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Munsami A, Dreyer AJ, Sibeko G, Gouse H, Nightingale S, Joska JA. Mental and cognitive healthcare training targeting primary healthcare workers providing HIV services in Africa: a scoping review. AIDS Care 2023; 35:280-288. [PMID: 35848488 DOI: 10.1080/09540121.2022.2099512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mental health and neurocognitive functioning remain a concern among people living with HIV. Symptomatic neurocognitive impairment (NCI) and mental illness can cause difficulties in daily functioning, including problems adhering to treatment. However, many healthcare workers in resource-limited settings have limited knowledge about the relationship between HIV and NCI. A synthesis of available literature on mental health and NCI training provided to healthcare workers delivering HIV services in Africa, is lacking. We conducted a scoping review of published literature to identify training interventions which targeted healthcare workers providing careto people with HIV in Africa. Ten studies met the inclusion criteria. One study focused on NCI, two studies mentioned HIV-associated dementia and seven studies were centred on common mental health disorders. Most studies used a multi-method training approach, with pre-and post-testing as the main evaluation technique. This review highlights the gap in training interventions addressing NCI in Africa. Although there is some commitment to building capacity for mental health and NCI assessment among healthcare workers in this setting, this review suggests that there is a need for research to develop and evaluate training interventions for healthcare workers delivering HIV services in Africa.
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Affiliation(s)
- Adele Munsami
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Goodman Sibeko
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Wu S, Roychowdhury I, Khan M. Evaluations of training programs to improve human resource capacity for HIV, malaria, and TB control: a systematic scoping review of methods applied and outcomes assessed. Trop Med Health 2017; 45:16. [PMID: 28680324 PMCID: PMC5493875 DOI: 10.1186/s41182-017-0056-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/16/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Owing to the global health workforce crisis, more funding has been invested in strengthening human resources for health, particularly for HIV, tuberculosis, and malaria control; however, little is known about how these investments in training are evaluated. This paper examines how frequently HIV, malaria, and TB healthcare provider training programs have been scientifically evaluated, synthesizes information on the methods and outcome indicators used, and identifies evidence gaps for future evaluations to address. METHODS We conducted a systematic scoping review of publications evaluating postgraduate training programs, including in-service training programs, for HIV, tuberculosis, and malaria healthcare providers between 2000 and 2016. Using broad inclusion criteria, we searched three electronic databases and additional gray literature sources. After independent screening by two authors, data about the year, location, methodology, and outcomes assessed was extracted from eligible training program evaluation studies. Training outcomes evaluated were categorized into four levels (reaction, learning, behavior, and results) based on the Kirkpatrick model. FINDINGS Of 1473 unique publications identified, 87 were eligible for inclusion in the analysis. The number of published articles increased after 2006, with most (n = 57, 66%) conducted in African countries. The majority of training evaluations (n = 44, 51%) were based on HIV with fewer studies focused on malaria (n = 28, 32%) and TB (n = 23, 26%) related training. We found that quantitative survey of trainees was the most commonly used evaluation method (n = 29, 33%) and the most commonly assessed outcomes were knowledge acquisition (learning) of trainees (n = 44, 51%) and organizational impacts of the training programs (38, 44%). Behavior change and trainees' reaction to the training were evaluated less frequently and using less robust methods; costs of training were also rarely assessed. CONCLUSIONS Our study found that a limited number of robust evaluations had been conducted since 2000, even though the number of training programs has increased over this period to address the human resource shortage for HIV, malaria, and TB control. Specifically, we identified a lack evaluation studies on TB- and malaria-related healthcare provider training and very few studies assessing behavior change of trainees or costs of training. Developing frameworks and standardized evaluation methods may facilitate strengthening of the evidence base to inform policies on and investments in training programs.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Imara Roychowdhury
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Mishal Khan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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Liu G, Jack H, Piette A, Mangezi W, Machando D, Rwafa C, Goldenberg M, Abas M. Mental health training for health workers in Africa: a systematic review. Lancet Psychiatry 2016; 3:65-76. [PMID: 26772066 DOI: 10.1016/s2215-0366(15)00379-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022]
Abstract
Commitment to building mental health treatment capacity in Africa is increasing but little agreement exists on strategies to train health workers on mental health or evaluation of training efforts. We systematically reviewed published literature on interventions to train health-care workers in Africa on mental health. 37 studies met our inclusion criteria. Training outcomes focused on changes in knowledge and attitude, with few studies evaluating skill and practice and only two studies measuring clinical outcomes. Quality of study methodology was generally not high, with scarce follow-up data and use of control cohorts. Existing studies provide examples of many training and evaluation strategies, but evidence to draw conclusions about the efficacy of different training techniques is inadequate. Key knowledge gaps include development and testing of innovative educational strategies; development of standardised, competency-based learning objectives and outcome measures; and training that facilitates implementation of integrated mental health systems. African institutions need to be empowered to do research in these areas to encourage the development of best practices for the continent.
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Affiliation(s)
- Germaine Liu
- School of Medicine, King's College London, Guy's Campus, London, UK
| | - Helen Jack
- Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, UK; Harvard Medical School, Boston, MA, USA.
| | - Angharad Piette
- Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, UK
| | - Walter Mangezi
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Mount Pleasant, Harare, Zimbabwe
| | - Debra Machando
- Department of Psychology, Women's University in Africa, Education Services Centre, Mount Pleasant, Harare, Zimbabwe
| | - Chido Rwafa
- Department of Psychiatry, University of Zimbabwe College of Health Sciences, Mount Pleasant, Harare, Zimbabwe
| | | | - Melanie Abas
- Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London, UK
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Kalungwana L, Elafros MA, Siddiqi OK, Bositis CM, Sikazwe I, Koralnik IJ, Theodore WH, Birbeck GL. Cognitive impairment and psychiatric morbidity in HIV+ Zambians with new-onset seizure. Am J Trop Med Hyg 2014; 91:1254-8. [PMID: 25311691 DOI: 10.4269/ajtmh.13-0758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A prospective cohort study of new-onset seizure in people with human immunodeficiency virus (HIV) in Zambia is ongoing to determine the incidence of subsequent epilepsy and risk factors for epileptogenesis in this population. At enrollment, we evaluated this cohort for cognitive impairment and psychiatric morbidity. Over 50% of participants had cognitive impairment and significant psychiatric morbidity. Most participants had advanced HIV disease based on CD4+ T-cell count and World Health Organization stage, but we found no association between cognitive impairment or psychiatric morbidity and HIV disease staging.
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Affiliation(s)
- Lisa Kalungwana
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - Melissa A Elafros
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - Omar K Siddiqi
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - Christopher M Bositis
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - Izukanji Sikazwe
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - Igor J Koralnik
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - William H Theodore
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
| | - Gretchen L Birbeck
- Department of Psychology, University of Zambia, Lusaka, Zambia; International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; College of Human Medicine, Michigan State University, East Lansing, Michigan; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Division of NeuroVirology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Greater Lawrence Family Health Center, Lawrence, Massachusetts; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Clinical Epilepsy Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurology, Epilepsy Division, University of Rochester, Rochester, New York; Chikankata Epilepsy Care Team, Mazabuka, Zambia
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