Evaluation of the effectiveness of an outreach clinical mentoring programme in support of paediatric HIV care scale-up in Botswana

Abstract

Clinical mentoring by providers skilled in HIV management has been identified as a cornerstone of scaling-up antiretroviral treatment in Africa, particularly in settings where expertise is limited. However, little data exist on its effectiveness and impact on improving the quality-of-care and clinical outcomes, especially for HIV-infected children. Since 2008, the Botswana-Baylor Children’s Clinical Centre of Excellence (COE) has operated an outreach mentoring programme at clinical sites around Botswana. This study is a retrospective review of 374 paediatric charts at four outreach mentoring sites (Mochudi, Phutadikobo, Molepolole, Thamaga) evaluating the effectiveness of the programme as reflected in a number of clinically-relevant areas. Charts from one visit prior to initiation of mentoring and from one visit after approximately one year of mentoring were assessed for statistically-significant differences (p<0.05) in the documentation of clinically-relevant indicators. Mochudi showed notable improvements in all indicators analyzed, with particular improvements in documentation of pill count, viral load (VL) results, correct laboratory monitoring and correct antiretroviral therapy (ART) dosing (p<0.0001, p<0.0001, p<0.0001 and p<0.0001, respectively). Broad and substantial improvements were also seen in Molepolole, with the most improvement in disclosure documentation of all four sites. At Thamaga, improvements were restricted to CD4 documentation(p<0.001), recent VL and documented pill count (p<0.05 and p<0.05, respectively). Phuthadikobo showed the least amount of improvement across indicators, with only VL documentation and correct ART dosing showing statistically-significant improvements (p<0.05 and p<0.0001, respectively). These findings suggest that clinical mentoring may assist improvements in a number of important areas, including ART dosing and monitoring; adherence assessment and assurance; and disclosure. Clinical mentoring may be a valuable tool in scale-up of quality paediatric HIV care-and-treatment outside specialized centres. Further study will help refine approaches to clinical mentoring, including assuring mentoring translates into improved clinical outcomes for HIV-infected children.

Food Insecurity and CD4% Among HIV+ Children in Gaborone, Botswana

“…The COE is a partnership between the Government of Botswana and the Baylor International Pediatric AIDS Initiative. 17 The COE is the largest pediatric ARV therapy clinic in Botswana 18 with over 2100 children on ARVs. All study materials including consent forms and questionnaires were available in Setswana and English.…”

Scoping review: strategies of providing care for children with chronic health conditions in low‐ and middle‐income countries

“…One paper involved encouraging quality in healthcare organisations through leadership . Professional mentoring of clinicians treating children with HIV improved clinician adherence to guidelines in Botswana .…”

Self-efficacy and Clinical Performance of Nurses Initiated and Management of Antiretroviral Therapy: Narrative Review

“…People with positive self-efficacy display mastery of their environment and more confident in acting safe and competent in challenging situations. Mastery experience is the most influential source of self-efficacy because it provides the most authentic evidence of whether one can master a skill and what it takes to succeed or reach a goal [22,42]. Therefore, nurses who are the backbone of the Department of Health, need to be upskilled, motivated and supported to have confidence in implementing NIMART.…”

“…People with lack of confidence exhibit low self-efficacy which interfere with initiation and pursue of intentions of NIMART programme [8]. Therefore, experience, clinical practice, motivation, supervision, support and knowledge are needed to develop the nurse's confidence and morale [7,42].…”