Rapid introduction of Option B+, whereby all pregnant women who test HIV positive are placed on combination antiretroviral therapy (cART) for life regardless of CD4 count or clinical stage, is rapidly expanding in many sub-Saharan countries with high HIV prevalence and limited resources, including Mozambique. However, earlier initiation of cART in the antenatal care setting dramatically alters the role of maternal and child health (MCH) nurses, namely with the additional clinical management tasks required of them. Preparations to support the introduction of cART in antenatal care have targeted country-level readiness tools, while less attention has been given to building essential clinical competencies for mid-level nurses now responsible for the care and management of HIV-infected pregnant women and their children.
In this study, initiated in November 2014, Health Alliance International is leading the development and evaluation of a tablet-based training approach incorporated into routine supervision efforts by nurse managers, which aims to build core clinical competencies for nurses who are introducing cART in pregnancy. Nurse managers will receive real-time data from competency assessments embedded in the modular training so they can assess trainees progress in mastering certain skills; by building in this function, we will be able to assess the feasibility of using a centralized data system with modular test results to identify specific training needs and develop targeted improvement efforts to meet these training needs. The overall goal of this study is to develop and evaluate a replicable model for on-the-job clinical training for nurses introducing Option B+ that can be adapted by PMTCT and HIV care and treatment programs operating in resource-limited settings.
Specific aims of the study are to:
- Identify gaps in maternal and child health nurse competencies related to Option B+ as a foundation for the development of an effective training approach;
- Develop a tablet-based training approach that uses video vignettes and competency testing to strengthen on-the-job training for nurses providing Option B+ services; and
- Assess the acceptability and impact of the tablet-based training on clinical competencies among maternal and child health nurses providing cART for HIV-infected women.
This study is being supported by a grant from the University of Washington’s Center For AIDS Research.