Chien Emily, Phiri Khumbo, Schooley Alan, Chivwala Mackenzie, Hamilton John, Hoffman Risa M
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
Partners in Hope Medical Center, EQUIP-Malawi, Lilongwe, Malawi.
PLoS One. 2016 Jun 28;11(6):e0158258. doi: 10.1371/journal.pone.0158258. eCollection 2016.
HIV clinical mentoring has been utilized for capacity building in Africa, but few formal program evaluations have explored mentee perspectives on these programs. EQUIP is a PEPFAR-USAID funded program in Malawi that has been providing HIV mentoring on clinical and health systems since 2010. We sought to understand the successes and challenges of EQUIP's mentorship program. From June-September 2014 we performed semi-structured, in-depth interviews with EQUIP mentees who had received mentoring for ≥ 1 year. Interview questions focused on program successes and challenges and were performed in English, audio recorded, coded, and analyzed using inductive content analysis with ATLAS.ti v7. Fifty-two mentees from 32 health centers were interviewed. The majority of mentees were 18-40 years old (79%, N = 41), 69% (N = 36) were male, 50% (N = 26) were nurses, 29% (N = 15) medical assistants, and 21% (N = 11) clinical officers. All mentees felt that EQUIP mentorship was successful (100%, N = 52). The most common benefit reported was an increase in clinical knowledge allowing for initiation of antiretroviral therapy (33%, N = 17). One-third of mentees (N = 17) reported increased clinic efficiency and improved systems for patient care due to EQUIP's systems mentoring including documentation, supply chain and support for minor construction at clinics. The most common challenge (52%, N = 27) was understaffing at facilities, with mentees having multiple responsibilities during mentorship visits resulting in impaired ability to focus on learning. Mentees also reported that medication stock-outs (42%, N = 22) created challenges for the mentoring process. EQUIP's systems-based mentorship and infrastructure improvements allowed for an optimized environment for clinical training. Shortages of health workers at sites pose a challenge for mentoring programs because mentees are pulled from learning experiences to perform non-HIV-related clinic duties. Evaluations of existing mentoring models are needed to continue to improve mentoring strategies that result in sustainable benefits for mentees, facilities, and patients.
艾滋病毒临床指导已被用于非洲的能力建设，但很少有正式的项目评估探讨学员对这些项目的看法。EQUIP是一个由美国总统艾滋病紧急救援计划（PEPFAR）-美国国际开发署（USAID）资助的马拉维项目，自2010年以来一直在临床和卫生系统方面提供艾滋病毒指导。我们试图了解EQUIP指导项目的成功之处和面临的挑战。2014年6月至9月，我们对接受指导≥1年的EQUIP学员进行了半结构化的深入访谈。访谈问题聚焦于项目的成功与挑战，以英语进行，录音、编码，并使用ATLAS.ti v7软件进行归纳性内容分析。来自32个卫生中心的52名学员接受了访谈。大多数学员年龄在18至40岁之间（79%，N = 41），69%（N = 36）为男性，50%（N = 26）是护士，29%（N = 15）是医疗助理，21%（N = 11）是临床干事。所有学员都认为EQUIP的指导是成功的（100%，N = 52）。报告的最常见益处是临床知识的增加，从而能够开始抗逆转录病毒治疗（33%，N = 17）。三分之一的学员（N = 17）报告称，由于EQUIP在系统方面的指导，包括文件记录、供应链以及对诊所小型建设的支持，诊所效率有所提高，患者护理系统得到改善。最常见的挑战（52%，N = 27）是医疗机构人员配备不足，学员在指导访问期间承担多项职责，导致专注学习能力受损。学员们还报告说，药品缺货（42%，N = 22）给指导过程带来了挑战。EQUIP基于系统的指导和基础设施改善为临床培训创造了优化环境。各地点卫生工作者短缺对指导项目构成挑战，因为学员会被从学习活动中抽离去执行与艾滋病毒无关的诊所职责。需要对现有的指导模式进行评估，以继续改进指导策略，从而为学员、医疗机构和患者带来可持续的益处。
