Clinical mentoring: a sustainable strategy for scaling up HIV/AIDS clinical expertise in developing countries

Background

Despite the fact that we are currently 25 years into the HIV epidemic, countless areas in the developing world still lack the practical clinical expertise and clinic management systems needed to deal with the complexities of treating HIV/AIDS. Examples include health workers refusing to touch AIDS patients for fear of becoming infected, CD4 count machines sitting in a corner of the laboratory unused, and doctors taking patients off antiretroviral treatment once patients "feel better". Clinical mentoring is an important tool to address this urgent need for trained local clinic personnel.

Methods

The International Center for Equal Healthcare Access (ICEHA) runs large clinical mentoring programs worldwide, in which experienced HIV health workers provide hands-on coaching to local health workers on topics related to HIV/AIDS care and treatment. Assessments of local health providers' skills are conducted at the beginning and end of mentor assignments to determine change over time.

Clinical mentoring is a teaching method proven to rapidly transfer clinical skills and immediately improve quality of care. It is sustainable only if mentoring is provided continuously for 3–4 months in any clinic setting. ICEHA's programs work within existing national treatment guidelines and are an essential complement to didactic training programs. By working closely with the host country, ICEHA has demonstrated that the transfer of this knowledge can be accomplished efficiently, cost effectively and with sustainable impact.

Summary of results

Between September 2004 and April 2008, ICEHA provided mentoring and instruction to 1,550+ healthcare workers worldwide. Analysis of results from the clinical mentor surveys from programs implemented in 12 countries across Asia, Africa, and the South Pacific have found the most progress in local clinicians' abilities in the following areas:

• 1. Improved monitoring of antiretroviral medication adherence;

• 2. Improved management of medication side-effects and ARV regimens;

• 3. Improved recognition and treatment of opportunistic infections.

Conclusion

Clinical mentoring is an effective method to rapidly develop local expertise to provide the best HIV care possible within developing countries' available resources. Existing programs have shown that clinical mentoring as part of a national healthcare strategy has a profound and lasting impact. This impact is felt immediately on the community level and, ultimately, on a national level as the health and welfare of citizens improve.