After Completing the Overview, Participants Will

Malawi PMTCT Trainer Manual

Course Overview

/ Total Time: 120 minutes

After completing the overview, participants will:

·  Be familiar with the structure and organization of the course.

·  Be acquainted with other participants in the course.

·  Verbalize concerns about HIV in the healthcare setting.

·  Identify the ground rules for the course.

·  State expectations for the course.

·  State general objectives for the course.

·  Complete the pre-test.

Have the following additional materials available:

·  For ‘’Introduction Exercise 1” have available blank sheets of paper (A4 size, one sheet participant) for those who do not have any paper

·  Bowl or large manila envelope for explanation of anonymous question

·  For “Introduction Exercise 2” have tape

·  Copies of the pre-test: one per participant

Course Overview

Activity/Method / Time
Official Opening, Introductions / 30 minutes
Lecture / 10 minutes
TOTAL TIME / 40 minutes

Ice Breaker and Ground Rules

Activity/Method / Time
Introduction Exercise 1: Exploring the concerns of providers of HIV care / 30 minutes
Explanation of anonymous question bowl or envelope / 5 minutes
Introduction Exercise 2: Determining the norms and ground rules for the course / 15 minutes
Explain and distribute course pre-test / 30 minutes
TOTAL TIME / 80 minutes

Note: Before the ‘Course Overview’ below, time (30 minutes) has been built in for official statements, opening and introductions.

/ Trainer Instructions
Slides 1-2

Begin by reviewing the module objectives listed above.

Course Overview

/ Advance Preparation
The trainer should be completely familiar with the course materials and be prepared to address participants’ questions.
/ Total Time: 10 minutes
/ Trainer Instructions
Slides 3-9

Introduce basic information about the course purpose and structure.

NOTE: The guiding principle for facilitating this course emphasizes team training with the trainer commitment to participation for the duration of the training.

Note: Where possible teach the content of the Introduction and Course Overview as part of the Opening Ceremony. Where there is no Opening Ceremony, the Introduction and Course Overview should be incorporated into Day 1 of the training.

/ Make These Points

·  Ensure that all participants are familiar with the structure of the course, the structure of the National PMTCT Training Package and the course schedule. Note that the course is designed for six days plus a five day practical attachment. Reiterate key organizational and logistical details, including daily start times, end times, and breaks.

·  Stress the importance of group interaction and participation.

·  Ensure that participants understand the structure and purpose of all course materials. Point out that the Participant Manual includes instructions for each group activity.

Course structure

The National Prevention of Mother-to-Child Transmission of HIV (PMTCT) Training Package is a comprehensive approach to the basic training of healthcare workers.

Components

The components in this package include the following:

·  Trainer Manual

·  Participant Manual

·  Presentation Booklet (Power Point presentations)

Teaching methods

Teaching methods include the following:

·  Lectures

·  Interactive exercises

·  Case presentations

·  Role plays

·  Demonstrations

·  Large and small group discussions

·  Small group work

·  Practical attachment

Modules

The course consists of ten modules designed for a 6-day facilitator-led course. The modules are as follows:

·  Module 1: Introduction to HIV and AIDS

·  Module 2: Overview of HIV Prevention in Mothers, Infants, and Young Children

·  Module 3: Specific Interventions to Prevent Mother-to-Child Transmission of HIV (PMTCT)

·  Module 4: Infant Feeding in the Context of HIV Infection

·  Module 5: Stigma and Discrimination Associated with HIV

·  Module 6: Testing and Counselling

·  Module 7: Comprehensive Care and Support for Mothers and Families with HIV Infection

·  Module 8: Referral for Treatment, Care and Support Services

·  Module 9 Safety and Supportive Care in the Work Setting

·  Module 10: Management of PMTCT Services

Course goal

The goal of the course is to build the capacity of healthcare workers to offer PMTCT services. The training offers participants the background to provide comprehensive care and support to HIV-infected women and implement integrated PMTCT services in health facilities to improve the quality of care to all women and children.

Course objectives

General course objectives are:

·  To provide knowledge and skills in HIV and PMTCT services including HIV testing and counselling, ARV prophylaxis, safe obstetric practices and infant-feeding counselling.

·  To facilitate the reduction of HIV-related stigma and discrimination by empowering healthcare workers to partner with community agencies and services.

·  To develop the capability of healthcare workers to provide comprehensive and appropriate care and support for HIV-infected and affected women and children.

·  To develop the capacity of healthcare workers to establish community-based linkages among individuals and groups, health facilities, communities, organizations and other agencies for continued care for people living with HIV.

·  To familiarize participants with the logistics of PMTCT programme implementation, monitoring and evaluation.

Full certification will be contingent upon completion of a practical attachment, which will take place after completion of classroom training.

Course design and implementation

This competency-based course addresses the acquisition of knowledge, practical skills, and professional qualities. Competency-based training is different from traditional educational processes. It focuses on the specific knowledge, attitudes and skills needed to carry out a procedure or activity. This training requires that the trainer facilitate and encourage learning rather than serve in the more traditional role of instructor or lecturer. Trained healthcare providers will be expected to develop competency in the provision of core PMTCT services targeting women and their children attending ANC and other RH and MCH services including labour and delivery. For a comprehensive list of competencies, see Appendix 1.

The course is organized into modules with each module divided into units. Each module includes the introduction or purpose, objectives, content and learning experiences. The implementation of the course will apply the principles of adult and problem-based learning. Participatory teaching methods will be applied. The assessment of participant performance will be continuous through learner and facilitator feedback. In order to facilitate the learning process, notes covering each unit are also provided.

Target group

Every setting that provides PMTCT services can maximize the effectiveness of their programmes by involving staff in specialized training and encouraging other healthcare workers (HCWs) to expand their existing knowledge. The design of the course assumes that participants are professional HCWs who are qualified and have experience working in community or hospital-based services ranging from MCH/RH to hospital based wards or the OPD. HCWs include nurses, nurse midwives, doctors, clinical officers, nutritionists, social workers/counsellors, laboratory staff, pharmacy staff and medical health information officers who need to develop skills in the delivery of PMTCT services.

Hands-on clinical training is strongly recommended. Where feasible, complementary onsite or offsite clinical training—especially in HIV testing and counselling and infant-feeding counselling—will greatly improve the capacity and confidence of healthcare workers to use their new knowledge to provide PMTCT services.

The knowledge and skills that participants bring to the course are important to the learning process and participants are encouraged to share their experiences and raise challenging issues that are presented at the work site.

The rapidly growing HIV epidemic requires collaborative efforts to maximize the use of existing human resources and develop strengthened human capacity. Training is a key part of this strategy.

Course duration and schedule

Although this PMTCT training was outlined as a six day course, it may be expanded or shortened to meet the needs and priorities of the target audience. The suggested schedule for the course is presented below.

Course schedule for National PMTCT Training Package

Day / Content and Time
Day 1 / / Opening remarks, Introductions, Course Overview including ground rules and pre-test

Module 1

/ Introduction to HIV and AIDS

Module 2

/ Overview of HIV Prevention in Mothers, Infants, and Young Children
Day 2 /

Module 3

/ Specific Interventions to Prevent Mother-to-Child Transmission of HIV (PMTCT)
Day 3 /

Module 4

/ Infant Feeding in the Context of HIV Infection

Module 5

/ Stigma and Discrimination Associated with HIV
Day 4 /

Module 6

/ Testing and Counselling
Day 5 /

Module 7

/ Comprehensive Care and Support for Mothers and Families With HIV Infection

Module 8

/ Referral for Treatment, Care, and Support Services
Day 6 /

Module 9

/ Safety and Supportive Care in the Work Setting

Module 10

/ Management of PMTCT Services
Briefing for Practical Attachment
/ Close of Course
Week 2 / Practical Attachment

Responsibilities of PMTCT healthcare workers

The course offers healthcare workers (HCWs, also referred to as “health workers” in other documents) information and skills development in PMTCT in order to implement core PMTCT activities in an integrated manner. The HCW will be able to undertake the following responsibilities:

·  Provide core PMTCT services (HIV testing and counselling, ARV prophylaxis/referrals for ARV therapy, safer infant feeding counselling and support).

·  Facilitate the reduction of HIV-related stigma and discrimination.

·  Provide comprehensive and appropriate care and support for HIV-infected and affected women and children.

·  Establish community-based linkages among individuals and groups, health facilities, communities, organizations, and other agencies for continued care of clients with HIV.

·  Implement PMTCT programme logistics, monitoring and evaluation.

See Appendix 1 for a listing of the competencies related to each of these responsibilities.

Certificate of participation

The course participants will be awarded a certificate signed by the Ministry of Health to acknowledge their participation in the National PMTCT Training course and subsequent completion of a supervised practical attachment.

/ Trainer Instructions

Review the following Key Points with participants.

Introduction: Key Points
·  The PMTCT course provides HCWs with knowledge and skills to deliver PMTCT services.
·  Hands-on clinical training will improve participants’ capacity to transfer knowledge to practice.
·  The course builds on the knowledge of the HCWs.
·  The course is participatory and interactive.

Ice Breaker and Ground Rules

/ Advance Preparation
The trainer should be completely familiar with the following exercises and prepared to address participants’ questions.
/ Total Time: 80 minutes
/ Trainer Instructions
Slide 10

Discussing or teaching about HIV can be difficult, and can trigger feelings about a range of issues, including sexuality, stigma, fear, and distrust. Be aware that talking about HIV in the clinical setting may raise an even higher level of fear.

Once you have completed the overview of the course and materials, it is important to set the appropriate tone. Create an atmosphere in which participants feel comfortable expressing fears and concerns.

Use Exercise 1 below to elicit introductions, create a comfortable and non-threatening atmosphere, and confront conflicting or inaccurate opinions.

/ Make This Point

·  Remind participants that HIV is a disease for which science does not have all the answers. Doing so will give participants permission to share their own fears and concerns.

Introduction Exercise 1: Exploring the concerns of providers of HIV care

/
Purpose / Explore participants’ concerns about taking care of women with HIV and introduce objectives for this training.
Provide an opportunity for everyone to get to know each other.
Duration / 30 minutes
Introduction / Welcome participants to the training course and explain that this introductory exercise will help them to:
·  Explore their individual concerns as providers of HIV care
·  Establish their individual goals and objectives for the course
·  Realise the value of their professions and acknowledge the personal strengths they bring to their work.
Activities / Ask participants to find one sheet of blank paper. Explain that these papers will not be collected.
Ask participants to spend 5 minutes thinking about the following questions and then to write their responses on their sheet of paper.
·  Concerns: What concerns you about taking care of women and children with AIDS?
·  Objectives: What do you want to learn or take away with you at the end of the course?
·  Strengths: What three strengths do you bring to your work as a healthcare provider?
While they complete their answers, write each question on a separate piece of flipchart paper and tape it to the wall, or divide the blackboard into three sections and write one question at the top of each.
Ask for responses and write each on the flipchart paper or blackboard. Allow for some discussion while documenting the concerns. Limit discussion about objectives, since they will be discussed later in the day.
Discuss the participants' strengths and the role they play in the care of women and children—with and without HIV.
Debriefing / Acknowledge that many healthcare workers must confront HIV not only at work, but also at home and in their communities. This training aims to support the participants in their efforts to cope with the wide-reaching impact of HIV disease.
Validate the individual concerns they have as healthcare workers in HIV.
Acknowledge the importance of professional affirmation.
Support the strengths they bring to their work.
Close by affirming their experiences and by acknowledging that:
·  Healthcare workers often are insufficiently recognized for their efforts.
·  Busy schedules can prevent them from sharing their time and ideas with colleagues.
/ Trainer Instructions

Anonymous question bowl or envelope

·  Some questions are difficult to ask in a group. Set up a question bowl or envelope along with paper and a pen or pencil. Place those materials, if possible, in an inconspicuous but accessible location. When participants have a question that they do not want to ask in the group setting, they can write it down and place it in the bowl or envelope.

·  Tell participants about the bowl, show them where it is, and invite them to submit questions about HIV at any time. Explain that the questions may include concerns about themselves, their families, co-workers, or patients.

·  Check the bowl each day before lunch and read the questions aloud to the group. Explain that you will give the group time to think about the questions and that after the afternoon break, you will ask for their responses so the group can learn together. Set aside a few minutes after the afternoon break to allow the participants to share their thoughts.