KEY PERSONNEL:  Dr. Mosa Moshabela (PI), Dr. Nisha Nadesan-Reddy (Project Director, Training Coordinator), Prem Ramnarain (Finance Administrator), Sandile Nzuza (eLearning Coordinator)

PROJECT TITLE: Strengthening the Workforce to Improve Treatment and Care for HIV (SWITCH)

PROJECT YEAR 1 RECAP: In the first year of SWITCH, eight training workshops were held for mixed cadres of 363 health care professionals, both pre-service and working in health care facilities, led by 40 trained facilitators.  The focus was placed on conducting HIV training using patient-centered, interprofessional education and introducing quality improvement at partnering institutions. Mentoring and administrative support was also provided to Mpumalanga College of Nursing in Mpumalanga Province, reaching additional learners. 

PROJECT YEAR 2 SUMMARY: SWITCH expanded its trainings and related activities in its second year, with 500 learners trained (396 preservice, 104 working health professionals) and 19 facilitators prepared to provide online learning to mixed interprofessional groups using a variety of digital technologies.  SWITCH developed an additional 3 modules on continuous quality improvement, interprofessional collaborative practice, and introducing telehealth principles and practices, delivered to learners in addition to core STRIPE HIV modules.  In partnership with the KwaZulu-Natal Department of Health, 7 additional modules were also developed and piloted reaching community health workers on health promotion, behavior change communication and counseling along with topics relevant to care and prevention of HIV and locally relevant common health issues.  The impact of COVID in KwaZulu-Natal was severe, and a toolkit and module on mental health and wellbeing were also developed and shared.

Other new initiatives undertaken by SWITCH included expanding the use of continuous quality improvement (CQI) tools as part of ongoing practice at sites where STRIPE learners were located.  The VULA mobile app, which requires far less data than others, was adapted and piloted to provide ongoing mentoring to groups of learners at a site, who were supported to design and implement a mini-QI project for improvement.  A new community of practice was also established to address the gap in curriculum on the care of key populations.  A curriculum mapping was done scoping out current relevant instruction, and a workshop with academics and the KZN Department of Health, along with representatives of the LGBTQI communities, to strengthen the inclusion of content in curriculum.

MAIN ACCOMPLISHMENTS

• Successful transition from in-person to eLearning methodologies for both facilitators, pre-service and working health professionals, with 500 trained
• 3 new modules developed to strengthen practices of CQI, IPE&C, telehealth
• Strong partnership with KZN Dept of Health to develop and provide 7 additional new modules strengthening the links between community-and facility-based prevention and care as part of the KZN Health Promotion strategy, now available on the data-free DoH Knowledge Hub learning management system
• Establishment of mentoring support activities for CQI to local STRIPE learners at their sites of practice

CHALLENGES AND SOLUTIONS

• The experience of learning online was challenging for many students, and difficult to hold in-depth discussions ensuring student participation. More successful adjustments were to request all students keep their cameras on and not record the sessions as learners were not comfortable with this. Smaller group discussions led by students with facilitators only facilitating was also more successful
• Use of virtual platforms was initially difficult for facilitators and students. Dry runs were instituted for facilitators. Students required more time to register, and it was recommended to look into more user-friendly functions to reduce barriers to uptake.
• Challenges in adapting to asynchronous learning was particularly evident for those working in busy facilities, both due to work pressures and never having engaged in remote learning. It is unclear if this is the optimal strategy to reach busy health care professionals in KZN in the future.

TRAINING PARTNERS

• Sefako Makghato Health Sciences University (SMU)
• KwaZulu-Natal Department of Health

PARTICIPATING CINICAL SITES

Post-graduate learners were recruited from the following hospitals:

• General Justice Gizenga Mpanza Regional Hospital, iLembe district
• Nkandla Hospital, King Cetshwayo District*
• Andrews Hospital, Ugu District*
• Madadeni Hospital, Amajuba District
• Vryheid Hospital, Zululand District
• Mseleni Hospital, Umkhanyakude District
• Bethesda Hospital, Umkhanyakude District

 

* = PEPFAR-supported

IMPLEMENTATION

• Training Cohorts: 10 (6 pre-service, 4 post-graduate)
• 19 new Facilitators trained

Profession		Years of experience		Gender		Teaching experience
Medical	4	0-5 years	16	Male	4	HIV educator	5
Nursing/Midwifery	6	6-10 years	3	Female	15	Non-HIV educator	14
Pharmacy	7				0
Other	1

 

• 500 new learners trained

	Medical	Nursing/Midwifery	Pharmacy	Other	TOTAL
Preservice	70	171	131	22	394
Postgraduate < 12 months	0	0	0	0	0
Postgraduate > 12 months	8	60	5	33	106
TOTAL	78	231	136	55	500

Gender
Male	150
Female	349
Unknown	1

INNOVATING HIV TRAINING DURING COVID-19:

• The many restrictions brought about in response to COVID-19 accelerated the transition from in-person to use of online and digital eLearning technologies. All trainings carried out for pre-service and working health professionals utilized eLearning platforms.
• The use of VULA and Cell-Ed were both explored as useful tools to employ, in addition to Blackboard and the LMS. An adaptation of the mobile VULA app was undertaken to use as a working tool for ongoing mentorship of clinical staff, often based at distant district and regional hospitals, who received STRIPE trainings, paired with support from the QI project team at UKZN.  

BROADER IMPACT:

• The SWITCH program has benefitted from a strong and ongoing engagement with the KZN Department of Health. Both the research and innovations taken forward by UKZN under STRIPE is positioned to introduce the innovations principles and skills of STRIPE HIV to the broader UKZN community. New modules developed as part of the collaboration on UKZN Health Promotion are now available on the data-free platform, Knowledge Hub.
• The innovation of the VULA-app supported CQI mentorship initiative holds promise for ongoing improvements in clinical practice and the delivery of high quality team-based HIV care.
• New modules and materials developed to introduce learners to the principles and practices of utilizing telehealth will continue to foster new thinking and innovations on how this could be used to expand access. All trainings included a one-hour introduction to telehealth as part of their curriculum.
• The SWITCH Program has been shared with the South African PEPFAR team and the Consul-General in Durban.

IMPACT VIGNETTES

Learners

• “I am grateful to be part of this training workshop, I dearly hope this programme becomes integrated into different courses as we lack intensive HIV education”
• “This information that I have acquired will be very helpful when I start practicing. This workshop has given me the opportunity to see how other disciplines function and learn from them.”
• “I am enjoying this workshop, it is much educational and feels great to be with other students from health sciences, it brings the picture of a multidisciplinary team we always talk about in class. Now I feel like part of a multidisciplinary team.”
• “The STRIPE workshop gave me confidence and reassurance about the gray area that I had about patients living with HIV on how to approach them and counsel them which is the emotional part.”
• “I learned more about the significance of PMTCT, which is the prevention of mother-to-child transmission of HIV and other diseases. This empowered me to come prepared for my allocation at the paediatric outpatient clinic, which sees many children that suffer from malnourishment, HIV and tuberculosis.”
• “ The SWITCH course came when I was seeking more information about HIV/AIDS, as I was currently placed at the Prince Mysheni Memorial Hospital medical ward. I observed a large influx of HIV-positive patients, most of whom are defaulters of ART treatment or not taking ART at all. So this course aided me in advancing my knowledge about the disease and barriers that cause patients to default on ART or not take treatment at all.”
• “It has also made me go back to my workplace and reflect on my own practice which has improved my interprofessional relationships which has actually been quite great.”

Facilitators

• “ The notion of flattening the hierarchy in the health sciences training and collaborative practice through interprofessional education, I saw it live. Whereby amongst the facilitators there was so much respect and collegial spirit in such a way students could not really tell who is who, but just saw equally capable facilitators in delivering the content. Also, the fact that the facilitators for each module were paired out from different disciplines was interesting so that each can draw from each other’s experiences, and engage in meaningful discussion and form partnership on how to best facilitate the modules.”
• “The workshop to go through the materials with us and offer tips on facilitation to us really did assist with the quality of the facilitation.”
• “Think about how to actually get people to interact but I must say it has not only has it been fun to facilitate but it also brought some personal growth as well for me especially in terms of getting people to work together, to interact together.”