School of Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Hum Resour Health. 2009 Mar 17;7:23. doi: 10.1186/1478-4491-7-23.
HIV counseling and testing, HIV prevention and provision of HIV care and support are essential activities to reduce the burden of HIV among patients with TB, and should be integrated into routine TB care.
The development of training materials to promote HIV services for TB patients involved the definition of target health care workers (HCWs); identification of required tasks, skills and knowledge; review of international guidelines; and adaptation of existing training materials for voluntary counseling and testing, prevention of mother-to-child transmission of HIV, and management of opportunistic infections (OIs). Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of HCWs with the centre's HIV testing acceptance rates, and through participatory observations at the time of on-site supervisory visits and monthly meetings.
Pre-training assessment identified gaps in basic knowledge of HIV epidemiology, the link between TB and HIV, interpretation of CD4 counts, prevention and management of OIs, and occupational post-exposure prophylaxis (PEP). Opinions on patients' rights and confidentiality varied. Mean test results increased from 72% pre-training to 87% post-training (p<0.001). Important issues regarding HIV epidemiology and PEP remained poorly understood post-training. Mean post-training scores of clinic's HCWs were significantly correlated with the centre's HIV testing acceptance rates (p=0.01). On-site supervisory visits and monthly meetings promoted staff motivation, participatory problem solving and continuing education. Training was also used as an opportunity to improve patient-centred care and HCWs' communication skills.
Many HCWs did not possess the knowledge or skills necessary to integrate HIV activities into routine care for patients with TB. A participatory approach resulted in training materials that fulfilled local needs.
HIV 咨询和检测、HIV 预防以及提供 HIV 护理和支持，对于减轻结核病患者的 HIV 负担至关重要，应将其纳入常规结核病护理。
为促进为结核病患者提供 HIV 服务而制定培训材料，涉及明确目标卫生保健工作者（HCWs）；确定所需任务、技能和知识；审查国际准则；以及改编现有的自愿咨询和检测、预防艾滋病毒母婴传播以及机会性感染（OIs）管理的培训材料。通过培训前后的问卷调查、将 HCWs 的培训后结果与中心的 HIV 检测接受率相关联以及在现场监督访问和每月会议期间进行参与性观察，评估培训效果。
培训前评估发现，HCWs 在 HIV 流行病学、结核病与 HIV 的关联、CD4 计数解读、OIs 的预防和管理以及职业性暴露后预防（PEP）方面存在基础知识的差距。对患者权利和保密性的看法存在差异。平均测试结果从培训前的 72%增加到培训后的 87%（p<0.001）。培训后，关于 HIV 流行病学和 PEP 的重要问题仍理解不足。诊所 HCWs 的平均培训后得分与中心的 HIV 检测接受率显著相关（p=0.01）。现场监督访问和每月会议促进了员工的积极性、参与性问题解决和继续教育。培训也为改善以患者为中心的护理和 HCWs 的沟通技巧提供了机会。
许多 HCWs 不具备将 HIV 活动纳入常规结核病患者护理所需的知识或技能。参与式方法产生了满足当地需求的培训材料。
