Measuring the Impact of On-Site Mentorship on Mid-level Practitioners' HIV and TB Care and Treatment Competencies (MENTORS)

Sustainable health outcomes in Africa are achieved through a developed healthcare system with the capacity to provide care for those living with infectious diseases.Uganda's shortage of healthcare workers is a major barrier to increasing access to care and meeting health targets.The medical officer to population ratio is 1:12,500 and even worse in rural areas, with the majority of available health workers being mid-level practitioners (MLPs), such as registered nurses or clinical officers.

Training MLPs to perform tasks conventionally assigned to doctors, known as task shifting, can expand the capacity of the existing health workforce and increase access to HIV and TB services. Task shifting is widely supported by PEPFAR and partner countries as an effective and appropriate approach for delivering HIV services in countries with workforce shortages. In order to expand necessary skills, as well as ensure the quality of scaled-up HIV services, the Ugandan Ministry of Health (MoH) champions on-site clinical mentoring for MLPs to support task shifting.

Funded by CDC Uganda, the Infectious Disease Institute and Accordia have begun implementing an operations research project, MENTORS, to assess the impact of on-site clinical mentorship on mid-level practitioners who provide HIV and TB care in Uganda. The mentoring teams started their mentoring visits in October 2013. The two-person teams are providing mentoring in TB and HIV care to mid-level practitioners (clinical officers and registered nurses) at each of the five intervention health centers, known as Health Center IVs or HCIVs. Key components of the district health system of Uganda, each sub-district's HCIV provides basic preventive and curative care to a population of 100,000 people, as well as referral services, for the health sub-district.

An additional five HCIVs will serve as the project's control group. There will be six mentoring visits over nine months to help achieve the project's aim of improving the quality of care for patients with TB and HIV at these sites.

Accordia is providing technical assistance in the evaluation design and administration, which builds off the Integrated Infectious Disease Capacity-Building Evaluation Project (IDCAP), using ten sites and the data surveillance system from IDCAP.[add Map] The sites include:

• Mulanda HCIV
• Magale HCIV
• Mukuju HCIV
• Apapai HCIV
• Omugo HCIV
• Koja HCIV
• Kiwangala HCIV
• Rukunyu HCIV
• Koboko HCIV
• Pakwach HCIV

We are also adapting the case scenarios and clinical observation evaluation tools to meet the needs of the MENTORS project as well as providing technical support in designing and implementing clinical mentorship.

The expected outcomes include increased knowledge and competence scores of MLPs on HIV and TB care case scenarios and clinical observations along with improved facility-level performance on HIV and TB indicators. We anticipate that the findings from this study will help guide decision making and resource allocation regarding the length of clinical mentoring necessary to improve MLPs' competence in managing patients with HIV and TB.