International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America.
Department of Global Health, University of Washington, Seattle, WA, United States of America.
PLoS One. 2017 Oct 17;12(10):e0186074. doi: 10.1371/journal.pone.0186074. eCollection 2017.
As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD.
Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach.
Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings.
To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes.
随着 HIV 和 TB 防治方面的创新不断推进，医护人员（HCW）的持续专业发展（CPD）仍然是当务之急，尤其是在撒哈拉以南非洲地区，那里的双重 TB/HIV 疫情因 HCW 严重短缺而更加复杂。进一步需要检查 CPD 计划，以确定挑战和有效解决方案，以加强与 HIV/TB 相关的 CPD。
在马拉维、坦桑尼亚和南非（RSA）进行了定性评估，在每个国家都进行了关键知情人访谈（KII）和焦点小组讨论（FGD），以确定有效的 HIV/TB 相关 CPD 的障碍和促成因素。主要利益相关者代表 CPD 实施者、监管者和开发者。HCW 是从高疾病负担地区有目的地抽取的；每位 HCW 都完成了简短的、半结构化的问卷，并参加了 FGD。KII 和 FGD 的结果使用扎根理论方法结合起来，形成了跨越国家的关键主题。
进行了 52 次 KII：17 次在马拉维，19 次在坦桑尼亚，16 次在 RSA。89 名 HCW（24 名来自马拉维，38 名来自坦桑尼亚，27 名来自 RSA）完成了问卷并参加了 FGD。主要是，缺乏可持续的财政资源和 CPD 协调方面的限制导致 CPD 监督缺乏问责制，并降低了 CPD 的质量保证。HCW 短缺限制了 CPD 机会，造成了 CPD 获得方面的差距。CPD 的相关性和 HCW 确定的 CPD 需求与当前计划之间的不平衡降低了对 CPD 的热情。设施层面的限制，包括基础设施差和供应链薄弱，限制了 CPD 技能和知识的实施。在农村地区，挑战更为严峻。
为了解决已确定的差距，需要在各级提供可持续的资金、强有力的领导和协作，以加强 CPD 监管和认证系统；增加工作场所的 CPD 可及性；并为 CPD 的实施创造有利环境。这些改进措施共同提高了 TB/HIV CPD 的质量和患者的结果。
