Assisted HIV partner services training in three sub‐Saharan African countries: facilitators and barriers to sustainable approaches

Abstract

Introduction Healthcare worker training is essential to successful implementation of assisted partner services (aPS), which aims to improve HIV testing and linkage‐to‐care outcomes for previously unidentified HIV‐positive individuals. Cameroon, Kenya and Mozambique are three African countries that have implemented aPS programmes and are working to bring those programmes to scale. In this paper, we present and compare different aPS training strategies implemented by these three countries, and discuss facilitators and barriers associated with implementation of aPS training in sub‐Saharan Africa. Discussion aPS training programmes in Cameroon, Kenya and Mozambique share the following components: the development of comprehensive and interactive training curricula, recruitment of qualified trainees and trainers with intimate knowledge of the community served, continuous training, and rigorous monitoring and evaluation activities. Cameroon and Kenya were able to engage various stakeholders early on, establishing multilateral coalitions that facilitated attainment of long‐term buy‐in from the local governments. Ministries of Health and various implementing partners are often included in strategic planning and delivery of training curricula to ensure sustainability of the training programmes. Kenya and Mozambique have integrated aPS training into the national HTS guidelines, which are being rolled out nationwide by the Ministries of Health and implementing partners. Continual revision of training curricula to reflect the country context, as well as ongoing monitoring and evaluation, have also been identified as key facilitators to sustain aPS training programmes. Some of the barriers to scale‐up and sustainability of aPS training include limited funding and resources for training and scale‐up and shortage of aPS providers to facilitate on‐the‐job mentorship. Conclusions These three programmes demonstrate that aPS training can be implemented and scaled up in sub‐Saharan Africa. As countries plan for initial implementation or national scale‐up of aPS services, they will need to establish government buy‐in, expand funding sources, address the shortage of staff and resources to provide aPS and on‐the‐job mentorship, and continuously collect data to evaluate and improve aPS training plans. Development of national standards for aPS training, empowered healthcare providers, increased government commitment, and sustained funding for aPS services and training will be crucial for successful aPS implementation.

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Development of a Blended Learning Approach to Delivering HIV-Assisted Contact Tracing in Malawi: Applied Theory and Formative Research

“…The facilitators we identified using the CFIR closely mirrored findings from successful ACT programs in SSA [ 50 ]. In 2017-2018, contacts form Kenya and Mozambique accounted for 51% of the 1.7 million contacts tested across 18 SSA PEPFAR countries, even though these countries only accounted for 14% of the population [ 12 ].…”

“…Similarly, several Cameroonian districts scaled and sustained ACT before the WHO guidelines were published [ 51 ]. In an analysis of ACT implementation in these three countries, the intensive ongoing nature of health worker capacity-building was essential [ 50 ]. Although the implementation contexts differed, the capacity-building processes were similar.…”

“…Our contributions to ACT implementation science are novel, timely, and noteworthy. In the few years since the WHO issued its guidelines surrounding ACT, there has been widespread ACT implementation in SSA [ 11 , 12 ] and numerous descriptions of barriers, facilitators, and corresponding ACT indicators [ 50 , 51 , 54 ]. However, the role of theory and frameworks has been limited.…”