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Training of Health Care Providers on Anti Retro Viral Therapy

Training of Health Care Providers on Anti Retro Viral Therapy Training Report

Dr. Shabnum Sarfraz Global Fund Project Office Fatima Memorial Hospital, Shadman, Lahore, Pakistan

Fatima Memorial Hospital |

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Training of Health Care Providers on Anti Retro Viral Therapy Contents Introduction ............................................................................................................................................ 2 Background ......................................................................................................................................... 2 Objective of Training ........................................................................................................................... 2 Specific objectives ............................................................................................................................... 2 Desired outcome of the training .......................................................................................................... 2 Selection of Audience .............................................................................................................................. 2 Defining content of Training .................................................................................................................... 3 Selection of Trainers ................................................................................................................................ 4 Training Methodology ............................................................................................................................. 5 Agenda of the Workshop ......................................................................................................................... 6 Work Shop Proceeding ............................................................................................................................ 8 Session Outline .................................................................................................................................... 8 Session 1: Demystifying HIV and AIDS - A Global Issue by Dr. Shabnum Sarfraz ........................................ 8 Session 2: When to start ARV? By Dr. Faisal Mehmood ............................................................................ 8 Session 3: ART for HIV/HBV and Tuberculosis Co-infection By Dr. Farheen Ali .......................................... 8 Session 4: PPTCT- District Model- An Overview By Dr. Azra Ghayas ......................................................... 8 Session 5: Post-Exposure Prophylaxis By Dr. Sunnil Kumar ...................................................................... 9 Session 6: Managing The Side Effects And Complications during ARV Therapy Lab Monitoring By Dr. Naseem Salahuddin ................................................................................................................................. 9 Session7: ART for Children By Dr. Fatima Mir ........................................................................................... 9 Session 8: Role of Counselling and Adherence in ARV Therapy By Dr. Asma Nasim .................................. 9 Annexure............................................................................................................................................... 11 Annexure 1: List of Participants Registered for HCP Karachi ............................................................... 11 Annexure 2: Trainer’s Evaluation Form .............................................................................................. 12 Annexure 3: Trainers’ Evaluations Actual ........................................................................................... 13

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Training of Health Care Providers on Anti Retro Viral Therapy INTRODUCTION Background The Training of Health Care Providers is a sequential of Training of Mentors which was aimed to prepare and select five mentors who will be further involved in training the health care providers.

Objective of Training The training of Health Care Providers is aimed at building up the knowledge base of the Health Care Providers (that includes doctors, nurses, psychologists and sociologists) about the HIV/AIDS for the effective handling of Patients Living with HIV/AIDS (PLHIVs). The workshop also attempts at developing a network/ liaison of health care providers who will be experts in ART. This workshop has been exclusively arranged for the participants from Punjab and KPK province.

Specific objectives This two-day rigorous training covers all aspects of ARV Therapy. By the end of this training, participants will be expected to have knowledge of following topics: 1.

When to start ARV

2.

What is the first line therapy?

3.

When to switch ART-Second and Third line Regimen

4.

Managing the side effects and complications during ARV Therapy

5.

ART for HIV/tuberculosis co-infection

6.

ART for HIV/HBV co-infection

7.

Counseling for ARV Therapy

Desired outcome of the training At the end of this two-days training, the participants are expected to be fully equipped with the HIV/AIDS as a disease, its implications and the treatment practices which will enable them to manage well while handling PLHIVs.

SELECTION OF AUDIENCE Fatima Memorial Hospital | Introduction

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Training of Health Care Providers on Anti Retro Viral Therapy The selection of participants was critical as all of them were filtered through stringent criteria. The participants had to have a background in medicine, allied sciences, nursing, psychology/sociology, a post-graduate degree or diploma and some experience in HIV/AIDS. Interaction/work experience with health care providers who are working with HIV/AIDS was an additional plus. This profile was chared with SACP Training Coordinator in Sindh and the Medical Colleges in Baluchistant, in order to have the right candidates from there.

DEFINING CONTENT OF TRAINING Since the program was meant to inculcate the latest knowledge on management of an HIV-positive patient, through the stages of HIV to AIDS, the content was designed to provide a holistic approach towards the management of PLHIV and hence included the following areas: i.

In-depth knowledge of the HIV regimens

ii.

In-depth knowledge about second and third line regimens, times and indications to switch

iii.

Management of side effects and complications during ART

iv.

ART treatment along with the co-infections

v.

Role of counseling of PLHIVs

vi.

Need of Adherence in PLHIVs

Fatima Memorial Hospital | Defining content of Training

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Training of Health Care Providers on Anti Retro Viral Therapy SELECTION OF TRAINERS The basic ideology of the Training of Health Care Providers was to equip the participants with the latest knowledge about HIV/AIDS. Since no participant from Karachi had been able to qualify as a mentor in the Training of Mentors held from 5th-7th of October, subject specialists form various hospitals had to be seeked. In order to do so, different leading hospitals and departments of infectious diseases were contacted to get subject specialists. The trainers were Dr. Faisal Mahmood, Assistant Professor, Internal Medicine, AKU Diplomate, American Board of Infectious Diseases; Diplomate, American Board of Internal Medicine; MBBS, The Aga Khan University

Dr. Faisal Mahmood is not only a subject specialist on HIV/AIDs but has also spoken on multiple forums regarding its clinical management. He took the session on 1st line therapy of ARV. Dr. Farheen Ali, Assistant Professor, Internal Medicine, AKU Diplomate, American Board of Infectious Diseases; Diplomate, American Board of Internal Medicine; MBBS, Dow Medical College

Dr. Farheen Ali is also a consultant in infectious diseases and spoke on the second line regimen. Dr. Azra Ghayas, Treatment Coordinator, ART Center, Civil Hospital MBBS Dr. Azra Ghayas has been involved in SACP for quite a while now, working diligently on treatment coordination for the provincial ART center established in Civil Hospital. Dr. Sunil Kumar, PG Trainee, Civil Hospital MBBS Dr. Sunil Kumar has shown a keen interest in Post-exposure prophylaxis and has been taking up a trainings of health care providers on the subject. He was engaged at the recommendation of SACP as a subject specialist and has also spoken on numerous forums.

Fatima Memorial Hospital | Selection of Trainers

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Training of Health Care Providers on Anti Retro Viral Therapy Dr. Naseem Salahuddin, Senior Consultant, Department of Infectious Diseases, Indus Hospital Diplomate, American Board of Internal Medicine, Fellowship, American College of Physicians, USA, Fellowship, Infectious Diseases, Henry Hospital, Detroit, USA, Internship,Rhode Island Hospital, USA, MBBS,Karachi. Dr. Naseem is a very senior and respected name in infectious diseases nationally. She has a keen interest in areas of HIV/AIDS and tuberculosis and is the most apt choice to talk about managing the side effects of ARV and the second and third regimes. Dr. Fatima Mir, Senior Instructor, Pediatrics, AKU MBBS, Dr. Fatima Mir has been working in the department of Mother and Child Health Care, AKU under Prof. Dr. Anita Zaidi. She frequently deals with children suffering from HIV and has spoken on the treatment protocol to be followed in this regard. Dr. Asma Nasim, Senior Registrar, Bismillah Taqqi Hospital MBBS, FCPS (Paediatrics) Dr. Asma Nasim has researched extensively on HIV/AIDS, malaria and dengue, infectious diseases being her specialty.

TRAINING METHODOLOGY The training sessions were interactive and participants were encouraged to reflect on the concepts and knowledge shared by the trainers. The trainers rigorously covered all the aspects of HIV/AIDS in two days time. The participants were persuaded to actively involve in the presentation and Q/A sessions for the improvisation of their knowledge and skills. At the end of each day, the participants were asked to fill an anonymous evaluation form, evaluating the trainers for the day. At the end of the second day, the participants were also asked to evaluating the entire workshop as well as give suggestions and recommendations. The recommendations have been noted down for future workshops.

Fatima Memorial Hospital | Training Methodology

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Training of Health Care Providers on Anti Retro Viral Therapy AGENDA OF THE WORKSHOP Dates

22nd - 23rd October, 2012

Venue

Conference Room, Civil Hospital Karachi

TIME

SESSIONS

09:00 - 10:00

10:00 - 11:00

11:00 - 11:15

11:15 - 12:15

Inaugural Ceremony & Group Photograph Session 1: Demystifying HIV & AIDS - A Global Issue Facilitator Dr. Shabnum Sarfraz

Tea Break Session 2: When to start ARV? What is the first line therapy? Facilitator Dr. Faisal Mahmood Session 3: ART for HIV/Tuberculosis & HBV co-infection

12:15 - 01:15 Facilitator Dr. Farheen Ali 01:15 - 02:00

Lunch Session 4: ART for Pregnant Women, PPTCT Model

02:00 - 03:00 Facilitator Dr. Azra Ghayas

Fatima Memorial Hospital | Agenda of the Workshop

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Training of Health Care Providers on Anti Retro Viral Therapy Dates

22nd - 23rd October, 2012

Venue

Conference Room, Civil Hospital Karachi

TIME

SESSIONS Session 5: Post Exposure Prophylaxis

09:00 - 10:00 Facilitator: Dr. Sunil Kumar

10:00 - 11:00

Session 6: Managing the side effects and complications during ARV Therapy Lab Monitoring, 2nd and 3rd regimens Facilitator: Dr. Naseem Salahuddin

11:00 - 11:30

Tea Break Session 3: ART for Children

11:30 - 12:30 Facilitator: Dr. Fatima Mir Session 8: Role of Counseling in ARV 12:30 - 1:30 Facilitator: Dr. Asma Nasim 1:30 - 2:00

Closing Ceremony

2:00 PM

Lunch

Fatima Memorial Hospital | Agenda of the Workshop

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Training of Health Care Providers on Anti Retro Viral Therapy WORK SHOP PROCEEDING Session Outline

SESSION 1: DEMYSTIFYING HIV AND AIDS - A GLOBAL ISSUE BY DR. SHABNUM SARFRAZ The session focused about the global and local spread of the disease till today. The disease stages along with the modes of transmission were also discussed briefly. The stigmas associated with PLHIVs were also shared in detail and the ways to remove such taboos were identified.

SESSION 2: WHEN TO START ARV? BY DR. FAISAL MEHMOOD The session conferred evidence-based recommendations for ARV Therapy, identification of most effective first-line, 2nd line and subsequent regimens. The time of initiation of treatment and the importance of careful decision making for ARV initiation with evidence based timing and regimen selection were also discussed. The access of ARV Therapy in low-income countries like Pakistan was also the part of the session.

SESSION 3: ART FOR HIV/HBV AND TUBERCULOSIS CO-INFECTION BY DR. FARHEEN ALI This session was primarily focused on HIV/TB co-infection as TB is responsible for 13% of deaths in HIV patients. The progression of HIV infection from latent to active TB was discussed in detail along with the clinical approach of TB co-infected PLHIV. The application of latest drug regimens for such co-infection was shared. The session also focussed on the findings of HIV/HBV co-infection. The aspects of counselling the patient for avoidance of alcohol, vaccination against hepatitis A (if not immune), advice on methods to prevent HBV transmission and evaluate severity of HBV infections were the main highlights of this session. The recommended testing for such co-infected patients was also discussed in detail along with the latest regimens for treatment.

SESSION 4: PPTCT- DISTRICT MODEL- AN OVERVIEW BY DR. AZRA GHAYAS This session focused PPTCT - District Model as the common modes of HIV/AIDS spread in females were the point of discussion. Like the discussion in Punjab, this presentation focussed on the practices underway in Sindh. The trainer further elaborated about the functioning and impact of PPTCT – District Fatima Memorial Hospital | Work Shop Proceeding

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Training of Health Care Providers on Anti Retro Viral Therapy Model adapted by Punjab AIDS Control Program in Punjab Province. The achievements to date of this model were also shared.

SESSION 5: POST-EXPOSURE PROPHYLAXIS BY DR. SUNNIL KUMAR This session was aimed specifically at the management of post-exposure prophylaxis, an area deficient in earlier trainings. The module outlined the measures one is to take in course of exposure to HIV, management of the inflicted and future actions and precautions. The presentation also threw light on mandatory precautionary measures that should be adopted in hospitals and clinics.

SESSION 6: MANAGING THE SIDE EFFECTS AND COMPLICATIONS DURING ARV THERAPY LAB MONITORING BY DR. NASEEM SALAHUDDIN The clinical and laboratory monitoring of drugs, important toxicities, complications and adverse effects of ARV Therapy was the core of this session. Management of drug toxities were also shared by the trainer in detail.

SESSION7: ART FOR CHILDREN BY DR. FATIMA MIR Management of children suffering from HIV was discussed at length, including the WHO-recommended protocols, regimens and precautions. The module also threw light upon family’s role in management of children LHIV.

SESSION 8: ROLE OF COUNSELLING AND ADHERENCE IN ARV THERAPY BY DR. ASMA NASIM The session primarily focused on the importance of level of commitment towards adherence and the consequences in case of non-compliance. Effective strategies to encourage adherence and ways to counsel patients about adherence were also discussed in detail. Adherence issue of PLHIVs in Pakistan were also the part of discussion. The session also included a group activity where participants were asked to present on various dimensions of ARV adherence and counselling. Comments of participants

Fatima Memorial Hospital | Work Shop Proceeding

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Training of Health Care Providers on Anti Retro Viral Therapy Following are the comments of the participants on the concluding day, collected anonymously:

It was a really nice experience to be here, which I was not expecting. All facilitators were very cooperative and tried their best to import their knowledge.

It is important to bring these types of workshops to professionals like barbers and beauticians and compounders, who are the source of such infections and can play an active role in stopping the spread of HIV.

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Training of Health Care Providers on Anti Retro Viral Therapy

ANNEXURE Annexure 1: List of Participants Registered for HCP Karachi Sr.# 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Name Dr.Nausheen Zulifqar Dr.Muhammad Rafique Dr.Aziz Ullah Khan Dhiloo Dr.Saima Dr.Noor-un-Nua Masqati Dr.Mubashar Saleem Dr.Bakhtawar .H.Rabadi Dr.Shehla Arif Dr.Gulfishan Haq Dr.Tahir ali Dr.Zawar Hussain Dr.Muhammad Zahid Dr.Zahid Hussain Dr.Kheenpal Das Dr Muhammad Rehan Dr.Pawan Kirar Dr.Kausar Rashidi Dr Arshad Mahmood Dr.Ghayas ud Din Dr Fawad Hameed Dr.Junaid Haq Dr Farheen Ali Dr.Faisal Mahmood Dr.Kiran Kalam Dr.Sunil Kumar

Designation Senior WMO MO CHK P-II Postgraduate JIMK Karachi Resident P-III WMO P-I PG-D-Derma SMO WMO Associate Prof.Gy-3 Assistant Professor WMO M-1 Chief MO MO Psychiatry Admin RMO MS-CHK RMO-M-5 CHK GP PPM-SACP CMO Pead emergency PG-M3-CHK CH Karachi Asst.Prof AKUH Asst.Prof AKUH Post Fellow Resident SIUT Fellow ID-SIUT

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Training of Health Care Providers on Anti Retro Viral Therapy Annexure 2: Trainer’s Evaluation Form

TRAINERS EVALUATION FORM Training Title: Training of Mentors

Dates: October 19, 20, 2012

Venue: Conference Room, 4th Floor, FMH College of Medicine & Dentistry, Shadman, Lahore Training

Training of Mentors on Anti Retro Viral Therapy

Venue

Fatima Memorial Hospital, Lahore

Date

October, 2012

We are interested in developing and honing the training for future use. Please take a minute to rate Dr. XYZ as a trainer. Strongly

Statement

Agree

Agree

Disagree

Strongly Disagree

The trainer was knowledgeable about the subject The trainer was well-prepared about the subject Explanations were clear and concise The trainer solicited questions and had the answers The trainer was interested in sharing information and knowledge The trainer’s presentation style was interesting and effective The trainer motivated, inspired and instilled confidence Comments if any:

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy Annexure 3: Trainers’ Evaluations Actual

Dr. Shabnum Sarfraz 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Dr. Faisal Mahmood 20 15 Strongly Agree

10

Agree 5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Dr. Farheen Ali 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy

Dr. Azra Ghayas 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Dr. Sunil Kumar 20 15

Strongly Agree

10

Agree

5

Disagree

Strongly Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Dr. Naseem Salahuddin 20 15 Strongly Agree

10

Agree 5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy

Dr. Fatima Mir 20 15 Strongly Agree

10

Agree 5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Dr. Asma Nasim 20 15 Strongly Agree

10

Agree

5

Disagree Strongly Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s presentation knowledgeable well-prepared were clear and solicited interested in about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

20

The trainer motivated, inspired and instilled confidence

Training Program/workshop

15 10

Strongly Agree

5

Agree Disagree

0 Objective of this Subject matter Training will Training session Participants Facillitator(s) training program was appropriate greatly assist you duration was were have good adequately met for your in your adequate to encouraged to presentation background and profession/area cover all relevant share skills/styles, experience of work materials information and knowledge and experiences grip over the subject

Strongly Disagree

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on ARV Therapy