clinical mentorship program: pre-departure readiness for ... - clinical... · clinical mentorship...

CLINICAL MENTORSHIP CLINICAL MENTORSHIP Program: PreProgram: Pre--departure departure Readiness for VolunteersReadiness for Volunteers

Canadian Nurses In AIDS Care Conference, Canadian Nurses In AIDS Care Conference, Vancouver, BCVancouver, BCDenise Thomas, Clinton FoundationDenise Thomas, Clinton FoundationClinical Mentorship Program, Lesotho, AFRICAClinical Mentorship Program, Lesotho, AFRICA

Clinton FoundationClinton Foundation

OverviewOverview

• Define the need for volunteers abroad• Highlight the Clinton HIV/AIDS Clinical

Mentorship Program in Resource Poor Settings• Define clinical mentorship in Lesotho• Overview a day in the life• Pre-departure readiness: a practical overview• Resources


Overview: Clinton FoundationOverview: Clinton Foundation’’s s HIV/AIDS Initiative HIV/AIDS Initiative


National HIV/AIDS Curricula National HIV/AIDS Curricula


IMAI: Integrated Management of IMAI: Integrated Management of Adolescent and Adult IllnessesAdolescent and Adult Illnesses

• The IMAI tools consist of simplified and operationalized guidelines, training materials, and communication and patient education aids. They address clinical care, counselling, patient monitoring, anddistrict ART coordination.

• The IMAI evidence-based guidelines have been simplified and operationalized, based on WHO's "Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach". The IMAI guidelines are based on a syndromic approach but also incorporate results from a limited number of lab tests. They have been prepared for use in health services in low resource countries, covering the continuum of HIV care/ART in the community, first-level health facilities, and the district hospital.

• Short, efficient training courses teach the essential skills andknowledge to support capacity building and the task shifts essential for ART scale-up and eventual universal access.


Clinical Mentorship Program:Clinical Mentorship Program:LESOTHOLESOTHO

• Located in Sub-Saharan Africa

• 2.2 million• 23.2% HIV

prevalence• Approximately 96,000 Orphans

and Vulnerable Children


Understand the Health Care Understand the Health Care Structure Structure

HQMOHSW

3 Tertiary hospitals(QEII, Mental and

Leprosy)

16 district hospitals1708 (GOL beds and

669 CHAL beds) + 4 F.Clinics151 Health Centers

(GOL= 73,CHAL = 78)

Community (6,000 CHWs + 17 Village Health Posts)


Lesotho: Accessing Lesotho: Accessing ARVsARVs in Lesothoin Lesotho


CHAI Lesotho: Rural InitiativeCHAI Lesotho: Rural Initiative

Phase II: 63 patients on ART within first 6 weeks of roll-out; tripled number of HIV tests carried out in previous 3 years


Understanding your patientUnderstanding your patient’’s s challengeschallenges

• After school chores• Approximately 49%

unemployment• Transportation • Access to drinking

water • Poverty• Harvest


Clinical Mentorship ProgramClinical Mentorship Program

Clinical SupportClinical SupportWHO Staging

Lesotho National GuidelinesSymptom Management

Record Keeping SupportARV side effect management

ARV stock reportingInpatient/Outpatient Referrals

Nurse TriagingPMTCT

Pediatric ARV initiationClinic follow ups

ARV Adherence supportTB/HIV Co-infection CTX/INH Prophylaxis


American Mentors with the Basotho American Mentors with the Basotho Nurse Clinician Nurse Clinician


Teaching moments: the waiting Teaching moments: the waiting roomroom


PrePre--clinic ARV reviewclinic ARV review


General Community Support

Home Care

Buddy(one-on-one

support)

Clinical

Team

COMMUNITY PREPAREDNESS- Support Groups, Advocacy Groups, Education

-Destigmatisation, Normalisation of HIV- Scale up Testing & Counselling

HOME PREPAREDNESS*Family members and visiting carers prepared for supportive

and palliative care, nutritional support, adherence support

INDIVIDUAL PREPAREDNESS*Caregiver skills

- Psycho-social support- Adherence support

ADVANCED INDIVIDUAL CAPACITY* Expert patients as trainers

* ART aid

* Dispensing skills- Laboratory skills- Record-keeping

- Policy development / Programme management*Triage for self-limited illness & side effects

Levels of Community Intervention in the Provision of Antiretroviral Therapy (ART)


Support GroupsSupport Groups


Clinical Mentorship ProgramClinical Mentorship Program

• Full-time HIV/AIDS treatment experienced expatriate mentors were deployed in Lesotho to assist with the decentralization of treatment & care.

• 24 clinics were assisted with rolling out ARVs, setting up clinic flow and implementation of clinical systems.

• Approximately 40 RNs, MDs & Physician Assistants volunteered for 6-12weeks

• 6 new ART clinics were opened in Mafeteng, Semonkong, Leribe & Maseru

• 18 sites were supported with hands on HIV/AIDS professionals


Activities of a Clinical MentorActivities of a Clinical Mentor• Phase 1: Introduction/relationship; establish ground

rules

• Phase 2: Observation of performance by mentor (intervene as necessary/appropriate to setting)

• Phase 3: Perform independently and reviews case management plan with mentor (mentor on-site)

• Phase 4: Perform independently and consult with mentor when needed (mentor off-site); mentor returns periodically to re-assess


A day in the life at work for RNsA day in the life at work for RNs……

• Clinic hours: Monday to Friday 8-5pm.

• Activities: Working with the clinic teams in the hospital based clinic & setting up in-services for the nurses in the hospitals.

• Assisting a clinic to see their patients: clinic flow, chart organization, documentation, education, triage, etc.

A matron & counselor reviews the charts

A ward nurse pours her morning meds

A nurse sits in an empty clinic at the end of the day


A day in the life for MDsA day in the life for MDs……

• Clinic hours: Monday to Friday: 8-5pm

• Usually 1:1 with the clinic MD & other team members

• Attending rounds for educational moments

• Facilitation of team meetings


ImpactImpact

Scale up in all sites were noted at a minimum of 25% increase.

For example, in one year one clinic has increased from 60 patients to 1300 patients, this district will now decentralize from the hospital-based clinic to the surrounding healthcare centers.

An increase in confidence in treating and caring for patients with HIV/AIDS.


Assessing ImpactAssessing Impact

05

1015202530354045

Aug-05

Sep-05

Oct-05

Nov-05

Dec-05

Jan-06

Feb-06

Mar-06

Apr-06

May-06

Jun-06

PreART ART


Impact: A Clinic ProfileImpact: A Clinic Profile

A Lesotho ART Clinic Profile

010203040506070

Aug Oct. Dec.

Feb.

April

08-Ju

n

New Patients ART Initiation


A mountain Clinic:A mountain Clinic:HIV Patients Enrolled into CareHIV Patients Enrolled into Care

Patients Enrolled in Care

0

50

100

150

200

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400

Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Month 2006

EnrolledCumulative EnrolledThoteng EnrolledThoteng Cumulative


A Mountain Clinic: Patients A Mountain Clinic: Patients Enrolled on ARTEnrolled on ART

Patients Started on ART

0

20

40

60

80

100

120

Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Month 2006

Started

Cumulative Started


Unexpected visitorsUnexpected visitors……


““The Clinton Foundation has made The Clinton Foundation has made HIV/AIDS an urgent issue!HIV/AIDS an urgent issue!””


THANK YOU!


Recommended ResourcesRecommended Resources

• “Race Against Time,” Stephen Lewis• “Mountains Beyond Mountains,” Tracey Kidder• www.clintonfoundation.org• www.who.int

Denise Thomas, Clinical Mentorship Program, Clinton Foundation:

[email protected]

clinical mentorship program: pre-departure readiness for ... - clinical... · clinical mentorship...

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