CLINICAL MENTORSHIP CLINICAL MENTORSHIP Program: PreProgram: Pre--departure departure Readiness for VolunteersReadiness for Volunteers
Canadian Nurses In AIDS Care Conference, Canadian Nurses In AIDS Care Conference, Vancouver, BCVancouver, BCDenise Thomas, Clinton FoundationDenise Thomas, Clinton FoundationClinical Mentorship Program, Lesotho, AFRICAClinical Mentorship Program, Lesotho, AFRICA
Clinton FoundationClinton Foundation
OverviewOverview
• Define the need for volunteers abroad• Highlight the Clinton HIV/AIDS Clinical
Mentorship Program in Resource Poor Settings• Define clinical mentorship in Lesotho• Overview a day in the life• Pre-departure readiness: a practical overview• Resources
Clinton FoundationClinton Foundation
Overview: Clinton FoundationOverview: Clinton Foundation’’s s HIV/AIDS Initiative HIV/AIDS Initiative
Clinton FoundationClinton Foundation
IMAI: Integrated Management of IMAI: Integrated Management of Adolescent and Adult IllnessesAdolescent and Adult Illnesses
• The IMAI tools consist of simplified and operationalized guidelines, training materials, and communication and patient education aids. They address clinical care, counselling, patient monitoring, anddistrict ART coordination.
• The IMAI evidence-based guidelines have been simplified and operationalized, based on WHO's "Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach". The IMAI guidelines are based on a syndromic approach but also incorporate results from a limited number of lab tests. They have been prepared for use in health services in low resource countries, covering the continuum of HIV care/ART in the community, first-level health facilities, and the district hospital.
• Short, efficient training courses teach the essential skills andknowledge to support capacity building and the task shifts essential for ART scale-up and eventual universal access.
Clinton FoundationClinton Foundation
Clinical Mentorship Program:Clinical Mentorship Program:LESOTHOLESOTHO
• Located in Sub-Saharan Africa
• 2.2 million• 23.2% HIV
prevalence• Approximately 96,000 Orphans
and Vulnerable Children
Clinton FoundationClinton Foundation
Understand the Health Care Understand the Health Care Structure Structure
HQMOHSW
3 Tertiary hospitals(QEII, Mental and
Leprosy)
16 district hospitals1708 (GOL beds and
669 CHAL beds) + 4 F.Clinics151 Health Centers
(GOL= 73,CHAL = 78)
Community (6,000 CHWs + 17 Village Health Posts)
Clinton FoundationClinton Foundation
Lesotho: Accessing Lesotho: Accessing ARVsARVs in Lesothoin Lesotho
Clinton FoundationClinton Foundation
CHAI Lesotho: Rural InitiativeCHAI Lesotho: Rural Initiative
Phase II: 63 patients on ART within first 6 weeks of roll-out; tripled number of HIV tests carried out in previous 3 years
Clinton FoundationClinton Foundation
Understanding your patientUnderstanding your patient’’s s challengeschallenges
• After school chores• Approximately 49%
unemployment• Transportation • Access to drinking
water • Poverty• Harvest
Clinton FoundationClinton Foundation
Clinical Mentorship ProgramClinical Mentorship Program
Clinical SupportClinical SupportWHO Staging
Lesotho National GuidelinesSymptom Management
Record Keeping SupportARV side effect management
ARV stock reportingInpatient/Outpatient Referrals
Nurse TriagingPMTCT
Pediatric ARV initiationClinic follow ups
ARV Adherence supportTB/HIV Co-infection CTX/INH Prophylaxis
Clinton FoundationClinton Foundation
American Mentors with the Basotho American Mentors with the Basotho Nurse Clinician Nurse Clinician
Clinton FoundationClinton Foundation
Teaching moments: the waiting Teaching moments: the waiting roomroom
Clinton FoundationClinton Foundation
General Community Support
Home Care
Buddy(one-on-one
support)
Clinical
Team
COMMUNITY PREPAREDNESS- Support Groups, Advocacy Groups, Education
-Destigmatisation, Normalisation of HIV- Scale up Testing & Counselling
HOME PREPAREDNESS*Family members and visiting carers prepared for supportive
and palliative care, nutritional support, adherence support
INDIVIDUAL PREPAREDNESS*Caregiver skills
- Psycho-social support- Adherence support
ADVANCED INDIVIDUAL CAPACITY* Expert patients as trainers
* ART aid
* Dispensing skills- Laboratory skills- Record-keeping
- Policy development / Programme management*Triage for self-limited illness & side effects
Levels of Community Intervention in the Provision of Antiretroviral Therapy (ART)
Clinton FoundationClinton Foundation
Clinical Mentorship ProgramClinical Mentorship Program
• Full-time HIV/AIDS treatment experienced expatriate mentors were deployed in Lesotho to assist with the decentralization of treatment & care.
• 24 clinics were assisted with rolling out ARVs, setting up clinic flow and implementation of clinical systems.
• Approximately 40 RNs, MDs & Physician Assistants volunteered for 6-12weeks
• 6 new ART clinics were opened in Mafeteng, Semonkong, Leribe & Maseru
• 18 sites were supported with hands on HIV/AIDS professionals
Clinton FoundationClinton Foundation
Activities of a Clinical MentorActivities of a Clinical Mentor• Phase 1: Introduction/relationship; establish ground
rules
• Phase 2: Observation of performance by mentor (intervene as necessary/appropriate to setting)
• Phase 3: Perform independently and reviews case management plan with mentor (mentor on-site)
• Phase 4: Perform independently and consult with mentor when needed (mentor off-site); mentor returns periodically to re-assess
Clinton FoundationClinton Foundation
A day in the life at work for RNsA day in the life at work for RNs……
• Clinic hours: Monday to Friday 8-5pm.
• Activities: Working with the clinic teams in the hospital based clinic & setting up in-services for the nurses in the hospitals.
• Assisting a clinic to see their patients: clinic flow, chart organization, documentation, education, triage, etc.
A matron & counselor reviews the charts
A ward nurse pours her morning meds
A nurse sits in an empty clinic at the end of the day
Clinton FoundationClinton Foundation
A day in the life for MDsA day in the life for MDs……
• Clinic hours: Monday to Friday: 8-5pm
• Usually 1:1 with the clinic MD & other team members
• Attending rounds for educational moments
• Facilitation of team meetings
Clinton FoundationClinton Foundation
ImpactImpact
Scale up in all sites were noted at a minimum of 25% increase.
For example, in one year one clinic has increased from 60 patients to 1300 patients, this district will now decentralize from the hospital-based clinic to the surrounding healthcare centers.
An increase in confidence in treating and caring for patients with HIV/AIDS.
Clinton FoundationClinton Foundation
Assessing ImpactAssessing Impact
05
1015202530354045
Aug-05
Sep-05
Oct-05
Nov-05
Dec-05
Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
PreART ART
Clinton FoundationClinton Foundation
Impact: A Clinic ProfileImpact: A Clinic Profile
A Lesotho ART Clinic Profile
010203040506070
Aug Oct. Dec.
Feb.
April
08-Ju
n
New Patients ART Initiation
Clinton FoundationClinton Foundation
A mountain Clinic:A mountain Clinic:HIV Patients Enrolled into CareHIV Patients Enrolled into Care
Patients Enrolled in Care
0
50
100
150
200
250
300
350
400
Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Month 2006
EnrolledCumulative EnrolledThoteng EnrolledThoteng Cumulative
Clinton FoundationClinton Foundation
A Mountain Clinic: Patients A Mountain Clinic: Patients Enrolled on ARTEnrolled on ART
Patients Started on ART
0
20
40
60
80
100
120
Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Month 2006
Started
Cumulative Started
Clinton FoundationClinton Foundation
““The Clinton Foundation has made The Clinton Foundation has made HIV/AIDS an urgent issue!HIV/AIDS an urgent issue!””
Clinton FoundationClinton Foundation
Recommended ResourcesRecommended Resources
• “Race Against Time,” Stephen Lewis• “Mountains Beyond Mountains,” Tracey Kidder• www.clintonfoundation.org• www.who.int
Denise Thomas, Clinical Mentorship Program, Clinton Foundation:
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