Copyright:
W. Michael Scheld, M.D.
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The Infectious Diseases Institute
Training Department
W. Michael Scheld, MD
August 2007
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Training Program

Mission:
To equip health care workers in Africa with
the knowledge and skill set to become leaders
in the provision of quality care, prevention and
research in HIV/AIDS and other infectious
diseases.
Focus on:
 equipping health care workers in Africa to
become leaders in the provision of quality
HIV/AIDS care and prevention
 Contributing to the enhancement of health
care infrastructure in Africa
 building a platform for multinational ARV
delivery programs
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Evolution of Training
Department
 Started in 2002 with HIV training program
offering 4 -week HIV core course
–
–
–
–
Targeting only medical doctors
6 courses a year
9 trainees per course
Manned by 2 staff
 Due to overwhelming demand, intake
increased to
– 12 trainees in February 2003
– 18 trainees in November 2003
– 25 trainees in 2004
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Evolution of HIV Training
Program
 In March 2004, 1-week HIV course started
– Focus on the diagnosis/ management of common OIs
and appropriate use of ARVs
– Targeting multi-disciplinary teams (Clinical officers,
Nurses/Midwives, Counselors, Lab personnel, etc)
 In Jan 2005, started 2-week HIV course
– Focusing on comprehensive HIV care including ART
– Targeting Senior Nurses/Midwives and Clinical officers
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Evolution of HIV Training
Program
In 2006,
– HIV core course modified to 3-week course
– Introduced 1-week modular courses (more
specialized);
Research in HIV care
Training of trainers
ART programme management
Peadiatric HIV care
After the core course, trainees may attend
at least one Modular course
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Core course: sample of
subjects
Epidemiology, transmission, control HIV infection
HIV biology, clades, receptors, immunology,
natural history
diagnosis and management of OIs, clinical
manifestations; WHO staging
ART: start, switch, adherence, toxicities,
monitoring, drug interactions
HIV prevention, infection control, counseling,
psychosocial support, palliative care
Comprehensive HIV care,; data management
ethics; clinical trials in RLS
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Core course: clinical placements
(≈ 40% course)
I.
AIDC
PIDC
↑
Uganda Cancer Institute
Department of Dermatology
ATIC
Uganda AIDS Commission
MOH
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Core course: clinical placements
(≈ 40% course)
II.
Hospice Uganda
Mildmay
TASO
↑
AIDS Information Centre
Joint Clinical Research Centre
Mwanamugimu (Mulago nutrition ward)
Mulago hospital medical wards
MU-JHU core laboratory
Nsambya home care
PMTCT clinic (MU-JHU)
(KCC clinics)
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Core course: assessments
Pre- and post-test (written exam)
Pre- and post-clinical examinations
Presentation of cases from home facility
Journal club
Group presentations
Take home examinations (weekly)
Daily evaluations of each session
Computer basics; electronic library
(Certificate at graduation)
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Evolution of HIV Training
Program
Other courses
– DATA management course in June, 2007
Targeting all health workers
Focusing on clinical data management and analysis
– Clinical Pharmacy in ART course (January 2007)
Targeting health workers involved in dispensing
ARVs
Focusing on clinical pharmacy in ART services
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Other training programmes
 Joint Uganda Malaria Training Program
(JUMP)
– A collaboration between UMSP, IDI and MoH
– Funded by Exxon Mobil
– Focusing on integrated management of malaria
using a team approach
– Targeting Clinicians, Laboratory and records
personnel
– Operating in 9 health facilities located in 8
districts
– First training course December, 2006
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Other training programs
BD Laboratory training Program
– A collaboration between MU-JHU,
Microbiology department (MUK) and IDI
– Funded by Becton Dickinson
– Targeting Laboratory personnel in
regional hospitals, district hospitals and
HC IVs
– Focusing on ART/HIV Laboratory
Management
– First training course in April, 2007
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Other training programs
 AIDS Treatment Information Center (ATIC)
– A warm line for HIV/AIDS treatment
– Health workers can beep ATIC number and ATIC
calls back to receive their queries
– Where need be ATIC consults relevant clinicians
before responding to the queries
– Queries can reach ATIC by e-mail as well
– It is an authorized national referral centre (by
MOH) for switching therapy from 1st line to 2nd
line
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Achievements
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Development of new
programs


Joint Uganda Malaria Training
Program (JUMP)
BD laboratory training program
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Development of new courses

Targeting a wide range of health workers

Modular courses




TOT
Research in HIV care
ART program management
Paediatric HIV care
Multi-disciplinary one-week course
 HIV/ART course for senior nurses and clinical
officers
 HIV/ART laboratory management
 Data management course
 Pharmacy module

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Training
HIV training program
– Conducted a national Training Needs
Assessment (TNA) for health workers
involved in HIV/AIDS care
– Developed a M&E framework
– Developed a database for training program
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Training- HIV training
cont’d
– Number of Trainees
 1,513 trainees as of June 30, 2007
– 296 (20%) Non-Ugandans
– 1,217 (80%) Ugandans
 Trainees from 28 countries including
– Netherlands (1)
– Papua New Guinea (2)
– 25 other African Countries with 44% (129) from Nigeria
 Trainees by profession
– 765 (51%) were medical doctors
– 748 (49%) were other health workers
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20
DoD sponsored trainees; IDI;
2005-2007
21 courses attended (2-26/course)
total = 221
112 MOs
32 COs
72 nurses/midwives
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Training – cont’d
Joint Uganda Malaria Training Program
(JUMP)
– Completed a training curriculum
– 209 health workers trained including
118 (56%) clinicians
39 (19%) laboratory personnel
52 (25%) records personnel
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Training – cont’d
 BD Laboratory training program
– Completed a training curriculum
– Completed a pilot course (unit I and II)
– 7 laboratory personnel working in Kampala
 Data management course
– Completed a training curriculum
– Conducted pilot course
– Trained 23 health workers (Multi-disciplinary) from
Kampala City Council health services
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Training – cont’d
Pharmacy course
– Completed a nation wide Trainees Needs
Assessment (TNA) for health workers involved
in dispensing ARVs
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Training – cont’d
 ATIC
– Responded to 2,662 queries by June, 2007
mainly from Uganda, but also from 15 other
African countries
– Other countries like US, UK, Ireland, India, Italy
and Belgium consult ATIC before sending
Ugandans on ART back home
– Held several CME sessions in Kitovu Hospital
– Now helping other countries to start similar
services
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Other Achievement

Staff has expanded from 2 in 2002 to 18
in 2007
Training team
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Leadership transition
Other training programs in the
IDI
Makerere University medical students
5 students/week (years 4 and 5)
One week rotation in IDI
August-November and↑ February-May
(entire class)
MMeds; Department of Medicine, MU
2 MMEds/block
One month rotation in IDI
Ten months/year (all MMEds 2s and 3s)
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Other training programs in the
IDI
ID fellowship (3 years; e.g. Andrew
Kampugu, Sabrina Bakeesa, David Meya)
Sewankambo scholars
↑
Gilead exchange program
U.S. residents and ID fellows (e.g. Shevin
Jacob, Chris Moore, Lisa Mills, etc.)
Gates proposal (submitted) (Cos and
nurses)
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Future plans
Committed to continue building capacity in
Africa
Expand to include other infectious
diseases like TB in our training programs
As a result of TNA, we plan to
– Develop a HIV core course for non-medical
doctors health workers prescribing ART
– Implement a new recruitment model to reach
more health workers in resource constrained
settings
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Challenges


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Lack of funding for implementation of new
recruitment model
Reduction in IDI sponsorship to trainees
Development of a core course for nurse
prescribing ART may be resisted as the policy in
Uganda does not allow nurses/midwives to
prescribe ARVs
Sites for clinical placements are overwhelmed
with our trainees (numbers and frequency)
Reliance on facilitators from outside IDI who are
busy
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IDI training department
budget
Expenditures 2007-2008 = $1.084 million
sources of support
paid tuition, scholarships, ExxonMobil, BD,
Gilead, DoD, Realta, etc.
Net cost 2006-2007 : $163,145
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Conclusion


The training department has built capacity
in health workers in 26 out of 52 Africa
countries
Built capacity of over 1,500 trainees who in
turn train other health workers (20 health workers
reportedly trained by each trainee per month in Uganda – Marcia
Weaver (2006))

The program has expanded to include other
areas such as malaria, laboratory and data
management
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