The effectiveness of a comprehensive four-week course in HIV medicine for postgraduate doctors at University of Nigeria

: 2.037_HRW Evaluation of a visual aid toolkit for water, sanitation, and hygiene education in the Bateyes of La Romana, Dominican

Project Purpose: By promoting peer-to-peer learning, the Community Health Club (CHC) participatory health education model empowers vulnerable communities to increase health literacy and stimulate behavior change. The CHC model uses a set of drawings depicting day-to-day activities related to water, sanitation and hygiene (WASH) to spur discussions around health behaviors. In order for the visual aids to be effective, they must reflect local contexts, customs, and practices. As such, we tested preexisting drawings from an earlier program in Western Dominican Republic for clarity and relevance to sugarcane production communities (bateyes) surrounding La Romana, Dominican Republic.
Methods: We selected 147 drawings from the preexisting WASH toolkit for testing. Over four days, a convenience sample of 112 respondents was taken from 8 communities identified by our in-country partner. Five teams of two medical students and a Spanish/Creole translator showed each respondent 10 drawings and asked a series of questions about each drawing. Qualitative analyses of the interview data were conducted to assess respondents' ability to understand the drawings. Population subsets were evaluated for associations between specific demographics and visual literacy.
Outcomes & Evaluation: Respondents included 88 women and 24 men ranging from 18 to 88 years of age with varying levels of education and areas of employment. Of the 112 respondents, only 7.1% of respondents could interpret actions or connotations for all 10 images they were shown. Younger and more educated respondents tended to more accurately observe and interpret images. 60 of the 147 drawings were identified for revision or exclusion from the tool kit, as fifty percent or more of the respondents were found to consistently misinterpret these images.
Going Forward: Survey results and feedback will guide visual aid revisions for greater cultural applicability and implementation in future CHCs. The interview data also suggests associations between age, education, and pictorial literacy. Future research projects should be conducted to support these associations. Finally, this study supports the foundation of CHCs using image-based educational models within La Romana bateyes. development meetings were held with university faculty, UMB, and CCCRN. The training capacity of facility and faculty were developed based on a needs assessment. UNN faculty and UMB/ CCCRN faculty taught the course jointly. Evaluation methods including pre/post tests, OSCE's, evaluation forms, and logbooks were jointly developed. Course alumni were followed up at 6 and 18 months using online surveys and telephone interviews to assess how useful the course was to them at their current workplaces.
Outcome and Evaluation: The first course was piloted in 2013 with 30 postgraduate doctors and MPH students. The mean OSCE score was 51% and the mean post-test score was 75% with an improvement of 22% from the pre-test; a follow-up exam six months later showed a mean score of 74%. In regression analysis, pretest score was strongly associated with post-test score (0.56, (p < 0.001), and moderately associated with OSCE (0.28, p ¼ 0.04). Online surveys revealed trainees continued to use knowledge and skills gained from the course .The course was highly rated on immediate and follow up evaluations.
Going Forward: Practicum-based curricula offer a practical way to teach evidence-based medicine with long-lasting retention of skills and knowledge. Further efforts and funding needed to sustain and improve this innovative approach to strengthening HIV pre-service medical education.
Funding: PEPFAR. Method: Forty primary health centers (PHC) were prospectively randomized 1:1 to intervention group (IG) or control group (CG). Data on HCT among pregnant women was collected from the PHC over a six months period. Following HCT training, TBAs surrounding PHC randomized to IG initiated HCT for their patients whereas HCT training was not provided to TBAs surrounding PHC in CG. The primary outcomes measure was the proportion of pregnant women who received HCT in the two groups over a six months period using antenatal clinic registries.
Going Forward: Significant increases in HCT can be achieved by engaging and training TBA especially in communities where a majority of prenatal care and deliveries occur outside of the formal healthcare facilities.
Funding: PEPFAR. Structure/Method: We identified 82 PMVs (2 each) from 41 communities in North-central Nigeria. These PMVs were trained on the identification and assessment of individuals with suspected TB using the modified Community TB Care module. A TB referral and assessment protocol was developed with the community and implemented from July 2014 through August 2015. Over the study period, a purposeful target was set to screen 5.7% of the target population (94,792).
Outcome & Evaluation: During the 12 months study period, 81,016 (85% of target) PMV patrons were screened for TB and 10,041 individuals with suspected TB were identified. A total of 9,099 AFB smear microscopy was completed, 71 sputum positive cases were identified and 68 commenced on treatment.
Going Forward: PMVs can be trained and used as part of the healthcare infrastructure to provide community based interventions such as TB screening and referral especially in resourcelimited countries like Nigeria with a dearth of trained health care provider.
Funding: WHO STOP TB Partnership.