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'Expert patient trainers' strengthen the healthcare team

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					‘Expert patient trainers’                                                                         Partners:
                                                                                                  Eastern Cape Provincial


strengthen the
                                                                                                  Department of Health
                                                                                                  World Health
                                                                                                  Organisation (WHO)

healthcare team                                                                                   Regional Training Centre
                                                                                                  (RTC) of Walter Sisulu
                                                                                                  University
     Patients help train healthcare workers in HIV                                                Centers for Disease
                                                                                                  Control, South Africa
     consultation
                                                                                                  Location:
                                                                                                  Cacadu, Nelson Mandela
                                                                                                  Metro, Amatole, Chris
                                                                                                  Hani, Ukhahlamba,
The problem                                                                                       Alfred Nzo and
                                                                                                  OR Tambo Districts,
     Just as clinicians are experts in clinical care, people living with HIV are experts on       Eastern Cape
     their experience of the illness. The patient’s experience of both the illness and of their
     interactions with the healthcare system can complement the clinical perspective on
     care can help improve healthcare delivery. The role of patients on the care team is
     well documented in both developed countries and resource-poor settings.1



The change
     The change was to recruit and train people living with HIV and AIDS
     (PLWHA) to contribute to the training of healthcare workers.

     The model is part of the IAMI (Integrated Management for Adolescents and Adults)
     training for nurse-managed HIV and ART care in the Eastern Cape (see Integrating
     HIV/AIDS into General Care in this section)



How it works
     Patients are recruited from accredited ART sites, and trained to become
     “Expert Patient Trainers”.

     They participate in the training of clinical healthcare workers through a structured
     process of role-playing in which Expert Patient Trainers (EPT) play the role of the
     patient allowing healthcare workers to practice their HIV/AIDS consultation skills.
     The role plays occur one-on-one and the EPT is trained to give feedback on various
     aspects of the consultation using a structured feedback form (see sample role play
     and feedback form below). This learning experience allows healthcare workers to
     identify strengths and weaknesses in their HIV consultation skills. Role-plays increase
     in complexity as the course proceeds.

     The training of the EPTs comprises a three-day course where they learn about the
     symptoms of HIV and how to role play a patient, what to expect from a thorough
     consultation for HIV (eg screening for STI’s, TB, contraception, safe sex, staging and
     whether cotrimoxazole or ART is needed), how to assess the consultation using a
     structured feedback form, and how to give constructive feedback. Each role play is




Sec tion 6: HUMAN RESOURCES – ‘E xper t patient trainers’ strengthen the healthcare team                          221
                                      carefully structured and the assessments of the consultation is speci c to each role
                                      play.

                                      The training and use of the EPTs supports the HIV/AIDS clinical training module in
                                      the IMAI course.



                    ent   The outcome
“The expert pati
                    ry
trainers were ve              Many health workers were at rst reluctant to work with EPTs, but soon realized that
                     ving
informative in gi             improved knowledge and communication skills would lead to improved adherence
                              among their patients, decreased loss to follow-up and increased access to ART.
 feedback. They
                      ask
 challenged us to             EPTs have been found to increase confidence and competence of the
 the right qu   estions       participants as well as to decrease stigma and improve health worker
  and created    very         perceptions.

  life like situ ations.      The success of this training has prompted experts in Eastern Cape to recommend
  A   fun educational         the use of EPTs as “an integral part of both clinical and training teams” when dealing
   re source.”                with a variety of chronic conditions, and that training programmes for pre-service
                      ning
     NGO head of trai                 curricula in South Africa be revised to reduce “gaps between service providers and
     at the end of the                clients.”
     Chronic HIV Care
                                      More than 160 EPTs have been trained in the Eastern Cape and most EPTs have been
     course
                                      employed as Lay Counsellors in primary health care facilities adding value to the
                                      clinical team.




                                   Ways that clients can contribute to HIV care systems:

                                    assist with tasks at the clinic

                                    provide health education on HIV at clinics

                                    lead support groups

                                    train as an HIV counsellor

                                    become a ‘treatment buddy’ for a friend

                                    become a member of an outreach team providing education door-to-door

                                    train as a community healthcare worker to support patients on ART in the
                                       community

                                    share their story during outreach days and community events

                                    share their story and experience of healthcare during workshops and trainings

                                    train as an ‘Expert Patient Trainer’ to support training of clinicians

                                    provide feedback to clinic sta

                                    become a member of a quality improvement team in the clinic




   222              Tried & Tested: Models for the scale up of HIV prevention, treatment and care from South Africa and beyond
                                                                                           Expert patient trainers
                                                                                           training healthcare
  Example of a Case Study for Role Playing                                                 workers through role
       Case 1                                                                              play.

       You are a 27 year-old HIV + woman. This is your rst visit to the clinic. You tell

       the health worker that you are married and come today because you and your

       husband would like to start a family.

       If asked:

        You are HIV+, tested 7 months ago

        You do not take any medications

        You have no symptoms

        You are not employed but keep house for your husband and yourself

        Your last menstrual period was 2 weeks ago

        You have been practicing safer sex

        You and your husband are now regularly using condoms

        You have disclosed your status to your husband, but he does not want to
           be tested




Sec tion 6: HUMAN RESOURCES – ‘E xper t patient trainers’ strengthen the healthcare team                   223
Example of an
Assessment Sheet




                                References:
                                1. Seung KJ, Bitalabeho A, Buzaalirwa LE, Diggle E, Downing M, Bhatt Shah M, Tumwebaze B, Gove
                                   S Standardized patients for HIV/AIDS training in resource-poor settings: the expert patient-trainer.Acad
                                   Med. 2008 Dec;83(12):1204-9
                                2. http://www.who.int/hiv/pub/imai/en/ and http://www.who.int/hiv/pub/imai/imai_publication_
                                   diagram.pdf
                                3. Horwood, C. Experiences of training and implementation of integrated management of childhood
                                   illness (IMCI) in South Africa: a qualitative evaluation of the IMCI case management training course.
                                   BMC Pediatrics 2009, 9:62

                                Contacts:
                                1. Eastern Cape: Regional Training Centre – Mrs F Mazwi 043 721 0581, 072 831 4243,
                                   telkomsa52092@telkomsa.net
                                2. KwaZulu-Natal: IMAI project, Centre for Rural Health – 031 260 4967, 082 827 9007,
                                   kirstymcharry@gmail.com, penniall@uKwaZulu-Natal.ac.za, khanyilen1@uKwaZulu-Natal.ac.za




224           Tried & Tested: Models for the scale up of HIV prevention, treatment and care from South Africa and beyond

				
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