Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-2 (of 2 Records) |
Query Trace: Kadengye DT[original query] |
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Retention of knowledge and clinical competence among Ugandan mid-level health providers 1year after intensive clinical mentorship in TB and HIV management
Senjovu DK , Naikoba S , Mugabe P , Kadengye DT , McCarthy C , Riley PL , Dalal S . Hum Resour Health 2021 19 (1) 150 INTRODUCTION: Clinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain. METHODS: The midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8 h a week, every 6 weeks over 9 months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm. RESULTS: At the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6 months (0.6% [95% CI - 1.4, 2.6]) or 12 months (- 2.8% [95% CI: - 5.9, 0.3]) while scores in the control arm significantly increased at 6 months (6.6% [95% CI: 4.4, 8.9]) and 12 months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6 month (2.8% [95% CI: - 1.8, 7.5] and 12 months (3.7% [95% CI: - 2.4, 9.8]) while in the control arm, a significant increase was seen at 6 months (5.8% [95% CI: 1.2, 10.3] and 12 months (11.5% [95% CI: 7.6, 15.5]). CONCLUSIONS: Mentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care. Trial Registration The study received ethics approvals from 3 institutions-the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board "JCRC's HIV/AIDS Research Committee" IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda. |
Improved HIV and TB knowledge and competence among mid-level providers in a cluster-randomized trial of one-on-one mentorship for task-shifting
Naikoba S , Senjovu KD , Mugabe P , McCarthy C , Riley PL , Kadengye DT , Dalal S . J Acquir Immune Defic Syndr 2017 75 (5) e120-e127 INTRODUCTION: Health worker shortages pose a challenge to the scale-up of HIV care and treatment in Uganda. Training mid-level providers (MLP) in the provision of HIV and TB treatment can expand existing health workforce capacity and access to HIV services. METHODS: We conducted a cluster-randomized trial of, on-site clinical mentorship for HIV and TB care at 10 health facilities in rural Uganda. Twenty MLP and were randomly assigned to an intervention of eight hours a week of one on one mentorship, every six weeks over a nine month period; and another twenty to the control of no clinical mentorship. Enrolled MLP's clinical knowledge and competence in management of HIV and TB was assessed using case scenarios and clinical observation at baseline, and immediately after the nine-month intervention. The performance of the study health facilities on eight TB and HIV care indicators was tracked over the nine months period using facility patient records. RESULTS: Thirty nine out of 40 enrolled MLP had case scenario and clinical observation scores for both the baseline and end of intervention assessments. The mean difference in difference was 16.7 %( 95% CI: 9.8-23.6, p<0.001) for the case scenario assessments and 25.9 %( 95%CI: 14.4-37.5, p<0.001) for the clinical observations. Onsite clinical mentorship was significantly associated with an overall improvement for five out of the eight health facility TB and HIV indicators tracked. CONCLUSIONS: One-on-one, on-site mentorship improves individual knowledge and competence, has a downstream effect on facility performance, and is a simple approach to training MLP for task-shifting. |
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