A national HIV clinical mentorship program: Enabling Zambia to accelerate control of the HIV epidemic

Abstract

Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those diagnosed should be on ART, and 90% of those on ART should achieve viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health, in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018–September 2018 and the post-mentorship period was July 2019–September 2019. Review of key programmatic indicators from the pre and post-deployment periods revealed the proportion of people who had a positive HIV test result out of those tested increased from 4.2% to 6.8% (P <0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8% to 90.1% (p <0.001). Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.

Clinical Characteristics and Outcomes of Patients Hospitalized With COVID-19 During the First 4 Waves in Zambia

“…Added investments in human resources are similarly needed for the country to develop a larger and better-trained workforce capable of responding to the needs presented by epidemics such as COVID-19. Use of virtual platforms to conduct trainings for health workers is one approach that is already in use in Zambia 38 but could benefit from additional resources and wider adoption. Additional practices can also be implemented to improve health system resiliency as it relates to COVID-19.…”

“…36,37 Addressing health system capacity limitations and implementing practices to improve health system resiliency are critical as Zambia prepares for upcoming COVID-19 waves and future epidemics. JAMA Network Open | Global Health conduct trainings for health workers is one approach that is already in use in Zambia 38 but could benefit from additional resources and wider adoption. Additional practices can also be implemented to improve health system resiliency as it relates to COVID-19.…”

“…Characteristics and Outcomes of Patients Hospitalized With COVID-19 in Zambia conduct trainings for health workers is one approach that is already in use in Zambia 38 but could benefit from additional resources and wider adoption. Additional practices can also be implemented to improve health system resiliency as it relates to COVID-19.…”

Catalyzing Quality Improvement in the HIV Control Programme of Rivers State: Evidence of the Impact of Clinical Mentorship Programme

“…This created opportunities to consistently improve program outcomes in the State using the established team-command structure. The CMP was strategically deployed as a mediating variable that optimized the moderating variables to achieve better outcomes in the monitored domains of the HIV Control Programme in Rivers State, as described by Boyd et al [6] and Chien et al [23]. This was facilitated by indigenous program experts (medical doctors) trained in the art of engineering continuous quality improvement at the site/district/LGA level using the advantages of a virtual platform for regular collective program SWOT review towards the desired objective.…”

“…Rivers State had a huge burden of PLHIV, and the UNAIDS Spectrum 2019 model projected the total number of PLHIV in the State in 2020 to be 184,551. However, despite decades of programming, closing the gap in treatment coverage had remained relatively poor before this time and far from the targets of epidemic control despite the support of the US President's Emergency Plan for AIDS Relief (PEPFAR) and other development partners [6].…”