Transcript Etyang_Poster_IAS_FI..

Physician Supervision and Mentorship to Improve
the Capacity of Clinical Officers to
Deliver HIV Care in Kenya
1
MMed,
2
MBChB,
2
MBChB,
Anthony Etyang, MBChB,
Samah Sakr,
Maged Moussa,
Grace C. John-Stewart, MD, PhD1 and Michael H. Chung, MD, MPH1
1University
of Washington, Seattle, USA, 2Coptic 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.
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
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
• 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
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.
Lessons Learned
• In an anonymous survey, COs reported:
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
• 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
• 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
• 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