Confidence in PMTCT skills after Community Health Worker training
Tingathe is a community outreach program with a focus on improving prevention of mother-to-child transmission of HIV (PMTCT), Early Infant Diagnosis (EID), and pediatric HIV care and treatment services in Malawi. The program employs community health workers (CHWs) to increase identification of people living with HIV, assist them with access to HIV care and treatment services, and provide comprehensive, longitudinal health services for HIV-infected pregnant women, children, and exposed infants and their families.
As the program continues to expand to new sites and patient enrolment at existing sites increases, additional CHWs are recruited. In March 2014, following a rigorous interview process, three new HTC counselors and 26 CHW candidates were selected to participate in a revised, optimized CHW training covering basic HIV prevention, diagnosis and treatment, PMTCT techniques, and practical work strategies such as giving health talks, counseling and conducting home visits.
The training was conducted over twelve days using a CHW Training Toolkit consisting of a manual and participant workbook along with a step-by-step facilitator guide. The training included classroom sessions and two days of hands-on attachments at existing Tingathe sites. Classroom sections covered basic theory through lecture, group work, role-plays, practice questions and discussions. Role-plays provided opportunities for CHWs to practice scenarios such as how to teach an HIV-infected mother to administer nevirapine syrup to her infant (an anti-retroviral drug given to HIV-exposed infants for the first 6 weeks of life) to help prevent transmission of HIV.
During site attachments, participants were encouraged to practice skills acquired during didactic sessions, including hands-on experience shadowing existing CHWs on home visits, giving adherence counseling, completing patient monitoring forms and conducting active case finding. Ongoing evaluations throughout training allowed for real-time optimization and editing of the new curriculum.
James, a Tingathe counselor at Kasungu District Hospital, attended the training in March 2014 as a new hire. Despite his previous work experience, he found the training very valuable, reporting “I got trained as a counselor in 2008 but frankly speaking I was ignorant about pediatric HIV/AIDS. Before the training I couldn't refer and provide appropriate support to exposed children, pregnant and lactating mothers because I never had PMTCT knowledge.”
The curriculum was effective, with 100% of the participants receiving a passing grade (>85%) on the post-training certification test. Students received an average score of 96% on the post-test, an improvement from an average score of 65.8% on the pre-test.
Following this training, participants like James are empowered to use their skills and knowledge to improve pediatric HIV and PMTCT care in the communities around the health facilities to which they report. James reports “I am now able to spot signs and symptoms of HIV/AIDS in children and I am able to encourage testing. I feel like I am now a complete asset as far as the fight against HIV/AIDS is concerned.”