Lesotho Clinical Mentorship Program

1. Lesotho Clinical Mentorship Program IAS Satelitte Meeting “Clinical Mentoring and Training of HIV/AIDS Healthcare Professionals in Resource Limited Settings---Development of New Models” Tuesday, August 15, 2006 Dr. Limpho Maile STI/HIV & AIDS Directorate Government of Lesotho Denise Thomas Clinical Mentorship Coordinator, CHAI Lesotho

2. Lesotho’s WHO IMAI Status

3. HIV/AIDS Educational Program CHAI/MOHSW’s primary objective for clinical mentoring in Lesotho is consistent with the World Health Organization’s approach to HIV care and Antiretroviral Therapy scale up. Programs used in Lesotho: • Professional Foundation- weekend course on HIV/AIDS • Advanced HIV/AIDS Training- five(5) days. • IMAI: Integrated Management of Adult Illnesses: fourteen days.

4. Lesotho Treatment Goals • Highest adult prevalence at 23.4% • Antiretroviral Treatment: started May 2004; ~11,000 on treatment at end April 2006 (against target of 28,000 by end of 2005 year) • Public/NGO/Private Sectors: MOHSW negotiated agreement with CHAL (mission hospital network) and private sector to subsidize ART and accelerate national scale up to increase HR resources • Know Your Status campaign: to offer an HIV test to everyone over 12 yrs by end 2007 NEED FOR CLINICAL MENTORSHIP

5. Program Description • Lesotho currently has national on-site mentoring program coordinated by Clinton HIV/AIDS Initiative (CHAI) with the Ministry of Health and Social Welfare (MOHSW) utilizing mentors recruited, trained and screened by the International Center of Equal Healthcare ICEHA. • The program was started in 2005. • Mentors are placed at ART clinics for a period of six to twelve weeks to work with local healthcare staff. • Follow-up visits and quality control checks conducted by a locally-based mentorship program manager at bimonthly intervals. • Sites are evaluated after initial 6-12 weeks mentoring & additional clinical mentorship provided if deemed necessary by the local healthcare providers, hospital administration and Ministry of Health & Social Welfare (MOHSW).

6. Phase I Phase II Phase III 2005 • Pilot Program 2006 • Health Centers • Hospital-based clinics & ongoing mentoring • Basotho mentors & partnerships 2007 • Self-sustaining mentorship model Lesotho Clinical Mentorship Program

7. Clinical Mentors Clinical Mentors in Lesotho are expatriate health care professionals: • Registered Nurses • Nurse Practitioners • Medical Doctors • Physician Assistants • Pharmacists with a minimum of three (3) years HIV/AIDS Treatment experience.

8. Mentor Readiness Prior to initiating their assignment, mentors are taken through an orientation to familiarise them with the provision of healthcare in Lesotho. Areas covered include: • Public health approaches to HIV/AIDS including the family-centred model for HIV care and treatment. • HIV epidemiology in Lesotho • The IMAI curriculum adopted for Lesotho • Practical procedures manual for ART clinics in Lesotho • Guidelines on management of HIV (including opportunistic infections) • National ARV Guidelines • The healthcare system in Lesotho, including different structures and procedures that are commonly followed.

9. Attributes of a Mentor • Interpersonal skills: compassion and respect for trainees, other clinic staff and patients. • Communication: non-judgemental feedback and active listening. • Professional integrity • Time and resource management skills • Flexibility and an understanding of the cultural context within which they function. • Patience While mentors provide the clinical expertise on HIV/AIDS management, it should be understood that they will have much to learn from the local trainees themselves.

10. Activities of the mentors Training of local multi-disciplinary teams responsible for the management of patients with HIV/AIDS. Training methods include: • Bedside training for physicians on infectious diseases and HIV/AIDS care, including ARV therapy. • Weekly conferences on topics related to infectious diseases and HIV/AIDS care (according to a country-specific HIV curriculum; topics will be chosen based upon knowledge gaps as they surface during day-to-day patient management and bedside teaching sessions). • Lecturing • Working alongside local physicians and treatment teams, in order to teach and share best practices in HIV/AIDS. • To serve as a referral/consultative resource for complicated HIV/AIDS cases, and to maintain a presence at the site. • To assist in the initial and ongoing teaching and training of doctors and nurses in HIV/AIDS, as well as related diseases.

11. 23 mentors 16 sites 5 sites have received continuing mentoring Site Placements ( Christian Health Association of Lesotho (CHAL) & Government of Lesotho (GOL) clinics)

12. Clinical Mentorship Coordinator Roles & Responsibilities • Communicating with mentors on progress & challenges on weekly basis; • Regularly liaising with management of the hospital & ART centre/health centre to gather feedback; • Facilitating regular communication between mentors, site and hospital management, the STI/HIV/AIDS Directorate, the Clinton Foundation, and ICEHA to ensure that all partners are aware of the progress at the sites and can discuss improvements in the program design as needed. • While the preceptors are on-site, he / she will also closely work with ICEHA’s Program Coordinator for the Volunteer Network. • Ongoing monitoring and supervision of the progress of the program. Communication, at the end of each assignment, mentors and mentees provide feedback on the program through a survey and exit interview.

13. ResultsRapid acceleration of ART enrollment (e.g. aver. 3.3 patients/wk to 10.8 in 6 weeks) *M Malave and others. The Effectiveness of Clinical Mentoring for Healthcare Professionals in Cambodia. Abstract MoPe11.4C06 (poster). Program Abstracts of the 3rd IAS Conference on HIV Pathogenesis and Treatment. July 24-27, 2005. Rio de Janeiro, Brazil. **Clinton HIV/AIDS Lesotho Clinical Mentoring Program, 2006

14. Monitoring and Evaluation • Mentors prepare weekly reports, program evaluations and summary trip reports that are made available to ICEHA, CHAI & MOHSW. • Ongoing communication with the on-site program manager on a weekly basis. • Pre& Post Tests of the Mentees are collected. • MOHSW monthly reporting is evaluated for uptake of the rollout of ARVs

15. “What will we do when we have 10,000 patients?” Sustainability Newly trained local physicians and nurses with at least twelve months of clinical experience in care and treatment will be sourced as mentors at new ART sites. To avoid further depletion of needed human resources, such local “experts” cannot be taken away from their jobs for extended periods of time. Instead, they will provide support on a part-time basis. The Future … Basotho Clinical Mentors Dr. Mpholo, ART Corner, Queen II Hospital

16. References World Health Organization (2006) Capacity building: The IMAI strategy. Geneva: World Health Organization. Available: http://www.who.int/3by5/capacity/en. Accessed 21 July 2006. www.clintonfoundation.org M Malave and others. The Effectiveness of Clinical Mentoring for Healthcare Professionals in Cambodia. Abstract MoPe11.4C06 (poster). Program and Abstracts of the 3rd IAS Conference on HIV Pathogenesis and Treatment. July 24-27, 2005. Rio de Janeiro, Brazil.