words
Listened to patient
Made sure patient understood
ASSESS
Asked why came to the clinic?
Reviewed symptoms on H10
Look: physical exam
ADVISE
Talked about prevention
On correct treatment
On adherence
AGREE
On treatment plan
Involved patient
GOOD
OK
NOT
GOOD
NOT
DONE
ASSIST
Provided treatment options
Helped solve treatment problems
Provided psychological support
ARRANGE
Follow-up date(s)
Support Group
Referral/Support outside clinic
Provided treatment plan
Completed patient card
CASE-SPECIFIC QUESTIONS
Classified patient in clinical stage 3?
Patient’s functional status—Ambulatory
Patient TB Status—No Signs
Gave treatment for thrush (painful white sore in
mouth) and seborrhoea?
Discussed about ART and drinking problem
Advised on how to address the drinking
problem?
Referred to TASO for drinking problem?
Linked to community support organization?
Discussed Septrin?
CASE 33

You are a married woman. You have
tested HIV+ 2 months ago. You are on
treatment for TB of the lungs, but
otherwise are feeling quite healthy. Your
husband is a policeman, but he has not
been working for several months now,
because he is too sick. You think he has
HIV as well.
If asked
You are managing the TB drugs well.
 Two days ago, you told him about your
positive test. He became very angry and
beat you. He does not want you to come
to the clinic anymore. So you have to
invent a story and come secretly.

Case specific questions








Checked adherence to TB drugs?
Discussed benefits and difficulties of disclosure?
Discussed safety?
Offered counselling for partner?
Advised on the importance of attending clinic
regularly?
Discussed peer support?
Discussed community support?
Arranged follow up appointment next week?
EPT Challenges
Enthusiasm
 Intimidation
 Stigma and discrimination
 Illness

Training plan—efficient, rapid, capable of
supporting continuous training
Group work:
10-12 participants
2 facilitators
Expert patients
Skill stations
Card
sorts
Video cases,
exercises
(group)
Inpatient clinical practice
Outpatient clinical practice
for Acute Care
Day One
Monday
Schedule
8:30 – 10:30
Welcoming and opening
Introduction of participants
Course objectives and introduction to
training materials
Administrative arrangements
The situation of the HIV/AIDS
epidemic in Ethiopia (Assegid)
7. Prophylaxis therapy
8. Adherence preparation
10:30 –
11:00
11:00 –
12:30
Pre-test
First level session
1. Introduction to good chronic care;
sequence of care
2. Introduction to HIV/AIDS and OIs;
WHO Clinical staging
3. HIV and antiretroviral drugs
9. First line ARV regimen in
uncomplicated cases
10. Four first-line ARV
regimens
Friday
3. OI's of the
neurological system
4. OI's of the GI
system (persistent
diarrhea)
OFF
16. Monitoring patients on
ART (30)
Post-test
5. OI's of the mouth
and throat (30)
6. OI's of the skin (30)
OFF
7. ARV drugs
8. Excluding OI's
OFF
Skill stations
OFF
Lunch break
4. Adherence and drug resistance
5. Assess and provide clinical care
11. Managing side effects and
new developments
12. ART initiation and followup of patients
13. Integration of prevention
and treatment
3:30 – 4:00
4:00 – 5:30
14. Special consideration
during pregnancy and postpartum period
15. Special considerations in
children
Day Four
Thursday
Tea/coffee Break
12:30 – 1:30
1:30 – 3:30
Day Three
Wednesday
Day Two
Tuesday
Skill stations
Tea/coffee break
6. Introduction to Patient monitoring:
HIV care/ART card
Home
Facilitators’ Meeting
Skill stations
Second level session
1. HIV and TB
2. OI's of the respiratory
system
Week 1: Chronic HIV Care with
ART
Monday
Tuesday
Wed
Thurs
Friday
Basic ART Clinical Course
Nurses, Midwives, Medical Assistants, Pharm techs
Basic ART Clinical Course
Clinical officers, Health officers
ART Aid Course
PLHA, other lay providers, Nursing or Health Assistants,
or Nurses
Basic ART Clinical
Course
Medical Officers/Doctors
Second Level ART
Clinical Course
Medical Officers/Doctors
Saturday
Clinical Team
Building
Patient
Monitoring
Week 2: Acute Care and Options
Mon
Tues
Wed
Short Acute Care/OI Course
Nurses, midwives
Short Acute Care/OI Course
Clinical Officers, Health Officers
Second level OI Course
Medical Officers/doctors
 PMTCT: Infant feeding counselling
Thurs
Fri
Optional:
 Acute Care: STI
 TB care with TB-HIV co-management
 Patient monitoring: registers, reports
 PMTCT: antenatal and post-partum
care, continuity of care and records
 IMCI-HIV short course
 Provider-initiated testing and
counselling
 PMTCT: reproductive choice, FP
Continuous Training Schedule
Week 1
Group 1
Group 2
Group 3
Group 4
Week 1
Week 2
Week 2