XVIII International AIDS Conference


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Lessons learned from nurse capacity-building activities

D. Parham-Hopson1, B. Aranda-Naranjo1, J. Yu-Shears1, C. Hall1, R. Conviser2

1U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, United States, 2Global Health Policy Partners, Missoula, United States

Issues: The President's Emergency Plan for AIDS Relief (PEPFAR), reauthorized in 2008, emphasizes strengthening of health care systems and training of 140,000 new healthcare workers by 2013.
Description: Under PEPFAR, the Health Resources and Services Administration (HRSA) and its grantees and partners have been building health care workforce capacity. HRSA's programs have strengthened the numbers and skills of nurses in sub-Saharan Africa, India, and the Caribbean. Grantees have pursued clinical goals like building capacity in prevention, care, and treatment; improving management of antiretroviral drugs (ARV); expanding programs for prevention of mother-to-child transmission of HIV; promoting provider-initiated testing and counseling; and building clinical mentorship programs. Grantees have also worked to strengthen pre-service training programs as well as the professional standing and certification of nurses. HRSA-supported activities have promoted expanded roles for nurses through mentoring and training that facilitates task shifting; however, some governments have been slow to recognize nurses' capacity to take over tasks like prescribing ARV.
Lessons learned: Program success is enhanced by respecting local contexts, promoting community involvement and coordination among cadres of health care workers, while working to clarify extensions in nurses' responsibilities. To assure nurses' skills, it is critical to include hands-on components in training sessions and to follow up those sessions with both training updates and practical experiences, having mentors and technical assistance available. Site visits by mentors help to improve both individual and institutional practices. Including a training of trainer component in programs creates a national cadre of health care workers who can sustainably monitor the quality of care. Finally, collaborative efforts with Ministries of Health (including their national or regional training centers, as well as state, provincial, or district entities and local universities in some places) also promote program sustainability.
Next steps: Apply and share best practices and lessons learned. Provide funding for strengthening of nursing schools.

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