Effective training solutions for ensuring highly competent health care workers are needed to address the 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 this proposed study previously implemented a large scale evaluation of an intervention with an on site support 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 is hypothesized that the clinical mentorship dosage may have been inadequate. This study will build upon the previous work to determine the effectiveness of using prolonged hours of on-site clinical mentorship 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 receive week long visits every six weeks for nine months from a mentorship team composed of one clinical officer, a laboratory specialist and a district health nurse. The mentors will provide 8-hours of focused one to one mentorship to each of the sites'MLP during the visit, teaching core principles of Uganda's TB and HIV/AIDS guidelines and standards of care and coaching as the MLP sees patients. Key outcomes of the study which will be measured using written case scenarios and observed clinical skills assessments at the start, end of intervention, and six months post intervention. Improved performance/practice against expected standards of care for HIV, TB and other related OIs will be monitored on continuous basis throughout the project implementation period using modified and computerized Ministry of Health management information data collection tools. The results from the study will guide decision making about the dosage levels of clinical mentorship required to make a significant impact on midlevel provider's competencies.
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.