Effective training solutions for ensuring highly competent health care workers are needed to addressthe vast need for capacity building in the context of task shifting to non physician practitioners(MLPs) of the management of HIV and related opportunistic infections. The partners in thisproposed study previously implemented a large scale evaluation of an intervention with an on sitesupport component including 1-2 hours of individual clinical mentorship monthly for nine months.That approach did not appear to achieve the expected impact on individual competencies and it ishypothesized that the clinical mentorship dosage may have been inadequate. This study will buildupon the previous work to determine the effectiveness of using prolonged hours of on-site clinicalmentorship to improve clinical competencies of clinical officers and nursing officers in prevention,care and treatment of HIV/AIDS and TB at eight rural based level IV health facilities in Uganda.Four intervention sites will be matched with four control sites. Each intervention site will receiveweek long visits every six weeks for nine months from a mentorship team composed of one clinicalofficer, a laboratory specialist and a district health nurse. The mentors will provide 8-hours offocused one to one mentorship to each of the sites' MLP during the visit, teaching core principles ofUganda's TB and HIV/AIDS guidelines and standards of care and coaching as the MLP seespatients. Key outcomes of the study which will be measured using written case scenarios andobserved clinical skills assessments at the start, end of intervention, and six months postintervention. Improved performance/practice against expected standards of care for HIV, TB andother related OIs will be monitored on continuous basis throughout the project implementationperiod using modified and computerized Ministry of Health management information data collectiontools. The results from the study will guide decision making about the dosage levels of clinicalmentorship required to make a significant impact on midlevel provider's competencies.

Public Health Relevance

Optimizing the role of mid-level providers (MLP), such as clinical officers and nursing officers, in the provision of HIV/AIDS, TB and other infectious disease prevention and care services is vital for strengthening African healthcare systems. Training MLP to perform tasks conventionally assigned to doctors can expand the total output of formal and informal health systems. This operational research seeks to determine the effect of a capacity building approach for MLP comprising longer hours of onsite clinical mentorship on their knowledge and practice;and whether this effect can be maintained at six months post intervention.

National Institute of Health (NIH)
Coordinating Office of Global Health (COGH)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZGH1-SRC (99))
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Infectious Diseases Institute
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