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Panda R, Lahoti S, Mishra N, Prabhu RR, Singh K, Rai AK, Rai K. A mixed methods evaluation of the impact of ECHO ® telementoring model for capacity building of community health workers in India. HUMAN RESOURCES FOR HEALTH 2024; 22:26. [PMID: 38654359 DOI: 10.1186/s12960-024-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION India has the largest cohort of community health workers with one million Accredited Social Health Activists (ASHAs). ASHAs play vital role in providing health education and promoting accessible health care services in the community. Despite their potential to improve the health status of people, they remain largely underutilized because of their limited knowledge and skills. Considering this gap, Extension for Community Healthcare Outcomes (ECHO)® India, in collaboration with the National Health System Resource Centre (NHSRC), implemented a 15-h (over 6 months) refresher training for ASHAs using a telementoring interface. The present study intends to assess the impact of the training program for improving the knowledge and skills of ASHA workers. METHODS We conducted a pre-post quasi-experimental study using a convergent parallel mixed-method approach. The quantitative survey (n = 490) assessed learning competence, performance, and satisfaction of the ASHAs. In addition to the above, in-depth interviews with ASHAs (n = 12) and key informant interviews with other stakeholders (n = 9) examined the experience and practical applications of the training. Inferences from the quantitative and qualitative approaches were integrated during the reporting stage and presented using an adapted Moore's Expanded Outcomes Framework. RESULTS There was a statistically significant improvement in learning (p = 0.038) and competence (p = 0.01) after attending the training. Participants were satisfied with the opportunity provided by the teleECHO™ sessions to upgrade their knowledge. However, internet connectivity, duration and number of participants in the sessions were identified as areas that needed improvement for future training programs. An improvement in confidence to communicate more effectively with the community was reported. Positive changes in the attitudes of ASHAs towards patient and community members were also reported after attending the training. The peer-to-peer learning through case-based discussion approach helped ensure that the training was relevant to the needs and work of the ASHAs. CONCLUSIONS The ECHO Model ™ was found effective in improving and updating the knowledge and skills of ASHAs across different geographies in India. Efforts directed towards knowledge upgradation of ASHAs are crucial for strengthening the health system at the community level. The findings of this study can be used to guide future training programs. Trial registration The study has been registered at the Clinical Trials Registry, India (CTRI/2021/10/037189) dated 08/10/2021.
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Affiliation(s)
- Rajmohan Panda
- Public Health Foundation of India (PHFI), Gurugram, Haryana, India
| | - Supriya Lahoti
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India.
| | - Nivedita Mishra
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India
| | | | | | - Apoorva Karan Rai
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India
| | - Kumud Rai
- Extension for Community Healthcare Outcomes (ECHO) India, Okhla Phase III, New Delhi, India
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Baldridge AS, Goldstar N, Bellinger GC, DeNoma AT, Orji IA, Shedul GL, Okoli RCB, Ripiye NR, Odukwe A, Dabiri O, Mobisson LN, Ojji DB, Huffman MD, Kandula NR, Hirschhorn LR. Formative Evaluation and Adaptation of a Hypertension Extension for Community Health Outcomes Program for Healthcare Workers within the Federal Capital Territory, Nigeria. Glob Heart 2023; 18:64. [PMID: 38045112 PMCID: PMC10691284 DOI: 10.5334/gh.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background The Extension for Community Health Outcomes (ECHO) model has been used extensively to link care providers in rural communities with experts with the aim of improving local patient care. Objective The aim of this qualitative research study was to assess the feasibility, acceptability, perceived needs, and contextual factors to guide implementation of a hypertension focused ECHO program for Community Health Extension Workers (CHEWs) in the Federal Capital Territory, Nigeria. Methods From September 2020 to December 2020, key informant interviews were performed with seven global organizations (hubs) providing ECHO training focused on cardiovascular disease or nephrology to identify contextual factors and implementation strategies used by each hub. In February 2022, seven focus group discussions were performed with 42 frontline healthcare workers in the Federal Capital Territory to inform local adaptation of a hypertension ECHO program. Directed content analysis identified major themes which were mapped to the Consolidated Framework for Implementation Research. Qualitative analyses were performed using Dedoose, and results were synthesized using the Implementation Research Logic Model. Results We found both barriers and facilitators across the Consolidated Framework for Implementation Research domains that mapped to a number of constructs in each one. The results of these analyses confirmed that the core components of the ECHO model are a feasible and appropriate intervention for hypertension education of healthcare workers. However, implementing the ECHO program within the Federal Capital Territory may require strategies such as utilizing communications resources effectively, developing incentives to motivate initial participation, and providing rewards or recognition for ongoing engagement. Conclusions These results provide valuable formative insights to guide implementation of our proposed hypertension ECHO program for CHEWs in the Federal Capital Territory, Nigeria. This information was used for key decisions around: 1) scope and content of training, 2) format and frequency, 3) selection of implementation strategies, and 4) building a community of practice.
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Affiliation(s)
- Abigail S. Baldridge
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Havey Institute for Global Health, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nadia Goldstar
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Grace C. Bellinger
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abigail T. DeNoma
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Gabriel L. Shedul
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | | | | | | | - Dike B. Ojji
- University of Abuja Teaching Hospital, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
| | - Mark D. Huffman
- Havey Institute for Global Health, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
- Washington University St. Louis, St. Louis, Missouri, USA
| | - Namratha R. Kandula
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
| | - Lisa R. Hirschhorn
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- The George Institute for Global Health, Sydney, Australia
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Corcorran MA, Thornton K, Struminger B, Easterbrook P, Scott JD. Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C. BMC Health Serv Res 2023; 23:824. [PMID: 37533025 PMCID: PMC10394928 DOI: 10.1186/s12913-023-09849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment. METHODS In early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes. RESULTS Eleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success. CONCLUSION The Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | - Karla Thornton
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Bruce Struminger
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - John D Scott
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Atuhairwe I, Ngabirano AA, Ahaisibwe B, Nsubuga A, Kanyike AM, Kihumuro RB, Balizzakiwa T, Ewing H, Ellis R, Forbush L, Joseph O, Nakyeyune MJ, Waniaye JB. Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda. Afr J Emerg Med 2023; 13:86-93. [PMID: 37124320 PMCID: PMC10130342 DOI: 10.1016/j.afjem.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda. Methods Investigators conducted a mixed-methods evaluation to assess the initial 4 months' implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively. Results The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (n = 751, 37%), and nurses (n = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed. Conclusions Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Randall Ellis
- Seed Global Health, Kampala, Uganda
- Department of Emergency Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Tilmon SJ, Lee KK, Gower PA, West KSH, Mittal K, Ogle MB, Rodriguez IM, Johnson D. Impact of an Urban Project ECHO: Safety-Net Clinician Self-Efficacy Across Conditions. Am J Prev Med 2023; 64:535-542. [PMID: 36635197 DOI: 10.1016/j.amepre.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/05/2022] [Accepted: 11/01/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION To mitigate the lack of specialty healthcare, Project ECHO (Extension for Community Health Outcomes) trains community-based primary care clinicians to better prevent the progression of, manage, and treat common health conditions. ECHO-Chicago launched in 2010 as the first urban-centered ECHO program, focusing on safety-net clinicians, and has trained over 5,175 community clinicians across 34 topic areas. This paper examines self-efficacy among ECHO-Chicago participants across 11 clinical series, including a novel use of qualitative themes from self-efficacy questions. METHODS Five years of baseline and postseries survey data were collected from 2014 to 2019, resulting in 951 participants. Paired t-tests assessed change from baseline survey to postsurvey, and Cohen's d determined effect size. Change was assessed by individual series, adult or pediatric focus, participants' prescription privilege status, and across series by qualitative question theme. Metrics included total change, any improvement, a 10% target, and a clinical competency threshold. Analysis occurred from July 2020 to January 2022. RESULTS All clinical series achieved statistically significant improvement in self-efficacy, and most had a large effect size. A total of 88% had any improvement, 65% met the 10% target of 0.7 points, and 52% met the competency threshold of 5.0 in the postsurvey. Prescribers had a significantly greater increase in their self-efficacy scores than nonprescribers. With a comparison across series, each theme achieved statistical significance, with most reaching large effect sizes. CONCLUSIONS ECHO-Chicago successfully increased participants' self-efficacy. This inquiry adds an urban focus, years of data, multiple series, and a novel qualitative theme component to enable comparisons across rather than solely within the ECHO series.
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Affiliation(s)
- Sandra J Tilmon
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois.
| | - Karen K Lee
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Patrick A Gower
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Kathryn S H West
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Kanika Mittal
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Marielle B Ogle
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Isa M Rodriguez
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Daniel Johnson
- Department of Pediatrics, Biological Sciences Division, The University of Chicago, Chicago, Illinois
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Mubanga B, Fwoloshi S, Lwatula L, Siamwanza N, Zyambo K, Sichinga H, Tappis H, Mulenga LB, Moonga A, Ziko L, Simushi F, Massamba HM, Hapunda G, Sichimba F, Mtonga H, Kalubula M. Effects of the ECHO tele-mentoring program on HIV/TB service delivery in health facilities in Zambia: a mixed-methods, retrospective program evaluation. HUMAN RESOURCES FOR HEALTH 2023; 21:24. [PMID: 36941682 PMCID: PMC10026214 DOI: 10.1186/s12960-023-00806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In the quest to ensure that quality healthcare is provided to all citizens through building healthcare worker capacity and extending reach for expert services, Zambia's Ministry of Health (MoH) in collaboration with its partners PEPFAR through the CDC and HRSA, began to implement the Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program across the country through the Health Workers for the 21st Century (HW21) Project and University Teaching Hospital HIV/AIDS Project (UTH-HAP). This ECHO tele-mentoring approach was deemed pivotal in helping to improve the human immunodeficiency virus (HIV) service delivery capacity of health care workers. METHOD The study used a mixed method, retrospective program evaluation to examine ECHO participants' performance in the management of HIV/AIDS patients in all the 10 provinces of Zambia. CASE PRESENTATION A phenomenological design was applied in order to elicit common experiences of ECHO users through focus group discussions using semi-structured facilitation guides in four provinces (Eastern, Lusaka, Southern and Western) implementing ECHO tele-mentoring approach. These provinces were purposively selected for this study. From which, only participants that had a monthly frequency of ECHO attendance of ten (10) and above were selected. The participants were purposively selected based on the type of cadre as well as facility type so that the final sample consisted of Doctors, Nurses, Midwives, Clinical Officers, Medical Licentiates, Pharmacy and Laboratory Personnel. All sessions were audio recorded and transcribed by the data collectors. A thematic content analysis approach was adopted for analyzing content of the interview's transcripts. RESULTS Enhanced knowledge and skills of participants on HIV/TB improved by 46/70 (65.7%) in all provinces, while 47/70 (67.1%) of the participants reported that ECHO improved their clinical practice. Further, 12/70 (17.1%) of participants in all provinces reported that presenter/presentation characteristics facilitated ECHO implementation and participation. While, 15/70(21.4%) of the participants reported that ownership of the program had contributed to ECHO implementation and participation. Coordination, another enabler accounted for 14/70 (20%). Inclusiveness was reported as a barrier by 16/70 (22.8%) of the participants while 6/70 (8.6%) of them reported attitudes as a barrier (8.6%) to ECHO participation. In addition, 34/70 (48.6%) reported poor connectivity as a barrier to ECHO implementation and participation while 8/70 (11.5%) of the participants reported that the lack of ownership of the ECHO program was a barrier. 22/70 (31.4%) reported that increased workload was also a barrier to the program's implementation. CONCLUSION Consistent with its logical pathway model, healthcare providers' participation in ECHO sessions and onsite mentorship contributed to improved knowledge on HIV/TB among health care providers and patient health outcomes. In addition, barriers to ECHO implementation were intrinsic to the program its self, such as coordination, presenter and presentation characteristics other barriers were extrinsic to the program such as poor connectivity, poor infrastructure in health facilities and negative attitudes towards ECHO. Improving on intrinsic factors and mitigating extrinsic factors may help improve ECHO outcomes and scale-up plans.
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Affiliation(s)
- Brian Mubanga
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia.
| | - Sombo Fwoloshi
- Zambian Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - Lastina Lwatula
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Nomsa Siamwanza
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Khozya Zyambo
- Zambian Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - Henry Sichinga
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Hannah Tappis
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA
| | - Lloyd B Mulenga
- Zambian Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
| | - Aurthur Moonga
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Lunga Ziko
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Faith Simushi
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | | | - Given Hapunda
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Francis Sichimba
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Hellen Mtonga
- Jhpiego Zambia Country Office, 8 Ngumbo Road, Longacres, Lusaka, Zambia
| | - Maybin Kalubula
- Zambian Ministry of Health, Ndeke House, Haile Selassie Avenue, Lusaka, Zambia
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Agarwal R, Agarwal U, Das C, Reddy RA, Pant R, Ho C, Kumar BR, Dabla V, Moonan PK, Nyendak M, Anand S, Puri AK, Mattoo SK, Sachdeva KS, Yeldandi VV, Sarin R. Building communities of practice through case-based e-learning to prevent and manage TB among people living with HIV-India. BMC Infect Dis 2022; 22:967. [PMID: 36581907 PMCID: PMC9798943 DOI: 10.1186/s12879-022-07957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Co-management of HIV-TB coinfection remains a challenge globally. Addressing TB among people living with HIV (PLHIV) is a key priority for the Government of India (GoI). In 2016, GoI implemented single-window services to prevent and manage TB in PLHIV. To strengthen HIV-TB service delivery, case-based e-learning was introduced to health care providers at Antiretroviral Therapy centres (ARTc). METHODS We implemented a hub and spoke model to deliver biweekly, virtual, case-based e-learning at select ARTc (n = 115), from four states of India-Delhi, Uttar Pradesh, Andhra Pradesh and Tamil Nadu. We evaluated feasibility and acceptability of case-based e-learning and its impact on professional satisfaction, self-efficacy, knowledge retention using baseline and completion surveys, session feedback, pre-and post-session assessments. We reviewed routine programmatic data and patient outcomes to assess practices among participating ARTc. RESULTS Between May 2018 and September 2020, 59 sessions were conducted with mean participation of 55 spokes and 152 participants. For 95% and 88% of sessions ≥ 80% of respondents agreed that topics were clear and relevant to practice, and duration of session was appropriate, respectively. Session participants significantly improved in perceived knowledge, skills and competencies (+ 8.6%; p = 0.025), and technical knowledge (+ 18.3%; p = 0.04) from baseline. Participating ARTc increased TB screening (+ 4.2%, p < 0.0001), TB diagnosis (+ 2.7%, p < 0.0001), ART initiation (+ 4.3%, p < 0.0001) and TB preventive treatment completion (+ 5.2%, p < 0.0001). CONCLUSION Case-based e-learning is an acceptable and effective modus of capacity building and developing communities of practice to strengthen integrated care. E-learning could address demand for accessible and sustainable continuing professional education to manage complex diseases, and thereby enhance health equity. We recommend expansion of this initiative across the country for management of co-morbidities as well as other communicable and non-communicable diseases to augment the existing capacity building interventions by provide continued learning and routine mentorship through communities of practice.
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Affiliation(s)
- Reshu Agarwal
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention (CDC), New Delhi, India
| | - Upasna Agarwal
- grid.419345.e0000 0004 1767 7309National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Chinmoyee Das
- grid.452679.bNational AIDS Control Organization, MoHFW, New Delhi, India
| | - Ramesh Allam Reddy
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention (CDC), New Delhi, India
| | - Rashmi Pant
- Society for Health Allied Research and Education India, Hyderabad, India
| | - Christine Ho
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention (CDC), New Delhi, India
| | - B. Ravi Kumar
- Society for Health Allied Research and Education India, Hyderabad, India
| | - Vandana Dabla
- Society for Health Allied Research and Education India, Hyderabad, India
| | - Patrick K. Moonan
- U.S. Centers for Disease Control and Prevention (CDC), Atlanta, India
| | - Melissa Nyendak
- Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention (CDC), New Delhi, India
| | | | - Anoop Kumar Puri
- grid.452679.bNational AIDS Control Organization, MoHFW, New Delhi, India
| | | | | | - Vijay V. Yeldandi
- Society for Health Allied Research and Education India, Hyderabad, India
| | - Rohit Sarin
- grid.419345.e0000 0004 1767 7309National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
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Wood BR, Bauer K, Lechtenberg R, Buskin SE, Bush L, Capizzi J, Crutsinger-Perry B, Erly SJ, Menza TW, Reuer JR, Golden MR, Hughes JP. Direct and Indirect Effects of a Project ECHO Longitudinal Clinical Tele-Mentoring Program on Viral Suppression for Persons With HIV: A Population-Based Analysis. J Acquir Immune Defic Syndr 2022; 90:538-545. [PMID: 35499527 PMCID: PMC9283242 DOI: 10.1097/qai.0000000000003007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Project Extension for Community Health Outcomes (ECHO) aims to connect community providers to academic specialists, deliver longitudinal clinical mentorship and case consultations, plus encourage dissemination of knowledge and resources. The impact on outcomes for persons with HIV (PWH) is uncertain. SETTING PWH in Washington and Oregon outside of the Seattle and Portland metro areas, January 2011 to March 2018. METHODS Using viral load (VL) surveillance data, we assessed difference in the percentage of PWH who were virally suppressed among PWH whose providers participated versus did not participate in Project ECHO. Analyses included multiple mixed-effects regression models, adjusting for time and for patient, provider, and clinic characteristics. RESULTS Based on 65,623 VL results, Project ECHO participation was associated with an increase in the percentage of patients with VL suppression (13.7 percentage points greater; P < 0.0001), although the effect varied by estimated provider PWH patient volume. The difference was 14.7 percentage points ( P < 0.0001) among patients of providers who order <20 VL's/quarter and 2.3 and -0.6 percentage points among patients of providers who order 20-40 or >40 VL's/quarter, respectively ( P > 0.5). The magnitude of difference in VL suppression was associated with the number of sessions attended. Among patients of lower-volume providers who did not participate, VL suppression was 6.2 percentage points higher if providers worked in a clinic where another provider did participate ( P < 0.0001). CONCLUSION Project ECHO is associated with improvement in VL suppression for PWH whose providers participate or work in the same clinic system as a provider who participates, primarily because of benefits for patients of lower-volume providers.
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Affiliation(s)
- Brian R. Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Mountain West AIDS Education and Training Center, Seattle, WA, USA
| | - Karin Bauer
- Mountain West AIDS Education and Training Center, Seattle, WA, USA
| | | | - Susan E. Buskin
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lea Bush
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Jeff Capizzi
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | | | - Timothy W. Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Matthew R. Golden
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Basenero A, Neidel J, Ikeda DJ, Ashivudhi H, Mpariwa S, Kamangu JWN, Mpalang Kakubu MA, Hans L, Mutandi G, Jed S, Tjituka F, Hamunime N, Agins BD. Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach. PLoS One 2022; 17:e0272727. [PMID: 35951592 PMCID: PMC9371294 DOI: 10.1371/journal.pone.0272727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within public-sector health facilities in Namibia. Methods Twenty-four facilities participated in the QIC with the aim of increasing HTN screening and treatment among adult PWH (>15 years). HTN was defined according to national treatment guidelines (i.e., systolic blood pressure >140 and/or diastolic blood pressure >90 across three measurements and at least two occasions), and decisions regarding initiation of treatment were made by physicians only. Teams from participating hospitals used quality improvement methods, monthly measurement of performance indicators, and small-scale tests of change to implement contextually tailored interventions. Coaching of sites was performed on a monthly basis by clinical officers with expertise in QI and HIV, and sites were convened as part of learning sessions to facilitate diffusion of effective interventions. Results Between March 2017 and March 2018, hypertension screening occurred as part of 183,043 (86%) clinical encounters at participating facilities. Among 1,759 PWH newly diagnosed with HTN, 992 (56%) were initiated on first-line treatment. Rates of treatment initiation were higher in facilities with an on-site physician (61%) compared to those without one (51%). During the QIC, facility teams identified fourteen interventions to improve HTN screening and treatment. Among barriers to implementation, teams pointed to malfunctions of blood pressure machines and stock outs of antihypertensive medications as common challenges. Conclusions Implementation of a QIC provided a structured approach for integrating HTN and HIV services across 24 high-volume facilities in Namibia. As rates of HTN treatment remained low despite ongoing facility-level changes, policy-level interventions—such as task sharing and supply chain strengthening—should be pursued to further improve delivery of HTN care among PWH beyond initial screening.
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Affiliation(s)
| | - Julie Neidel
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Daniel J. Ikeda
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | | | - Linea Hans
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Gram Mutandi
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Suzanne Jed
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Pretoria, South Africa
| | | | | | - Bruce D. Agins
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
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10
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Merali HS, Hemed M, Fernando AM, Rizwan S, Mangala EL, Wood AM, Abdalla K, Patterson J, Amick E, Foehringer Merchant H, Smith SL, Wheatley RR, Kamath-Rayne BD. Telementoring initiative for newborn care providers in Kenya, Pakistan and Tanzania. Trop Med Int Health 2022; 27:426-437. [PMID: 35239251 DOI: 10.1111/tmi.13743] [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: 11/27/2022]
Abstract
OBJECTIVES To support governments' efforts at neonatal mortality reduction, UNICEF and the American Academy of Pediatrics launched a telementoring project in Kenya, Pakistan and Tanzania. METHODS In Fall 2019, an individualised 12-session telementoring curriculum was created for East Africa and Pakistan after site visits that included care assessment, patient data review and discussion with faculty and staff. After the programme, participants, administrators and UNICEF staff were surveyed and participated in focus group discussions. RESULTS Participants felt the programme improved knowledge and newborn care. Qualitative analysis found three common themes of successful telementoring: local buy-in, use of existing training or clinical improvement structures, and consideration of technology needs. CONCLUSIONS Telementoring has potential as a powerful tool in newborn education. It offers more flexibility and easier access than in-person sessions. This project has the potential for scale-up, particularly when physical distancing and travel restrictions are the norm.
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Affiliation(s)
- Hasan S Merali
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | | | | | - Amy M Wood
- Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA
| | | | | | - Erick Amick
- American Academy of Pediatrics, Itasca, IL, USA
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11
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Hennein R, Ggita JM, Turimumahoro P, Ochom E, Gupta AJ, Katamba A, Armstrong-Hough M, Davis JL. Core components of a Community of Practice to improve community health worker performance: a qualitative study. Implement Sci Commun 2022; 3:27. [PMID: 35272705 PMCID: PMC8908651 DOI: 10.1186/s43058-022-00279-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/24/2022] [Indexed: 12/28/2022] Open
Abstract
Background Communities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs. Methods We organized community health workers (CHWs) from two tuberculosis (TB) clinics in Kampala, Uganda, into a CoP from February to June 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs’ perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the Behavior Change Technique (BCT) Taxonomy and the Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes. Results All eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as core to improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities incorporated nine different BCTs and five distinct intervention functions. CHWs reported that these activities provided a venue for them to share challenges, exchange knowledge, engage in group problem solving, and benefit from social support. CHWs also explained that they felt a shared sense of ownership of the CoP, which motivated them to propose and carry out innovations. CHWs described that the CoP strengthened their social and professional identities within and outside the group, and improved their self-efficacy. Conclusions We identified the core components and several mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00279-1.
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Affiliation(s)
- Rachel Hennein
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Joseph M Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Patricia Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Emmanuel Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Amanda J Gupta
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda. .,Department of Social and Behavioral Sciences, New York University, New York, NY, USA. .,Department of Epidemiology, New York University, New York, NY, USA.
| | - J Lucian Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, USA.,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
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12
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Goldin S, Hood N, Pascutto A, Bennett C, Barbosa de Lima AC, Devereaux N, Caric A, Rai K, Desai S, Lindstrand A, Struminger B. Building global capacity for COVID-19 vaccination through interactive virtual learning. HUMAN RESOURCES FOR HEALTH 2022; 20:16. [PMID: 35120542 PMCID: PMC8815394 DOI: 10.1186/s12960-022-00710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To support the introduction of the COVID-19 vaccine, the World Health Organization and its partners developed an interactive virtual learning initiative through which vaccination stakeholders could receive the latest guidance, ask questions, and share their experiences. This initiative, implemented between 9 February 2021 and 15 June 2021, included virtual engagement between technical experts and participants during a 15-session interactive webinar series as well as web and text-messaging discussions in English and French. METHODS This article uses a mixed-methods approach to analyze survey data collected following each webinar and a post-series survey conducted after the series had concluded. Participant data were tracked for each session, and feedback surveys were conducted after each session to gauge experience quality and content usability. Chi-square tests were used to compare results across professions (health workers, public health practitioners, and others). RESULTS The COVID-19 Vaccination: Building Global Capacity webinar series reached participants in 179 countries or 93% of the WHO Member States; 75% of participants were from low- and middle-income countries. More than 60% of participants reported using the resources provided during the sessions, and 47% reported sharing these resources with colleagues. More than 79% of participants stated that this initiative significantly improved their confidence in preparing for and rolling out COVID-19 vaccinations; an additional 20% stated that the initiative "somewhat" improved their confidence. In the post-series survey, 70% of participants reported that they will "definitely use" the knowledge derived from this learning series in their work; an additional 20% will "probably use" and 9% would "possibly use" this knowledge in their work. CONCLUSION The COVID-19 Vaccination: Building Global Capacity learning initiative used a digital model of dynamic, interactive learning at scale. The initiative enhanced WHO's ability to disseminate knowledge, provide normative guidance, and share best practices to COVID-19 vaccination stakeholders in real time. This approach allowed WHO to hear the information needs of stakeholders and respond by developing guidance, tools, and training to support COVID-19 vaccine introduction. WHO and its partners can learn from this capacity-building experience and apply best practices for digital interactive learning to other health programs moving forward.
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Affiliation(s)
| | - Nancy Hood
- Project ECHO, University of New Mexico, Albuquerque, USA
| | | | - Celine Bennett
- Project ECHO, University of New Mexico, Albuquerque, USA
| | | | | | | | - Karan Rai
- Project ECHO, University of New Mexico, Albuquerque, USA
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13
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Draper B, Yee WL, Pedrana A, Kyi KP, Qureshi H, Htay H, Naing W, Thompson AJ, Hellard M, Howell J. Reducing liver disease-related deaths in the Asia-Pacific: the important role of decentralised and non-specialist led hepatitis C treatment for cirrhotic patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100359. [PMID: 35024676 PMCID: PMC8733182 DOI: 10.1016/j.lanwpc.2021.100359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Bridget Draper
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia
| | | | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia.,Health Services Research and Implementation, Monash Partners, Melbourne, Australia
| | | | - Huma Qureshi
- Gastroenterologist, Doctors Plaza, Clifton, Karachi, Pakistan
| | - Hla Htay
- Burnet Institute Yangon, Myanmar
| | - Win Naing
- Myanmar Liver Foundation.,Yangon Specialty Hospital, Myanmar
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Australia.,Department of Medicine, University of Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia.,Hepatitis Services, Department of Infectious Diseases Alfred Hospital Melbourne Australia.,Doherty Institute, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Australia
| | - Jessica Howell
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia.,St Vincent's Hospital Melbourne, Australia.,Department of Medicine, University of Melbourne, Australia
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14
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Abstract
PURPOSE OF REVIEW This review summarizes technology-based interventions for HIV in low- and middle-income countries (LMICs). We highlight potential benefits and challenges to using telehealth in LMICs and propose areas for future study. RECENT FINDINGS We identified several models for using telehealth to expand HIV health care access in LMICs, including telemedicine visits for pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) services, telementoring programs for providers, and virtual peer-support groups. Emerging data support the acceptability and feasibility of these strategies. However, further investigations are needed to determine whether these models are scalable and sustainable in the face of barriers related to cost, infrastructure, and regulatory approval. HIV telehealth interventions may be a valuable approach to addressing gaps along the HIV care cascade in LMICs. Future studies should focus on strategies for expanding existing programs to scale and for assessing long-term clinical outcomes.
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15
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Agley J, Delong J, Janota A, Carson A, Roberts J, Maupome G. Reflections on project ECHO: qualitative findings from five different ECHO programs. MEDICAL EDUCATION ONLINE 2021; 26:1936435. [PMID: 34076567 PMCID: PMC8174483 DOI: 10.1080/10872981.2021.1936435] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Project ECHO (Extension for Community Healthcare Outcomes) was developed in 2003 as an innovative model to facilitate continuing education and professional development. ECHO emphasizes 'moving knowledge, not people.' To accomplish this, ECHO programs use virtual collaboration and case-based learning to allow practitioners, including those in rural and underserved areas, to receive specialist training. The ECHO model has expanded rapidly and is now used in 44 countries. Preliminary research on ECHO's efficacy and effectiveness has shown promising results, but evidence remains limited and appropriate research outcomes have not been clearly defined. To improve the evidence basis for ECHO, this study of 5 ECHO programs (cancer prevention/survivorship, integrated pain management, hepatitis C, HIV, and LGBTQ+ health care elucidated actionable insights about the ECHO programs and directions in which future evaluations and research might progress. This was a qualitative study following COREQ standards. A trained interviewer conducted 10 interviews and 5 focus groups with 25 unique, purposively sampled ECHO attendees (2 interviews and 1 focus group for each of the 5 programs). Data were transcribed verbatim and analyzed using the general inductive approach, then reviewed for reliability. We identified four major categories (reasons to join ECHO, value of participating in ECHO, ways to improve ECHO, and barriers to participation) composed of 23 primary codes. We suggest that thematic saturation was achieved, and a coherent narrative about ECHO emerged for discussion. Participants frequently indicated they received valuable learning experiences and thereby changed their practice; rigorous trials of learning and patient-level outcomes are warranted. This study also found support for the idea that the ECHO model should be studied for its role in convening communities of practice and reducing provider isolation as an outcome in itself. Additional implications, including for interprofessional education and model evolution, were also identified and discussed.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, Indiana, USA
- CONTACT Jon Agley Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9 St., Bloomington, Indiana, 47405, USA
| | - Janet Delong
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Andrea Janota
- IUPUI ECHO Center & Center for Public Health Practice, Richard M. Fairbanks School of Public Health, Indiana University, Purdue University, Indianapolis (IUPUI), Indiana, USA
| | - Anyé Carson
- IUPUI ECHO Center & Center for Public Health Practice, Richard M. Fairbanks School of Public Health, Indiana University, Purdue University, Indianapolis (IUPUI), Indiana, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Gerardo Maupome
- Richard M. Fairbanks School of Public Health, Indiana University, Purdue University, Indianapolis (IUPUI), Indiana, USA
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16
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Alidina S, Tibyehabwa L, Alreja SS, Barash D, Bien-Aime D, Cainer M, Charles K, Ernest E, Eyembe J, Fitzgerald L, Giiti GC, Hellar A, Hussein Y, Kahindo F, Kenemo B, Kihunrwa A, Kisakye S, Kissima I, Meara JG, Reynolds C, Staffa SJ, Sydlowski M, Varallo J, Zanial N, Kapologwe NA, Mayengo CD. A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment. HUMAN RESOURCES FOR HEALTH 2021; 19:115. [PMID: 34551758 PMCID: PMC8458007 DOI: 10.1186/s12960-021-00652-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/01/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. METHODS We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania's Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. RESULTS Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention's success emerged: (1) the intervention's design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee-mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors' understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. CONCLUSIONS Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | | | - Danta Bien-Aime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Monica Cainer
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Kevin Charles
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | | | - Laura Fitzgerald
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Geofrey C. Giiti
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Yahaya Hussein
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Benard Kenemo
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Steve Kisakye
- D-Implement, Dalberg Advisors, Dar es Salaam, Tanzania
| | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cheri Reynolds
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Ntuli A. Kapologwe
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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Munyayi FK, van Wyk B. Interventions for improving treatment outcomes in adolescents on antiretroviral therapy with unsuppressed viral loads: a systematic review protocol. BMJ Open 2021; 11:e049452. [PMID: 34551946 PMCID: PMC8461276 DOI: 10.1136/bmjopen-2021-049452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Adolescents represent one of the most underserved population groups among people living with HIV. With successes in the elimination of mother to child transmission initiatives and advances in paediatric HIV treatment programmes, a large population of HIV-infected children are surviving into adolescence. Adolescence presents unique challenges that increase the risk of non-suppressed viral loads in adolescents living with HIV (ALHIV). There is a need to develop, implement and test interventions to improve viral suppression among ALHIV. Systematic reviews of recent studies present scarce and inconclusive evidence of effectiveness of current interventions, especially for adolescents. This protocol provides a description of a planned review of interventions to improve treatment outcomes among unsuppressed ALHIV. METHODS AND ANALYSIS A comprehensive search string will be used to search six bibliographic databases: PubMed/MEDLINE, Sabinet, EBSCOhost, CINAHL, Scopus and ScienceDirect, for relevant studies published between 2010 and 2020 globally, and grey literature. Identified articles will be exported into Mendeley Reference Management software and two independent reviewers will screen the titles, abstracts and full texts for eligibility. A third reviewer will resolve any discrepancies between the two initial reviewers. Studies reporting on interventions to improve viral suppression, retention and adherence for adolescents will be considered for inclusion. The systematic review will be performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Where feasible, a meta-analysis will be conducted using Stata Statistical Software: Release V.16. The quality of the studies and risk of bias will be assessed using the Critical Appraisal Skills Programme checklists and Risk of Bias in Non-randomised Studies of Interventions tool, respectively. ETHICS AND DISSEMINATION The systematic review entails abstracting and reviewing already publicly available data rather than any involvement of participants, therefore, no ethical clearance will be required. Results will be shared with relevant policy-makers, programme managers and service providers, and published and share through conferences and webinars. PROSPERO REGISTRATION NUMBER CRD42021232440.
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Affiliation(s)
- Farai Kevin Munyayi
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Clinical services, I-TECH Namibia, Windhoek, Namibia
| | - Brian van Wyk
- School of Public health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
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18
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Nhung LH, Dien TM, Lan NP, Thanh PQ, Cuong PV. Use of Project ECHO Telementoring Model in Continuing Medical Education for Pediatricians in Vietnam: Preliminary Results. Health Serv Insights 2021; 14:11786329211036855. [PMID: 34408433 PMCID: PMC8366124 DOI: 10.1177/11786329211036855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/01/2021] [Indexed: 12/30/2022] Open
Abstract
The ECHO (Extension for Community Health Outcomes) model has been introduced and implemented in several hospitals and health programs in Vietnam since 2015. In 2018, Vietnam National Children’s Hospital (VNCH) officially implemented the ECHO model to provide continuing medical education (CME) credits on pediatrics topics for medical staff in its satellite hospitals and health centers in the Northern region of Vietnam. This paper presents preliminary results of the ECHO program at VNCH. Methods included pre- and post-program assessments of pediatricians’ clinical knowledge, self-efficacy, and professional satisfaction. The analysis compared the differences between pre/post scores descriptively. Knowledge of participants increased by 22.5% points on average. More than 90% of Project ECHO-Pediatrics participants experienced increased confidence. Overall, there was an improvement in participants’ self-efficacy in the post-training compared to the pre-training (range 14.7%-22.6% difference from pre-training). All participants improved on their results in the clinical test immediately after the training and maintained it after 3 months. The study demonstrated the ability Project ECHO to improve healthcare worker knowledge and satisfaction.
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Affiliation(s)
- Le Hong Nhung
- Vietnam National Children's Hospital, Hanoi, Vietnam
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19
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Leveraging natural history biorepositories as a global, decentralized, pathogen surveillance network. PLoS Pathog 2021; 17:e1009583. [PMID: 34081744 PMCID: PMC8174688 DOI: 10.1371/journal.ppat.1009583] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic reveals a major gap in global biosecurity infrastructure: a lack of publicly available biological samples representative across space, time, and taxonomic diversity. The shortfall, in this case for vertebrates, prevents accurate and rapid identification and monitoring of emerging pathogens and their reservoir host(s) and precludes extended investigation of ecological, evolutionary, and environmental associations that lead to human infection or spillover. Natural history museum biorepositories form the backbone of a critically needed, decentralized, global network for zoonotic pathogen surveillance, yet this infrastructure remains marginally developed, underutilized, underfunded, and disconnected from public health initiatives. Proactive detection and mitigation for emerging infectious diseases (EIDs) requires expanded biodiversity infrastructure and training (particularly in biodiverse and lower income countries) and new communication pipelines that connect biorepositories and biomedical communities. To this end, we highlight a novel adaptation of Project ECHO’s virtual community of practice model: Museums and Emerging Pathogens in the Americas (MEPA). MEPA is a virtual network aimed at fostering communication, coordination, and collaborative problem-solving among pathogen researchers, public health officials, and biorepositories in the Americas. MEPA now acts as a model of effective international, interdisciplinary collaboration that can and should be replicated in other biodiversity hotspots. We encourage deposition of wildlife specimens and associated data with public biorepositories, regardless of original collection purpose, and urge biorepositories to embrace new specimen sources, types, and uses to maximize strategic growth and utility for EID research. Taxonomically, geographically, and temporally deep biorepository archives serve as the foundation of a proactive and increasingly predictive approach to zoonotic spillover, risk assessment, and threat mitigation.
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Virtual Peer-to-Peer Learning to Enhance and Accelerate the Health System Response to COVID-19: The HHS ASPR Project ECHO COVID-19 Clinical Rounds Initiative. Ann Emerg Med 2021; 78:223-228. [PMID: 34325856 PMCID: PMC8052469 DOI: 10.1016/j.annemergmed.2021.03.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 12/15/2022]
Abstract
Tasked with identifying digital health solutions to support dynamic learning health systems and their response to COVID-19, the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response partnered with the University of New Mexico’s Project ECHO and more than 2 dozen other organizations and agencies to create a real-time virtual peer-to-peer clinical education opportunity: the COVID-19 Clinical Rounds Initiative. Focused on 3 “pressure points” in the COVID-19 continuum of care—(1) the out-of-hospital and/or emergency medical services setting, (2) emergency departments, and (3) inpatient critical care environments—the initiative has created a massive peer-to-peer learning network for real-time information sharing, engaging participants in all 50 US states and more than 100 countries. One hundred twenty-five learning sessions had been conducted between March 24, 2020 and February 25, 2021, delivering more than 58,000 total learner-hours of contact in the first 11 months of operation.
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Iyer K, Nisenholtz M, Gutierrez D, Winkler M, Tappenden K, Seidner D, Kirby DF, Spangenburg M, Potts R, Bonagura A, Bishop J, Metzger L, Arora S. Disseminating Knowledge in Intestinal Failure: Initial Report of the Learn Intestinal Failure Tele-ECHO (LIFT-ECHO) Project. JPEN J Parenter Enteral Nutr 2021; 45:1108-1112. [PMID: 33533531 DOI: 10.1002/jpen.2078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intestinal failure (IF) is defined as an ultrarare disease, with an estimated prevalence of ∼25,000 cases in the US. There is a suspicion of disparities in outcomes in IF care, likely related to widespread lack of expertise. The Extension for Community Healthcare Outcomes (ECHO) model originally described by Dr Sanjeev Arora has been used to disseminate knowledge and best practices in many chronic diseases to improve outcomes. We examined our initial experience with using the ECHO model to disseminate learning in IF. METHOD This is a retrospective review of the launch, growth, and geographic reach of the Learn Intestinal Failure TeleECHO (LIFT-ECHO) program using prospectively collected data. RESULTS The LIFT-ECHO program has achieved significant geographic reach and clinician engagement. The program has reached close to two-thirds of the states in the US and several countries outside. Clinician engagement in the learning program appears to be growing exponentially. CONCLUSION It is feasible to use the ECHO model to disseminate knowledge in managing a rare disease like IF while maintaining fidelity to the proven model. Studies are underway to demonstrate direct benefit to patients.
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Affiliation(s)
- Kishore Iyer
- Mount Sinai School of Medicine, Intestinal Rehab and Transplant Program, New York, New York, USA
| | - Marjorie Nisenholtz
- Mount Sinai School of Medicine, Intestinal Rehab and Transplant Program, New York, New York, USA
| | - David Gutierrez
- Mount Sinai School of Medicine, Intestinal Rehab and Transplant Program, New York, New York, USA
| | - Marion Winkler
- Department of Surgery and Nutritional Support Service, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kelly Tappenden
- Kinesiology and Nutrition, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Douglas Seidner
- Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle Spangenburg
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | | | | | | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico, Albuquerque, New Mexico, USA
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Finn M, Gilmore B, Sheaf G, Vallières F. What do we mean by individual capacity strengthening for primary health care in low- and middle-income countries? A systematic scoping review to improve conceptual clarity. HUMAN RESOURCES FOR HEALTH 2021; 19:5. [PMID: 33407554 PMCID: PMC7789571 DOI: 10.1186/s12960-020-00547-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Capacity strengthening of primary health care workers is widely used as a means to strengthen health service delivery, particularly in low- and middle-income countries. Despite the widespread recognition of the importance of capacity strengthening to improve access to quality health care, how the term 'capacity strengthening' is both used and measured varies substantially across the literature. This scoping review sought to identify the most common domains of individual capacity strengthening, as well as their most common forms of measurement, to generate a better understanding of what is meant by the term 'capacity strengthening' for primary health care workers. METHODS Six electronic databases were searched for studies published between January 2000 and October 2020. A total of 4474 articles were screened at title and abstract phase and 323 full-text articles were reviewed. 55 articles were ultimately identified for inclusion, covering various geographic settings and health topics. RESULTS Capacity strengthening is predominantly conceptualised in relation to knowledge and skills, as either sole domains of capacity, or used in combination with other domains including self-efficacy, practices, ability, and competencies. Capacity strengthening is primarily measured using pre- and post-tests, practical evaluations, and observation. These occur along study-specific indicators, though some pre-existing, validated tools are also used. CONCLUSION The concept of capacity strengthening for primary health care workers reflected across a number of relevant frameworks and theories differs from what is commonly seen in practice. A framework of individual capacity strengthening across intra-personal, inter-personal, and technical domains is proposed, as an initial step towards building a common consensus of individual capacity strengthening for future work.
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Affiliation(s)
- Mairéad Finn
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin, Ireland
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
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