The Role of CHART and the Importance of Continuing Education for PMTCT

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The Role of CHART and the Importance of
Continuing Education for PMTCT
Wendy Sealy Training Coordinator CHART Barbados,
HIV/AIDS Programme Management Unit, Ministry of
Health, Barbados. Symposium on Management of
Mother-to-Child Transmission of HIV/AIDS Feb. 5
6, 2009
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Objectives

• Outline the role of the CHART Network in the
  training and education of healthcare workers in
  the Caribbean region.
• Identify the role of continuing education in
  healthcare
• Describe the importance of continuing education
  in PMTCT

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Why CHART?
Caribbean HIV/AIDS Regional Training
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HIV Infection Rates in Adults by Region of the
World in 2004
Source UNAIDS
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The Pan-Caribbean Partnership against HIV/AIDS

• Established February 2001
• PANCAPs five-year strategic agenda seeks to
• decrease the no. of new HIV infections
• provide care and support for those affected by
  HIV/AIDS
• reduce stigma and discrimination, and
• mobilize the response to the epidemic

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• CHART began as an idea at more than one
  location
• An idea shared with neighbours
• In early 2001, CARICOM CAREC requested needs
  assessment related to HIV/AIDS care support
  training in the Caribbean region
• Key stakeholders in the region shared their
  experience and thoughts with the assessment team
  from CDC/GAP, Univ. of Washington and US
  Southeast AIDS Education Training Center (AETC)

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• Gestational period 14 years

• Multiple pregnancy !

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• The Vision Statement
• The Caribbean HIV/AIDS Regional Training
  (CHART) Network leads the way in training
  excellence with the aim of reducing the burden
  and impact of HIV, AIDS and related conditions in
  every Caribbean country and territory.

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Mission Statement

• The mission of the CHART Network is to strengthen
  the capacity of national healthcare personnel and
  systems to provide access to quality HIV and AIDS
  prevention, care, treatment and support services
  for all Caribbean people through the development
  of a robust and sustainable training network.

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Location of Training Centres

• Jamaica
• Bahamas
• Haiti-GHESKIO/ PIH Zami Lazante
• Barbados
• OECS HAPU
• Trinidad and Tobago
• Regional Coordinating Unit, UWI, Mona, Jamaica

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The shape of
PANCAP
FUNDING
TECHNICAL SUPPORT
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A Caribbean Map
CHART Coordinating Center
CAYMAN IS.
ST. KITTS
BELIZE
NEVIS
PANCAP
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Governance Structure

• CHART Network Governance Structure consists of
• Advisory Board which meets once a year
• 2. Executive Council at least twice a year
• NB. The organization is governed by a
  constitution and Bye-Laws

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Regional Partners

• PANCAP
• CARICOM
• Caribbean Association of Pharmacists
• Caribbean Dental Group
• CAREC/PAHO
• Caribbean Nurses Organization

• CRN
• CCNAPC
• CFNI/PAHO
• CHRC
• OECS Regional Coordinating Mechanism
• Others

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International Partners

• I-TECH
• ANAC
• BroadReach
• CDC-GAP
• FXB

• HRSA
• HIV/AIDS Alliance
• IAS-USA
• Lutheran Medical Center
• MEASURE/MACRO
• Merck

• Universities
• Cornell
• Harvard
• UAB
• Vanderbilt
• UNAIDS
• USAID
• Others

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Categories of personnel being trained across the
CHART Network

• Physicians
• Nurse practitioners
• Clinical nurses
• Public Health nurses
• Pharmacists
• Dentists
• Laboratory workers
• Social workers

• Counsellors
• Community health aides
• Accompagnateurs
• Contact investigators
• Health administrators
• PLWHAs

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Priority Themes (1)

• Comprehensive Treatment, Care and Support
• Team approaches to care, support and treatment
• The approach to the patient and the family
• PMTCT
• VCT

• Use of ARVs
• Prophylaxis and Rx of Opportunistic Infections in
  the Caribbean
• Dx and Rx of TB
• Rx of STIs
• Appropriate use of the laboratory techniques

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Priority Themes (2)

• Nutrition for non-nutritionists
• Record keeping informatics
• Notification
• Confidentiality
• Prevention in the context of care

• Stigma and discrimination
• Psychosocial care
• The health care worker as an advocate
• Basic counselling skills for the health care
  worker

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a flexible model

• By prior arrangement, teams of trainers
• will work either at CHART Centres or other
  training sites
• Learning activities
• will occur at points of delivery of care as
  much as possible

• Trainers
• Caribbean nationals and experienced persons from
  outside of the Caribbean
• Learners
• may sometimes go abroad

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The Model levels of training

• Taken from the US AIDS Education and Training
  Centers (AETC) Model

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Level 1 mainly didactic

• Large groups
• Typically
• Lectures
• Journal club
• Grand rounds
• Special topic seminars

Learners largely in passive mode some
interaction.
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Level 2 Skills-building workshops

• Smaller groups, interactive, e.g.
• Case discussion
• Simulated patients
• Role play

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Level 3 Working with real patients and situations

• Clinical observation of patient care
• Interaction with patients during care
• Mini-residencies
• Preceptorships
• Telemedicine

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Level 4 Clinical consultation mentorship style

• Interaction between the mentee and the mentor
  via
• Telephone or fax
• Internet
• On-site consultation
• Other

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Focus present and future

• Scaling up Number and Quality of Training Efforts
• National Training Centers as Centers of
  Excellence
• linked to Health Facilities for Study Tours and
  Preceptorships
• Database of trainers

• Regular Clinical Consultation
• Study Tours
• Training Certification
• Strengthening In-service and Pre-Service
  Training

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Importance of Continuing Education

• DEFINITIONS
• Continuing Education
• Specialist courses to update professionals
  regular courses or training designed to bring
  professionals up to date with the latest
  developments in their particular field. Encarta
  Dictionary
• Educational classes or experiences for licensed
  professionals that extend, update, or renew their
  knowledge of practices in their field.
  Answers.com
• For the profession of pharmacy is the structured
  educational activity designed or intended to
  support the continuing development of pharmacists
  and /or pharmacy technicians to maintain and
  enhance their competence (promote problem-solving
  and critical thinking). Accreditation Council for
  Pharmacy Education

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The context of Continuing Education

• Continuing education vs traditional education
• The latter offers formal schooling which offers
  basic skills to start persons off in the world of
  work
• The former however offers additional knowledge
  and skills to enhance the work of the participant
  and to apply lessons to their work experience

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Benefits of Continuing Education

• A more skilled workforce which is more productive
• Employers more likely to hire or retain persons
  who have continuing education on their resume
  (organization likely to remain competitive)
• Use of a variety of teaching/learning
  methodologies and interactive media to allow for
  continuing education through distance learning

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Applicability of continuing education to pharmacy
practice

• The development and maintenance of
  proficiency in five core areas
• Delivering patient-centered care
• Working as part of a multidisciplinary team
• Practicing evidence-based medicine
• Focusing on quality improvement
• Using information technology
• (Adapted from Institutes of Medicines Health
  Professions Education A bridge to Quality, 2003)

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The Importance of Continuing Education in PMTCT
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Barbados National PMTCT Curriculum Goals

• To equip healthcare workers (HCW) with sufficient
  knowledge and basic skills to care for pregnant
  women with HIV and their infants.
• To demonstrate the benefit of antiretroviral
  therapy (ART) in reducing the risk of
  mother-to-child transmission of HIV (MTCT) and
  caring for mothers and families

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Curriculum Development process

• Design- Conceptualization stage attention given
  to varied components including the philosophical
  underpinnings, goals, objectives, content,
  learning experiences and and evaluation.
• Develop- planning, construction and logical step
  by step procedures used to produce written
  documents.E.g. vision statements, goals,
  standards, performance benchmarks.
• Implement-Stakeholder contribution to
  operationalize the curriculum through meetings.
• Monitor-Follow through to ensure that practice
  is in keeping with goals and objectives of
  national curriculum.
• Evaluate-Data collection process on the field to
  determine the effectiveness of the curriculum
  design.
• Review-Information gained from data analysis is
  used to guide appropriate adjustments.

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Barbados National PMTCT Curriculum Process

• Participation of a group of health care
  providers from the LRU, QEH and Polyclinics
  participated in I-TECH/CHART training activity in
  Bahamas for the Scaling up of PMTCT activities
  in the Caribbean region in 2005
• The participation of CHART Coordinator and Health
  Education Officer of the MOH to the Technical
  Working Group meeting of the Bahamas National
  PMTCT Curriculum process in 2006
• Establishment of a PMTCT Curriculum Committee in
  2007
• PMTCT Stakeholder Meeting, May, 2007
• Draft curriculum compiled by a curriculum
  specialist from I-TECH
• PMTCT Technical Working Group meeting, September,
  2007
• Piloting of the Barbados PMTCT National
  Curriculum, November 2007

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Barbados National PMTCT Curriculum

• Course Structure
• Format
• 5 full days
• 10 Modules
• Interactive, adult learning
• Didactic (lectures)
• Two main documents
• Facilitator manual
• Participant manual

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Barbados PMTCT Curriculum Course content

• Course Introduction
• Module 1 Introduction to HIV/AIDS
• Module 2 Introduction to PMTCT
• Module 3 PMTCT Interventions/ARV Prophylaxis
• Module 4 Adherence in HIV Care
• Module 5 HIV Testing
• Module 6 Infant Feeding
• Module 7 Continuum of Care for Women, Children,
  Families
• Module 8 Stigma and Discrimination
• Module 9 Healthcare Worker Safety

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Key Points

• CHART promotes multidisciplinary team education
  and training programmes for health care workers
  including pharmacists in the Caribbean region.
• PMTCT is concerned with care and services for
  pregnant women and their families.
• Continuing education is lifelong learning geared
  at enhancing and strengthening the knowledge and
  skills of healthcare workers in their area of
  specialization.
• The importance of PMTCT in continuing education
  in PMTCT assures that healthcare workers are able
  to access current information to enable them in
  providing quality care to clients.

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Thank youAcknowledgements Dr. Anton Best,
SMOH (CD), Ministry of Health, BarbadosProf.
Brendan Bain, Director, CHART RCUwww.chartcaribb
ean.org