Mother to Child Transmission is the most significant route of transmission of HIV infection in children below the age of 15 years. In the absence of any intervention the risk of such transmission is 15–30% in non-breastfeeding populations. Breast feeding by an infected mother increases the risk by 5–20% to a total of 20–45%. The risk of parent to child transmission can be reduced to fewer than 2% by interventions that include, antiretroviral (ARV) prophylaxis given to women during pregnancy and labour and to the infant in the first weeks of life, obstetrical interventions including elective cesarean delivery and complete avoidance of breastfeeding. With these interventions, new HIV infections in children are becoming increasingly rare in many parts of the world, particularly in high-income countries.
However under the national PPTCT program, single dose Nevirapine (NVP) regimen for mother and babies was being followed to prevent HIV vertical transmission. The single dose NVP is not completely effective to prevent the transmission of HIV from mother to child and the HIV virus has potential to develop resistance strains to single dose NVP easily. Considering these facts, National AIDS Control Organisation (NACO) has revised PPTCT technical guidelines in line with WHO recommendation. The new PPTCT guidelines are currently being implemented in Karnataka and Andhra Pradesh (AP) with a focus on further reducing the transmission to 2% and lower.
Why Train Private Medical Colleges?
Since 2005, SHARE India supported by Centers for Disease Control and Prevention (CDC) has formed a consortium of private medical colleges in AP. The objective of the consortium was to initiate HIV care, treatment and prevention services as per the national guidelines.
Along with a range of other HIV related services these medical colleges are now involved in conducting deliveries of HIV positive women, provision of Nevirapine prophylaxis as well as counselling and testing services through the Integrated Counselling and Testing Centres (ICTC) established through the partial support of APSACS.
With the introduction of new multidrug regimen for the PPTCT program by NACO, SHARE India conceptualized training of private medical college staff to update and strengthen the PPTCT program among the consortium partners with valuable inputs/support from APSACS.
• Medical colleges are tertiary teaching hospitals where treatment services are viewed as a primary responsibility. However treatment for prevention of HIV involves the follow-up of the mother and the child hence the faculty should be capacitated on the referral mechanisms which is not part of the private system.
• PLHIV are accessing services from these institutions and trained staff attending to these cases will result in proper care and treatment.
• The new multi-drug PPTCT regimen is complex compared to the single dose Nevirapine and will require a focussed hands on a case study based training.
In order to address the above SHARE India has proposed training the staff of private medical colleges along with resource support (of NACO trained state resource persons) and guidance from APSACS.
Training aims
By the end of the capacity building program, the health care providers in the private medical colleges will be able to implement the new PPTCT guidelines and establish referrals with the NACP service delivery points for further treatment care and follow up.
Expected Outcomes
• As many as 75 to 100 health care providers will be trained on revised PPTCT guidelines creating a pool of a trained team in each of the private consortium hospitals.
• Each college will conduct at least 4-5 CMEs post training as part of the medical college activity to faculty, postgraduates and medicos.
• Prescribed national guidelines for HIV PPTCT will be followed in the medical colleges
Process adopted
In order to reach the more number of health care providers in the consortium, SHARE India has adopted a cascade model of trainings by creating local pool of resource persons. The twenty medical colleges in the consortium will be covered over 4 trainings; with each training covering select staff of 5 medical colleges. From each medical college 6 participants will be invited; 4 doctors (one doctor from each of the following departments-OBG, Paediatrics, Community Medicine and microbiology) and 2 nurses (posted in labour room). These trained doctors and nurses are expected to orient the remaining faculty at the private medical colleges through CMEs as per the activity plan developed at the end of the training program. The CME will also cover the post graduate students and inters who would be involved in patient care either directly or indirectly. The trained nurses will orient the nurses working in the hospital on the revised guidelines.
Methodology
A conscious attempt is made to include a variety of training aids such as films and case studies, and to use participatory methodologies such as small group work, discussion etc. The program for each day is divided into different sessions, allowing for a logical sequencing of activities.
Evaluation Plan
Formative Evaluations
1. Pre and Post-test
Pre- and post-tests will be used to measure knowledge gained by participants during the training. A set of questions will be administered to participants before the commencement of training to determine their knowledge level and the same questions, will be given to them after the training.
2. Daily Feedback and Debriefing
At the end of every day feedback will be sought from the participants through a structured questionnaire consisting of both close and open ended questions. These will be discussed during the facilitators de-briefing meet and required changes will be made for day 2. The debriefing will also include the feedback of observers on facilitation processes .
Summative Evaluation
1. Follow up plan
A follow up plan to assess the absorption and implementation of the knowledge gained by the participants is underway. The participants have communicated their willingness to be part of such an exercise.
