training of health care providers on arv therapy

Training of Health Care Providers on Anti Retro Viral Therapy

Fatima Memorial Hospital | Introduction 0

Training of Health

Care Providers on

Anti Retro Viral

Therapy

Training Report

Dr. Shabnum Sarfraz Global Fund Project Office Fatima Memorial Hospital, Shadman, Lahore, Pakistan



Contents

Introduction .................................................................................................................................................. 2

Background ............................................................................................................................................... 2

Objective of Training ................................................................................................................................. 2

Specific objectives ..................................................................................................................................... 2

Desired outcome of the training ............................................................................................................... 2

Selection of Audience ................................................................................................................................... 3

Defining content of Training ......................................................................................................................... 3

Selection of Trainers ..................................................................................................................................... 4

Training Methodology ................................................................................................................................... 5

Agenda of the Workshop .............................................................................................................................. 7

Work Shop Proceeding ................................................................................................................................. 9

Session Outline.......................................................................................................................................... 9

Session 1: Demystifying HIV and AIDS - A Global Issue by Prof. Dr. Aman Ullah Khan ................................ 9

Session 2: The Psychosocial Impact of HIV/AIDS on Individual, Society and Family By Dr. Ayesha Nauman

...................................................................................................................................................................... 9

Session 3: Drug Adherence and Strategies for Compliance By Dr. Ayesha Nauman .................................... 9

Session 4: Nursing Care for Patients on ART By Ms. Saba Watto ................................................................ 9

Session 5 & 6: Role of Counselling and Adherence in ARV Therapy By Dr. Noreen Hashmi ...................... 10

Session 7: The Multidisciplinary Adherence Team Referral Networking To Enhance ART Adherence By Dr.

Shabnum Sarfraz ......................................................................................................................................... 10

Session 8: PPTCT- District Model- An Overview By Dr. Roomi Aziz ........................................................... 10

Session 9: When To Start ARV? What Is The First Line Therapy? When To Switch Art Second And Third

Line Regimen? By Dr. Fatima Imran ............................................................................................................ 10

Session 10: Managing The Side Effects And Complications during ARV Therapy Lab Monitoring By Dr.

Inam Ul Haq ................................................................................................................................................ 11

Session 8: ART For HIV/Tuberculosis & HIV/HBV Co-Infection By Dr. Fatima Rahman .............................. 11

Comments of Participants ........................................................................................................................... 12

Annexure ..................................................................................................................................................... 13

Annexure 1: List of Participants .............................................................................................................. 13

Annexure 2: Trainer’s Evaluation Form .................................................................................................. 14

Annexure 3: Trainers’ Evaluations Actual ............................................................................................... 15



INTRODUCTION

Background

The Training of Health Care Providers is a sequential of Training of Mentors which was aimed to prepare

and select five mentors who would take up the future trainings for the health care providers.

Objective of Training

The training of Health Care Providers is aimed at building up the knowledge base of the Health Care

Providers (that includes doctors, nurses, psychologists and sociologists) about the HIV/AIDS for the

effective handling of Patients Living with HIV/AIDS (PLHIVs). The workshop also attempts at developing a

network/ liaison of health care providers who will be experts in ART. This workshop has been exclusively

arranged for the participants from Punjab and KPK province.

Specific objectives

This two-day rigorous training covers all aspects of ARV Therapy. By the end of this training, participants

will be expected to have knowledge of following topics:

1. When to start ARV

2. What is the first line therapy?

3. When to switch ART-Second and Third line Regimen

4. Managing the side effects and complications during ARV Therapy

5. ART for HIV/tuberculosis co-infection

6. ART for HIV/HBV co-infection

7. Counseling for ARV Therapy

Desired outcome of the training

At the end of this two-days training, the participants are expected to be fully equipped with the

HIV/AIDS as a disease, its implications and the treatment practices which will enable them to manage

well while handling PLHIVs.


Fatima Memorial Hospital | Selection of Audience 3

SELECTION OF AUDIENCE

The selection of participants was critical as all of them were filtered through stringent criteria. The

participants had to have a background in medicine, allied sciences, nursing, psychology/sociology, a

post-graduate degree or diploma and some experience in HIV/AIDS. Interaction/work experience with

health care providers who are working with HIV/AIDS was an additional plus. Invitations were sent via

Principal’s Office to the Medical colleges, Heads of Nursing institutions and health academies, and the

CHBC centers all over Punjab and KPK. The participants’ portfolio was very rich, including Senior Doctors,

Nursing Staff and Counsellors belonging to both the Public and Private Sector Health Institutions and

from the Punjab and KPK province. (Annexure: 1 List of Participants).

DEFINING CONTENT OF TRAINING

Since the program was meant to inculcate the latest knowledge on management of an HIV-positive

patient, through the stages of HIV to AIDS, the content was designed to provide a holistic approach

towards the management of PLHIV and hence included the following areas:

i. In-depth knowledge of the HIV regimens

ii. In-depth knowledge about second and third line regimens, times and indications to switch

iii. Management of side effects and complications during ART

iv. ART treatment along with the co-infections

v. Role of counseling of PLHIVs

vi. Need of Adherence in PLHIVs


Fatima Memorial Hospital | Selection of Trainers 4

SELECTION OF TRAINERS

The basic ideology of the Training of Health Care Providers was to equip the participants with the latest

knowledge about HIV/AIDS through the five mentors who were selected after the successful completion

of Training of Mentors. Moreover, two leading experts of Infectious Diseases and Community Medicine

were also among the trainers. The trainers were

Prof. Dr. Aman Ullah Khan, Technical Advisor, Nur Center for Research & Policy

B.Sc., MBBS, DPH, MPH & TM, FCPS, PhD, FRSTM&H, FAPHA

Prof. Dr. Aman Ullah Khan had been the dean of College of Physician and Surgeons of Pakistan

before joining Fatima Memorial Hospital. He has also served as the Professor of Institute of Public

Health Pakistan. He had been involved on miscellaneous research activities on HIV/AIDS in Pakistan

and abroad. He is the author of many publications.

Dr. Noreen Rahat Hashmi, Head - Community Medicine Department, Rahbar Medical & Dental College

MD, Diplomate American Board of Internal Medicine, MPH

Dr. Noreen Rahat Hashmi is an expert of Internal Medicine and had been managing PLHIVs back in

USA. She recently moved to Pakistan and is currently serving Rahbar Medical & Dental College.

Dr. Ayesha Nauman, Consultant Gynaecology and Director HR, Fatima Memorial Hospital

MBBS, MBA

Dr. Ayesha Nauman is currently a practicing gynaecologist at Fatima Memorial Hospital. Moreover,

she is serving FMH as Director Human Resources Department as well. She was ranked top among

the five mentors selected from Training of Mentors.

Ms. Saba Watto, Nursing Instructor, Saeeda Waheed FMH College of Nursing

M.Sc. Nursing

Ms. Saba Watto is currently working as Nursing Instructor at Saeeda Waheed FMH College of

Nursing. She has a post graduation qualification from Agha Khan University with a special interest in

HIV/AIDS. Ms. Watto was ranked fifth in the selection of mentors.


Fatima Memorial Hospital | Training Methodology 5

Dr. Shabnum Sarfraz, Health Specialist & COO (NCRP), Fatima Memorial Hospital

MBBS, MBA

Dr. Shabnum Sarfraz is a leading health specialist in the country with a vast experience of managing

local and international health projects with different funding agencies like WHO, USAID, The Global

Fund, UNICEF, Health Ministry Pakistan, Punjab Education Foundation and many more. Currently

she is working in the capacity of Chief Operating Officer, Nur Center for Research and Policy, a sister

concern of Fatima Memorial Hospital.

Dr. Roomi Aziz, Health Specialist & SPM (NCRP), Fatima Memorial Hospital

MBBS, MBA

Dr. Roomi Aziz is serving as Senior Manager Strategy and Planning at NCRP. She has conducted

miscellaneous trainings under different international and local donor agencies’ projects as trainer.

Dr. Fatima Imran, Senior Registrar, Paediatrics, Fatima Memorial Hospital

MBBS, FCPS (Paediatrics)

Dr. Fatima Imran opted for medicine with a major in Paediatrics in her post graduation certification. She was ranked fourth in the selection of mentors. She is currently working as Senior Registrar at Paediatrics Department, Fatima Memorial Hospital.

Dr. Inam ul Haq, In charge Special Clinic for HIV/AIDS, Mayo Hospital Lahore

MBBS, Post Graduation Trainee

Dr. Inam ul Haq is currently working as In charge Special Clinic for HIV/AIDS at the Mayo Hospital

Lahore and has the hands on experience of dealing PLHIVs. He secured third position among the

selection of mentors. He is also appearing in his final examinations for specialization in internal

medicine.

Dr. Fatima Rahman, Registrar, Paediatrics Department, Services Hospital Lahore

MBBS, Post Graduation Trainee

Dr. Fatima Rahman is a Post Graduate Trainee in the Department of Paediatrics at Services Hospital

Lahore. She has the hands on experience of managing PLHIVs especially children. She was ranked

second among the five mentors selected.

TRAINING METHODOLOGY


Fatima Memorial Hospital | Training Methodology 6

The training sessions were interactive and participants were encouraged to reflect on the concepts and

knowledge shared by the trainers. The trainers rigorously covered all the aspects of HIV/AIDS in two

days time. The participants were persuaded to actively involve in the presentation and Q/A sessions for

the improvisation of their knowledge and skills.

At the end of each day, the participants were asked to fill an anonymous evaluation form, evaluating the

trainers for the day. At the end of the second day, the participants were also asked to evaluating the

entire workshop as well as give suggestions and recommendations. The recommendations have been

noted down for future workshops.


Fatima Memorial Hospital | Agenda of the Workshop 7

AGENDA OF THE WORKSHOP

Day 1 19-Oct-12

FOCUS Basic information on adherence and ARV Therapy

TIME SESSIONS

09:00 - 10:00 Inaugural Ceremony & Group Photograph

Session 1:

Demystifying HIV & AIDS - A Global Issue

Facilitator

Prof Aman Ullah

10:45 - 11:00 Tea Break

Session 2:

The Psychological impact of HIV/AIDS on Individual, Society and

Family

Facilitator

Dr. Ayesha Nauman

Session 3:

Drug Adherence and Strategies for Compliance

Facilitator

Dr. Ayesha Nauman

Session 4:

Nursing Care for patients on ART

Facilitator

Ms Sabba Watto

01:15 - 02:00 Lunch & Jumma Prayers

Session 5:

Role of Counselling and Adherence in ARV Therapy-1

Facilitator

Dr Noreen R. Hashmi

Session 6:

Role of Counselling and Adherence in ARV Therapy- Group Activity

Post- Exposure Prophylaxis

Facilitator

Dr Noreen R. Hashmi

12:30 - 01:15 pm

02:00 - 02:45

10:00 - 10:45

11:45 - 12:30

11:00 - 11:45

02:45 - 03:30


Fatima Memorial Hospital | Agenda of the Workshop 8

Day 2 20-Oct-12

FOCUS Management of patients on ARV Therapy

TIME SESSIONS

Session 7:

The Multidisciplinary Adherence Team

Referral Networking to enhance ART Adherence

Facilitator

Dr Shabnum Sarfraz

Session 8:

An introduction to the PPTCT Model

Facilitator

Dr Roomi Aziz

10:30 - 11:00 Tea Break

Session 8:

When to start ARV?

What is the first line therapy?

When to Switch ART Second and Third line Regimen?

Facilitator:

Dr Fatima Imran

Session 9:

Facilitator:

Dr Inam ul Haq

Session 10:

ART for HIV/Tuberculosis & HBV co-infection

Facilitator

Dr. Fatima Rahman

01:15 - 02:00 pm Lunch

02:00 - 02:45 Closing Ceremony

12:30 - 1:15

09:00 - 09:45

11:00 - 11:45

Managing the side effects and complications during ARV Therapy

11:45 - 12:30

09:45 - 10:30


Fatima Memorial Hospital | Work Shop Proceeding 9

WORK SHOP PROCEEDING

Session Outline

SESSION 1: DEMYSTIFYING HIV AND AIDS - A GLOBAL ISSUE BY PROF. DR.

AMAN ULLAH KHAN

The session focused on the global and local spread of the disease till today. The disease stages along

with the modes of transmission were also discussed briefly. The stigmas associated with PLHIVs were

also shared in detail and the ways to remove such taboos were identified.

SESSION 2: THE PSYCHOSOCIAL IMPACT OF HIV/AIDS ON INDIVIDUAL, SOCIETY

AND FAMILY BY DR. AYESHA NAUMAN

The psychological management of PLHIVs were brought up for discussion in this session. The trainer

shared the counselling aspects like listening, respect for the client, confidentiality, questioning, self

decisions and help for other services, in relation to PLHIVs. The confidentiality and privacy of a PLHIV

was also discussed in detail. Moreover, the psychological impact of HIV/AIDS on society and family were

also the part of discussion.

SESSION 3: DRUG ADHERENCE AND STRATEGIES FOR COMPLIANCE BY DR.

AYESHA NAUMAN

The session primarily highlighted various aspects of drug adherence and strategies to compliance. The

role of adherence support workers was emphasized upon. Their role in improvement of patient

adherence, knowledge, and understanding; provision of education and counselling in the patient's own

language allows nurses and doctors to focus on other technical and clinical aspects of the patients’

treatment.

SESSION 4: NURSING CARE FOR PATIENTS ON ART BY MS. SABA WATTO

This session was aimed at the nursing care of the patients who on ART. As nurses have to perform a

pivotal role in managing the PLHIVs, all the aspects like counselling, drug adherence were discussed in

detail.



SESSION 5 & 6: ROLE OF COUNSELLING AND ADHERENCE IN ARV THERAPY BY

DR. NOREEN HASHMI

The session primarily focused on the importance of level of commitment towards adherence and the

consequences in case of non-compliance. Effective strategies to encourage adherence and ways to

counsel patients about adherence were also discussed in detail. Adherence issue of PLHIVs in Pakistan

were also the part of discussion. The session also included a group activity where participants were

asked to present on various dimensions of ARV adherence and counselling.

SESSION 7: THE MULTIDISCIPLINARY ADHERENCE TEAM REFERRAL NETWORKING

TO ENHANCE ART ADHERENCE BY DR. SHABNUM SARFRAZ

The session primarily highlighted various aspects of ART adherence with respect to team referral

networking. The role of adherence support workers was emphasized upon. Their role in improvement of

patient adherence, knowledge, and understanding; provision of education and counselling in the

patient's own language allows nurses and doctors to focus on other technical and clinical aspects of the

patients’ treatment.

SESSION 8: PPTCT- DISTRICT MODEL- AN OVERVIEW BY DR. ROOMI AZIZ

This session focused PPTCT - District Model as the common modes of HIV/AIDS spread in females were

the point of discussion. The trainer further elaborated about the functioning and impact of PPTCT –

District Model adapted by Punjab AIDS Control Program in Punjab Province. The achievements to date of

this model were also shared.

SESSION 9: WHEN TO START ARV? WHAT IS THE FIRST LINE THERAPY? WHEN

TO SWITCH ART SECOND AND THIRD LINE REGIMEN? BY DR. FATIMA IMRAN

The session conferred evidence-based recommendations for ARV Therapy, identification of most

effective first-line, 2nd line and subsequent regimens. The time of initiation of treatment and the

importance of careful decision making for ARV initiation with evidence based timing and regimen

selection were also discussed. The access of ARV Therapy in low-income countries like Pakistan was also

the part of the session.



SESSION 10: MANAGING THE SIDE EFFECTS AND COMPLICATIONS DURING ARV

THERAPY LAB MONITORING BY DR. INAM UL HAQ

The clinical and laboratory monitoring of drugs, important toxicities, complications and adverse effects

of ARV Therapy was the core of this session. Management of drug toxities were also shared by the

trainer in detail.

SESSION 8: ART FOR HIV/TUBERCULOSIS & HIV/HBV CO-INFECTION BY DR.

FATIMA RAHMAN

This first part of the session was primarily focused on HIV/TB co-infection as TB is responsible for 13% of

deaths in HIV patients. The progression of HIV infection from latent to active TB was discussed in detail

along with the clinical approach of TB co-infected PLHIV. The application of latest drug regimens for such

co-infection was shared. The second part of the session aimed for the finding of HIV/HBV co-infection.

The aspects of counselling the patient for avoidance of alcohol, vaccination against hepatitis A (if not

immune), advice on methods to prevent HBV transmission and evaluate severity of HBV infections were

the main highlights of this session. The recommended testing for such co-infected patients was also

discussed in detail along with the latest regimens for treatment.


Fatima Memorial Hospital | Comments of Participants 12

COMMENTS OF PARTICIPANTS

Following are the comments of the participants on the concluding day, collected anonymously:

It was a really nice experience to be

here, which I was not expecting. All

facilitators were very cooperative and

tried their best to import their

knowledge.

It is important to bring these types of

workshops to professionals like

barbers and beauticians and

compounders, who are the source of

such infections and can play an active

role in stopping the spread of HIV.


Fatima Memorial Hospital | Annexure 13

ANNEXURE

Annexure 1: List of Participants

Name Designation Department Organization

Dr Idrees Afridi Doctor Family Care Center CHBC, HMC, Peshawar

Dr Saima Afridi Doctor Family Care Center CHBC, HMC, Peshawar

Ms Saima Bibi VCT Nurse Family Care Center CHBC, HMC, Peshawar

MS Sana Parveen Counselor Family Care Center CHBC, HMC, Peshawar

Ms Malika Tahir VCT Nurse Family Care Center CHBC, HMC, Peshawar

Ms Maria Sadiq ORW Family Care Center CHBC, HMC, Peshawar

MS Shamsa Kanwal Service Delivery Officer Family Care Center CHBC, Kohat

Ms Farhat Naz VCT Nurse Family Care Center CHBC, Kohat

Ms Seraphine Majid Senior Instructor Faculty Saida Waheed FMH College of Nursing,

Lahore

Ms Asifa Shahzadi Senior Instructor Faculty Saida Waheed FMH College of Nursing,

Lahore

Dr Anis Fatima Consultant Gynaecology Fatima Memorial Hospital, Lahore

Dr Farah Nadia Medical Officer Medicine Sir Ganga Ram Hospital, Lahore

Dr Zia ul Haq Registrar Medicine Sir Ganga Ram Hospital, Lahore

Dr Naeem Amin Registrar Medicine Sir Ganga Ram Hospital, Lahore

Dr Farah Sadiq Senior Registrar Medicine Mayo Hospital, Lahore

Dr Umar Aftab Post Graduate Trainee Medicine Jinnah Hospital, Lahore

Dr Naila Altaf Post Graduate Trainee Medicine Jinnah Hospital, Lahore

Dr Anwar Sulehri Associate Professor Medicine Punjab Medical College, Faisalabad

Ms Uzma Azam CO&SDO Field Work CHBC - PakPlus Society, Lahore

Mr Samiuallah CO&SDO Field Work CHBC - PakPlus Society, Lahore

Ms Naseem Abdullah Manager Nursing Emergency Jinnah Hospital, Lahore

Ms Rukhsana William Manager Nursing Medicine Jinnah Hospital, Lahore

Ms Farrukh Yousaf Senior Nurse Medicine Mayo Hospital, Lahore

Ms Riffat Zahid Senior Nurse Pediatric Medicine Mayo Hospital, Lahore

Dr Bushra Noor Registrar Medicine Sir Ganga Ram Hospital, Lahore



Annexure 2: Trainer’s Evaluation Form

TRAINERS EVALUATION FORM

Training Title: Training of Mentors Dates: October 19, 20, 2012

Venue: Conference Room, 4th Floor, FMH College of Medicine & Dentistry, Shadman, Lahore

We are interested in developing and honing the training for future use.

Please take a minute to rate Dr. XYZ as a trainer.

Statement Strongly

Agree Agree Disagree

Strongly

Disagree

The trainer was knowledgeable about the subject

The trainer was well-prepared about the subject

Explanations were clear and concise

The trainer solicited questions and had the answers

The trainer was interested in sharing information and knowledge

The trainer’s presentation style was interesting and effective

The trainer motivated, inspired and instilled confidence

Comments if any:

Training Training of Mentors on Anti Retro Viral Therapy

Venue Fatima Memorial Hospital, Lahore

Date October, 2012



Annexure 3: Trainers’ Evaluations Actual

0

5

10

15

20

The trainer was knowledgeable

about the subject

The trainer was well-prepared

about the subject

Explanations were clear and

concise

The trainer solicited

questions and had the answers

The trainer was interested in

sharing information and

knowledge

The trainer’s presentation

style was interesting and

effective

The trainer motivated,

inspired and instilled

confidence

Prof. Dr. Aman Ullah Khan

Strongly Agree

Agree

Disagree

Strongly Disagree

0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Dr. Ayesha Nauman

Strongly Agree

Agree

Disagree

Strongly Disagree

0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Ms. Saba Watto

Strongly Agree

Agree

Disagree

Strongly Disagree



0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Dr. Noreen R. Hashmi

Strongly Agree

Agree

Disagree

Strongly Disagree

0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Dr. Shabnum Sarfraz

Strongly Agree

Agree

Disagree

Strongly Disagree

0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Dr. Roomi Aziz

Strongly Agree

Agree

Disagree

Strongly Disagree



0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Dr. Fatima Imran

Strongly Agree

Agree

Disagree

Strongly Disagree

0

5

10

15

20


about the subject


about the subject


concise





knowledge



effective



confidence

Dr. Inam Ul Haq

Strongly Agree

Agree

Disagree

Strongly Disagree

training of health care providers on arv therapy

Documents

objective of training

content of training

training methodology

session outline

art adherence

arv therapy

nursing care

drug adherence