HealtheFoundationThe Ugandan experience

Dr Nadine Pakker

18 May 2009

UgandaUganda

HealtheFoundation in Uganda

2004

� Dr Fransje van der Waals

� Cordaid

� Joint Clinical Research Centre

Masindi

Nakasongola

Kases

e

Hoima

Kib

aale

KibogaLuwero

Apac

Mukono

Kamp

ala

MubendeKabarole

Nebbi

Arua

Gulu

Adjumani

Kabale

Mbarara

Rakai

SembabuleMasaka

Kalangala

JinjaIganga

Busia

Mbal

eTororo

KapchorwaPallisa

Kumi

Katakwi

Moroto

Kotido

Kitgum

Soroti

Lira

Mpigi

Bushenyi

Rukungiri

Kamuli

Ntungamo

Moyo

SUDAN

KENYA

TANZANIARWANDA

Kamwenge

Kyenjojo

Kayunga

Kanungu

Yumb

e

Pader

Sironko

Nakapiripi

ritKaberamai

do

BugiriMayugeWakis

o

DRC

Kisoro

Bundib

ujo

27 January 2004

� Round Table Meeting: launch of HIVeDucation with participants from all training organizations in Uganda (UCMB, JCRC, Academic Alliance, Hospice Africa Uganda, Mildmay, TASO, ATIC) and Ministry of Health

� Annual report 2006:Uganda was the first African country where the computer-based format of HIV education was instantly accepted as a useful and timely tool to train the many health care workers who are needed to roll out the treatment program.

27 January 2004

� Joint venture between Cordaid, JCRC and

HealtheFoundation in logistics and finance

� Collaboration of JCRC with Nyakibale

hospital and other hospitals in the Nyakibale

district

February - April 2004

� Uganda HIV epidemiology module (MoH)

� Clinical cases by physicians from JCRC and Prof Katabira

� Initiation workshop

HIVeDucation

Nyakibale

44 participants

Initiation workshop Nyakibale

April 2004

Nyakibale follow up

� Support team

– IT support: UICT

– Continuous support:

Mrs Hanipha Kakooza

– Evaluation: I-Tech

University of Washington

Prof Marcia Weaver

Nyakibale follow up workshop Mbarara25 August 2004

Lectures

Clinical cases

Drug adherence test

Focus groupRole play

DVD

PLWHA

33 participants

Nyakibale follow up workshop Mbarara25 August 2004

Nyakibale follow up workshop Mbarara25 August 2004 / 7 April 2005

Physician 41%

Clinical officer 25%

Nurse 30%

Counselor 4%

Profession

100%73%Completed 1 or more courses

53%39%Completed 10 or more courses

41%30%Completed all 15 courses

Conclusions Nyakibale training course25 August 2004 / 7 April 2005

� Strong assembly of enthusiastic trainers created� Training program appreciated by the trainees:

language understandable, courses useful and informative for both ARV and non-ARV clinics and information applicable

� Trainees enjoyed the training method

� Appreciation expressed by all levels of health care workers

� Positive impact on both HIV knowledge and computer skills

� Certificates provided a strong motivation

Conclusions Nyakibale training course25 August 2004 / 7 April 2005

� Learning method could be improved by “print” option

� Technical problems with use of USB stick

� Computer access biggest problem, internet access almost impossible

� More interaction requested during self-learning period and follow-up workshop

� Formal accreditation for HIVeDucation preferred by

trainees

Conclusions Nyakibale training course25 August 2004 / 7 April 2005

� Additional modules suggested:

– Palliative care

– Pharmacokinetics

– Disclosure

– Nutrition

HIVeDucation 2006 - 2007

� Acknowledgement by Ministry of Health Uganda

� Computer donation through Close the Gap

� Added modules: Palliative care and Pharmacology logistics

� During follow-up workshop more attention for nutrition (scenario) and disclosure (trigger tape)

� Challenges <–> solutions group activity

� Change in software program

� Print option

� Participant portal

HIVeDucation 2006 - 2007

Participants

� Hospice 46

� UCMB 96

� TASO 167

� JCRC - Mpigi 48

Hospice workshop July 2006

Mpigi workshopMarch 2007

UCMB workshop

September 2006

HIVeDucation UCMB

37

12

15

29

24

27

34

6

19

16

18

18

20

21

21

27

79

75

110

104

96

116

97

92

108

37

72

96

88

64

116

137

36

56

58

40

50

42

40

71

53

64

59

53

53

58

48

39

74

63

64

69

70

90

94

97

93

96

94

97

97

99

99

92

Natural history and pathogenesis

ARV interactions

Lab diagnostics and monitoring

ARV drug resistance

ARV toxicity

Palliative care

HIV-TB

OI’s

Pediatric HIV

Clinical monitoring of HIV

Counseling on adherence

Initiation ARV

Principles ARV

pMTCT

VCT, prevention and care

Epidemiology

Do

ne

Pre

Dif

f

Tim

e

HIVeDucation UCMB

Mean increase in scoreComputer use

Daily 12%

Often 18%

Rarely 22%

Never 48%

19%

20%

26%

19%

Increase post-testPre-testGroup

50%

45%

57% 19%22%Doctors

24%34%Nurses

22%44%Other

2007 Pediatric HIVeDucation

� Collaboration with the PENTA group

� 50 Ugandan pediatricians

� Follow-up activities and workshop needed to

optimize training effect

Challenges

� Workload

� Computer access

� Virus

� Online versus offline

– Participant portal

– Continuous medical education

HealtheFoundation 2008 - 2009

HealtheFoundation and INTERACT - AMC-CPCD Foundation

The Infectious disease Network for Treatment

and Research in Africa

Building capacity for clinical research in Africa

– Tuberculosis, HIV, malaria

– Uganda and Rwanda

– 2006 – 2011

– NWO-WOTRO

– European Union

HealtheFoundation 2008 - 2009

� HIVeDucation

– KCC 96 participants

� TBeDucation

– KCC 67 participants

– IDI 40 participants

HealtheFoundation 2008 - 2009

� HIVeDucation Mentoring program

Training - of - Trainers

15 mentors

45 mentees

Acknowledgements

HealtheFoundation AmsterdamPartnering institutes UgandaFacilitators UgandaParticipants UgandaDonors