IMAI TrainingIMAI Training

Training MethodsTraining Methods

No PowerPoint; no specialistsNo PowerPoint; no specialistsSkills-based learningSkills-based learning

Patient monitoring formsPatient monitoring formsPatient education materialsPatient education materials

Exercises and drillsExercises and drillsExpert Patient-trainersExpert Patient-trainers

Active training with cases, Active training with cases, interaction, clinical team buildinginteraction, clinical team building

What is the Expert Patient-Trainer?What is the Expert Patient-Trainer?

A person living with HIV/AIDS (PLHA) and/or on A person living with HIV/AIDS (PLHA) and/or on ART ART

Trained to role-play a patient in specific HIV Trained to role-play a patient in specific HIV cases that were often (but not necessarily) cases that were often (but not necessarily) similar to their own life experiencesimilar to their own life experience

Trained to assess the important skills that the Trained to assess the important skills that the health worker should acquire from the clinical or health worker should acquire from the clinical or aid training courses aid training courses

Trained to give appropriate feedback to the Trained to give appropriate feedback to the health worker after the role-play, which allowed health worker after the role-play, which allowed the health worker to practice these skillsthe health worker to practice these skills

Role of the Expert Patient-Trainer Role of the Expert Patient-Trainer in IMAIin IMAI

Worked in the skill stations as patients in a clinical Worked in the skill stations as patients in a clinical encounter related to Chronic HIV Care/ART where the encounter related to Chronic HIV Care/ART where the health workers would interact with them through their health workers would interact with them through their cases and practice important skills.cases and practice important skills.

Simulated role-plays with the course facilitators in the Simulated role-plays with the course facilitators in the classroom, so health workers could learn training classroom, so health workers could learn training material and important clinical health worker - patient material and important clinical health worker - patient interactions through the demonstrationsinteractions through the demonstrations

Shared personal experiences with HIV/ART with the Shared personal experiences with HIV/ART with the course participants pertaining to topics discussed within course participants pertaining to topics discussed within the classroom environmentthe classroom environment

CASE 8 CASE 8

You are a 47 year-old man, who tested You are a 47 year-old man, who tested HIV+ two years ago. You are a very heavy HIV+ two years ago. You are a very heavy drinker and do not go to the clinic drinker and do not go to the clinic regularly. You come to the clinic today regularly. You come to the clinic today because you want ART. This is your first because you want ART. This is your first visit.visit.

IF ASKED:IF ASKED: You are not taking any medicationsYou are not taking any medications Clinical ReviewClinical Review: You do have a pain in your : You do have a pain in your

mouth when eating. You do not have any mouth when eating. You do not have any problems swallowing. You also have an itching problems swallowing. You also have an itching rash around your nose and eyes. You do have a rash around your nose and eyes. You do have a poor appetite and problems with sleeping. poor appetite and problems with sleeping.

You do not practice safer sexYou do not practice safer sex You do not work but are able to do some things You do not work but are able to do some things

at home when you are motivatedat home when you are motivated You feel very lonely. Your wife and baby boy died You feel very lonely. Your wife and baby boy died

last year, and you are living with friends. last year, and you are living with friends.

________CUT HERE________________CUT HERE________

Physical ExamPhysical Exam: Current weight 65kg (last : Current weight 65kg (last visit 8mo ago-77kg); Patient has white visit 8mo ago-77kg); Patient has white patches in his mouth which when checked patches in his mouth which when checked can be scraped off and 1-2 mouth ulcers can be scraped off and 1-2 mouth ulcers which are not deep or extensive. He also which are not deep or extensive. He also has a scaly rash around his nose and has a scaly rash around his nose and eyes.eyes.

Case #8Observer:

Health Worker:

GOOD OK NOT GOOD

NOT DONE

GENERALRespectfulSimple wordsListened to patientMade sure patient understood

ASSESSAsked why came to the clinic?Reviewed symptoms on H10Look: physical exam

ADVISETalked about preventionOn correct treatmentOn adherence

AGREEOn treatment planInvolved patient

ASSISTProvided treatment optionsHelped solve treatment problemsProvided psychological support

ARRANGEFollow-up date(s)Support GroupReferral/Support outside clinicProvided treatment planCompleted patient card

CASE-SPECIFIC QUESTIONSClassified patient in clinical stage 3?Patient’s functional status—AmbulatoryPatient TB Status—No SignsGave treatment for thrush (painful white sore in mouth) and seborrhoea?Discussed about ART and drinking problem Advised on how to address the drinking problem?Referred to TASO for drinking problem?Linked to community support organization?Discussed Septrin?

CASE 33CASE 33

You are a married woman. You have You are a married woman. You have tested HIV+ 2 months ago. You are on tested HIV+ 2 months ago. You are on treatment for TB of the lungs, but treatment for TB of the lungs, but otherwise are feeling quite healthy. Your otherwise are feeling quite healthy. Your husband is a policeman, but he has not husband is a policeman, but he has not been working for several months now, been working for several months now, because he is too sick. You think he has because he is too sick. You think he has HIV as well.HIV as well.

If askedIf asked

You are managing the TB drugs well.You are managing the TB drugs well.Two days ago, you told him about your Two days ago, you told him about your

positive test. He became very angry and positive test. He became very angry and beat you. He does not want you to come beat you. He does not want you to come to the clinic anymore. So you have to to the clinic anymore. So you have to invent a story and come secretly.invent a story and come secretly.

Case specific questionsCase specific questions

Checked adherence to TB drugs?Checked adherence to TB drugs? Discussed benefits and difficulties of disclosure?Discussed benefits and difficulties of disclosure? Discussed safety?Discussed safety? Offered counselling for partner?Offered counselling for partner? Advised on the importance of attending clinic Advised on the importance of attending clinic

regularly?regularly? Discussed peer support?Discussed peer support? Discussed community support?Discussed community support? Arranged follow up appointment next week?Arranged follow up appointment next week?

EPT ChallengesEPT Challenges

EnthusiasmEnthusiasm IntimidationIntimidationStigma and discriminationStigma and discrimination IllnessIllness

Training plan—efficient, rapid, capable of supporting continuous training

Group work:10-12 participants

2 facilitatorsExpert patients

Card sorts

Skill stations

Video cases, exercises

(group)Outpatient clinical practice

for Acute Care

Inpatient clinical practice

Schedule Day OneMonday

Day TwoTuesday

Day ThreeWednesday

Day FourThursday

Friday

8:30 – 10:30 Welcoming and opening Introduction of participants Course objectives and introduction to training materialsAdministrative arrangements The situation of the HIV/AIDS epidemic in Ethiopia (Assegid)

7. Prophylaxis therapy 8. Adherence preparation

14. Special consideration during pregnancy and post-partum period15. Special considerations in children

3. OI's of the neurological system 4. OI's of the GI system (persistent diarrhea)

OFF

10:30 – 11:00

Tea/coffee Break

11:00 – 12:30

Pre-testFirst level session1. Introduction to good chronic care; sequence of care2. Introduction to HIV/AIDS and OIs; WHO Clinical staging3. HIV and antiretroviral drugs

9. First line ARV regimen in uncomplicated cases10. Four first-line ARV regimens

16. Monitoring patients on ART (30)Post-test

5. OI's of the mouth and throat (30)6. OI's of the skin (30)

OFF

12:30 – 1:30 Lunch break

1:30 – 3:30 4. Adherence and drug resistance 5. Assess and provide clinical care

11. Managing side effects and new developments 12. ART initiation and follow-up of patients13. Integration of prevention and treatment

Skill stations 7. ARV drugs8. Excluding OI's

OFF

3:30 – 4:00 Tea/coffee break

4:00 – 5:30 6. Introduction to Patient monitoring: HIV care/ART card

Skill stations Second level session 1. HIV and TB2. OI's of the respiratory system

Skill stations OFF

Home

Facilitators’ Meeting

Week 1: Chronic HIV Care with Week 1: Chronic HIV Care with ARTART

Monday Tuesday Wed Thurs Friday Saturday

Basic ART Clinical Course Nurses, Midwives, Medical Assistants, Pharm techs

Clinical Team Building

Patient MonitoringBasic ART Clinical Course

Clinical officers, Health officers

ART Aid Course PLHA, other lay providers, Nursing or Health Assistants,

or Nurses

Basic ART Clinical Course

Medical Officers/Doctors

Second Level ART Clinical Course

Medical Officers/Doctors

Week 2: Acute Care and OptionsWeek 2: Acute Care and Options

Mon Tues Wed Thurs Fri

Short Acute Care/OI Course Nurses, midwives

Optional: Acute Care: STI TB care with TB-HIV co-management Patient monitoring: registers, reports PMTCT: antenatal and post-partum

care, continuity of care and records IMCI-HIV short course Provider-initiated testing and

counselling PMTCT: reproductive choice, FP

Short Acute Care/OI CourseClinical Officers, Health Officers

Second level OI Course Medical Officers/doctors

PMTCT: Infant feeding counselling

Continuous Training ScheduleContinuous Training Schedule

Week 1 Week 1

Group 1

Group 2

Group 3

Group 4

Week 2Week 2