OpiniãoThis statement has several components which underline the importance of training programmes and include ongoing education concerning prevention, treatment and care.
As noted recently in the Lancet (Baleta 2008), while in-service training provides an immediate response to an acute need for rapid HIV prevention, care, and treatment scale-up, training needs evolve over time. The increased requirements for more robust training place additional pressures on in-service training delivery and require an adaptation of training initiatives. HIV medicine is a rapidly evolving science with a short half-life of current knowledge. More mechanisms need to be built into training programmes in resource-limited settings to provide staff with regular updates on HIV knowledge. A practical solution to this dilemma is strengthening pre-service education accompanied by continuing professional or health worker education programmes.
Several organizations are offering training materials, including trade unions and associations of health professionals, such as PSI's "Focus on Health" periodicals. (http://www.world-psi.org/TemplateEn.cfm?Section=PSI publications&CONTENTID=19238&TEMPLATE=/ContentMa nagement/ContentDisplay.cfm), and many NGOs.
Training and education on "care" explicitly must include sexual and reproductive health as well as occupational health issues. The WHO document: "Integrating gender into HIV/AIDS programmes in the health sector: Tool to improve responsiveness to women's needs" (WHO 2009) provides details on how to effectively train programme managers and service providers to incorporate gender-responsive actions into their daily work and how to integrate gender into pre-service and/or in-service basic HIV training curricula.
Although in-service training courses are needed as a short-term response to disseminate new knowledge in HIV and TB prevention, care, and treatment, the proper education of all health professionals and health workers generally is essential, along with the timely integration of adequate and regularly updated comprehensive HIV and TB training into pre-service curricula of all cadres of health workers. Continuing collaboration between WHO, partners, and ministries to rapidly produce and continuously update strong HIV and TB content for pre-service education and continuing health professional and health worker education is needed. Key HIV and TB training (including education and training on infection control at the workplace; VCT; antiretroviral therapy; sexual and reproductive health services including preconception planning; maternal and child health; prevention and management of gender based violence; and sexually transmitted infection management) should be integrated with other HIV and TB services.
It is also noteworthy that the programmes identified in the Systematic Evidence Review highlighted training as essential. For example, recommendations from the 70-site RSA workplace programme included the need for continuing education about HIV/ART, being respectful, and addressing the issues of infected partners and stigma (Charalambous et al. 2007a). Additional training needs identified by the providers included counselling of family and friends, family planning, sexually transmitted infections and running support groups. As shown in Table 10, other authors echoed this conclusion.
The Guideline Group stresses the following:
- Specific training is necessary for workplace managers, workers' representatives, health and safety committee members, and any front-line workers who may be exposed to blood or other body fluids.
- Education and training should include a basic level of information about how HIV and TB are transmitted in addition to how risks of transmission (both occupational and non-occupational) can be minimized.
- Stand alone training curriculum and/or tool kits should be developed. A comprehensive tool kit that would allow for trainers to pick and choose training sessions/exercises based on the needs of their target audiences.
- As stated in the Joint ILO/WHO guidelines on health services and HIV "appropriate training is necessary of personnel at all levels of responsibility in order to increase understanding of HIV and to help reduce negative and discriminatory attitudes towards colleagues and patients living with the disease."
- This training should provide health workers with:
- information on the modes of transmission of HIV , TB, and other infectious diseases (both occupational and non-occupational risks), the level of occupational risk, to address the fear of physical contact with patients and provide a platform for continuous learning;
- inter-personal skills to help health workers understand the impact of HIV, TB and the burden of stigma, and provide them with the tools to communicate with patients, colleagues and others in a respectful and non-discriminatory manner;
- techniques to manage stress and avoid burnout, such as through the provision of appropriate staffing levels; more opportunities for front-line worker involvement; determining shift patterns; work rotation; promotion and personal development; early recognition of stress; development of communication skills for supervision; staff support groups; and time away from the workplace;
- awareness of existing legislation and regulations that protect the rights of healthcare workers and patients regardless of their HIV status.
- Training must go well beyond the provision of information. While misinformation about modes of transmission and the magnitude of occupational risk, may well underlie stigmatizing attitudes, there is more required than simply the provision of correct information to shift stigmatizing attitudes.