Research

Training needs assessment for clinicians at antiretroviral therapy clinics: evidence from a national survey in Uganda

Ibrahim M Lutalo^1* , Gisela Schneider^2* , Marcia R Weaver^3* , Jessica H Oyugi⁴ , Lydia Mpanga Sebuyira¹ , Richard Kaye⁵ , Frank Lule⁶ , Elizabeth Namagala⁷ , W Michael Scheld⁸ , Keith PWJ McAdam^1,9,10 and Merle A Sande^{11^}

¹  Infectious Diseases Institute, Makerere University, Kampala, Uganda

²  DIFAEM – German Institute of Medical Mission, Tuebingen, Germany

³  Department of Global Health and International Training and Education Centre on HIV (I-TECH), University of Washington, Seattle WA, USA

⁴  Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Lilongwe, Malawi

⁵  African Palliative Care Association, Kampala, Uganda

⁶  Regional Office for Africa, World Health Organization, Brazzaville, Congo

⁷  Ministry of Health, Kampala, Uganda

⁸  Department of Internal Medicine, University of Virginia, Charlottesville VA, USA

⁹  Department of Clinical Tropical Medicine, London School of Hygiene and Tropical Medicine, London, UK

¹⁰  Pratt Medical Group, Tufts-New England Medical Center, Boston MA, USA

¹¹  Formerly of the Department of Medicine, University of Washington, Seattle, WA, and the Accordia Global Health Foundation, Arlington, VA, USA

author email corresponding author email^Deceased * Contributed equally

Human Resources for Health 2009, 7:76doi:10.1186/1478-4491-7-76

Published:	23 August 2009

Abstract

Background

To increase access to antiretroviral therapy in resource-limited settings, several experts recommend "task shifting" from doctors to clinical officers, nurses and midwives. This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy training needs among clinicians to whom tasks have shifted.

Methods

The Infectious Diseases Institute, in collaboration with the Ugandan Ministry of Health, surveyed health professionals and heads of antiretroviral therapy clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed, previous human immunodeficiency virus training, and self-assessment of knowledge of human immunodeficiency virus and antiretroviral therapy. Heads of the antiretroviral therapy clinics reported on clinic characteristics.

Results

Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) who worked in accredited antiretroviral therapy clinics reported that they prescribed this therapy (p < 0.001). Sixty-four percent of the people who prescribed antiretroviral therapy were not doctors. Among professionals who prescribed it, 76% of doctors, 62% of clinical officers, 62% of nurses and 51% of midwives were trained in initiating patients on antiretroviral therapy (p = 0.457); 73%, 46%, 50% and 23%, respectively, were trained in monitoring patients on the therapy (p = 0.017). Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good (p = 0.001).

Conclusion

Training initiatives should be an integral part of the support for task shifting and ensure that antiretroviral therapy is used correctly and that toxicity or drug resistance do not reverse accomplishments to date.