Human Capacity Building Strategy to Support ART Scale Up in Ukraine (Sept. 2005)

Ukrainian National AIDS Center
Regional Knowledge Hub for Care and Treatment of HIV /AIDS in Eurasia

Human Capacity Building Strategy to Support ART Scale Up in Ukraine
Meeting

KMAPE, conference room, 9 Dorogozhytska Street, Kiev, Ukraine
September 26, 2005, 09:30–17:00

MEETING MINUTES

 

In attendance:

  • Alla Scherbinska, Ukrainian National AIDS Center (NAC), Director
  • Olga Sakalska, Ukrainian Ministry of Health (MOH), Department of Infectious Diseases, Deputy Head of Department
  • Svitlana Antonyak, Department of HIV / AIDS Infection (Lavra Clinic), Kiev's Gromashevsky Institute of Epidemiology and Infectious Diseases , Head of Department
  • Alla Podsviriva, Kiev Narcology Hospital, Head Of Department
  • Yaroslav Zyatyuk, Kherson Oblast AIDS Center, Chief Doctor
  • Mykola Turchin, Dnipropetrovsk Oblast AIDS Center, Chief Doctor
  • Svitlana Cherenko, Institute of Phthisiatry and Pulmonology after F.Yanovsky, Senior Scientific Specialist
  • Oksana Titarenko, State Department of Penitentiary System, Senior Specialist
  • Artur Ovsepyan, All-Ukrainian Network of PLWHA, Counselor to the Chairman
  • Yuriy Voronenko, Kyiv Medical Academy of Post-Graduate Education (KMAPE), Rector
  • Nina Goida, Kyiv Medical Academy of Post-Graduate Education (KMAPE), Deputy Rector
  • Igor Olyinyk, WHO/Ukraine, HIV/AIDS Coordinator
  • Ariele Braye, WHO 3 by 5 Country Program Officer
  • Ani Shakarishvili, UNAIDS/Ukraine, Program Officer
  • Iryna Borushek, International HIV/AIDS Alliance, Ukraine, Head of Department
  • Serhiy Filippovich, International HIV/AIDS Alliance, Ukraine, Senior Specialist
  • Tetyana Perepelytsya, International HIV/AIDS Alliance, Ukraine, Specialist
  • Zahed Islam, MSF-Ukraine, Head of Mission
  • Nadiya Pylypchuk, AFEW, Ukraine, Lead Trainer, HR Programme
  • Elena Voskresenskaya, AFEW, Ukraine, Deputy Regional Director
  • Valeriy Khmarsky, World Bank HIV/AIDS Control in Ukraine Project Group, AIDS Component Manager
  • Henry Chang, AHF-Global Immunity, Executive Director, USA
  • Christoph Weber, Vivantes Auguste-Viktoria-Klinikum, Medical Doctor, Germany
  • Armin Traute, Connect+, Member of the Executive Committee, Germany
  • James Smith, AIHA, Executive Director
  • Zoya Shabarova, AIHA, Regional HIV/AIDS Coordinator
  • Andriy Styopkin, AIHA / Knowledge Hub, Program Coordinator

Support Knowledge Hub/AIHA Staff:

  • Olena Dolotova, AIHA / Knowledge Hub, Administrative and Financial Director
  • Svitlana Sviridenko, AIHA / Knowledge Hub, Chief Accountant
  • Maria Bodnar, AIHA / Knowledge Hub, Administrator
  • Vira Illiash, AIHA, Staff Writer
  • Grigory Naumovets, AIHA, IT Coordinator

Translators:

  • Iryna Reshevska
  • Olga Nikolaenko

Facilitator:

  • James Smith, AIHA, Executive Director

Agenda:

Handouts distributed:

  1. Meeting Agenda.
  2. Meeting Concept Paper.
  3. Regional Knowledge Hub: Human capacity building activities in Ukraine. Report: June 2004 – September 2005.
  4. Knowledge Hub Training Course Guide. September 2005
  5. Knowledge Hub Newswire. Summer 2005.
  6. Set of all Power Point Presentations.

 

Opening and welcome greetings.

The meeting was opened by a welcoming greeting to the participants from James Smith. He thanked everyone for the attendance and spoke about the history of the Knowledge Hub, its founding partners, mission and achievements for the past 15 months of activities. He pointed out that the Knowledge Hub’s activities are unique not only in Ukraine but also in NIS, where Ukrainian experience is regarded as a model because of systematic approach to HIV/AIDS care and treatment human capacity building in connection with national care model, consensus with main national and international stakeholders on training methodology, multidisciplinary care team approach, adult learning methodology, quality assurance system.

James Smith asked the participants to introduce themselves. After the introductions he invited the founding partners of the Knowledge Hub (National AIDS Center, WHO and KMAPE) to welcome the meeting participants.

Alla Sherbinska welcomed the participants. She said that the main result of the Knowledge Hub’s successful 1 year activities in Ukraine was the education of dozens of care teams from 15 regional AIDS Centers on comprehensive methods of treatment and management, who are providing ART for more than 2,500 patients. She pointed out that the need to train medical and social care providers is growing alone with the need of ART provision to PLWHA. She wished Knowledge Hub success in its future activities.

Yuriy Voronenko welcomed the meeting participants on the behalf of the KMAPE. Speaking about the Knowledge Hub’s activities in Ukraine he noted that the successful realization of its training program is very important for Ukrainian postgraduate medical education. National certification by KMAPE of physicians who successfully completed series of Knowledge Hub trainings is very important result of cooperation between KMAPE and Knowledge Hub. He wished the meeting success in achieving its goals.

Ariele Braye greeted the participants and thanked the Knowledge Hub and the National AIDS Center for the organization of meeting. She said that all the work conducted by the Knowledge Hub is very significant taking into consideration the number of the care teams trained in ART, but a more important issue is planning of future activities in regard of the human capacity-building program. She expressed her hope that the meeting would formulate clear vision to the parties involved in the program realization about current status of human capacity development and what additional needs and resourced will be needed.

Summing up the welcoming session of the meeting James Smith explained the goals of the meeting: (1) to review and discuss the effectiveness of the Regional Knowledge Hub for Care and Treatment of HIV /AIDS in Eurasia (Knowledge Hub) capacity building programs to date from multiple perspectives; (2) to examine lessons learned at the conclusion of a year’s activities; (3) to discuss the learning needs of Ukrainian healthcare workers on HIV / AIDS care and treatment; and (4) to identify priorities for further capacity building in support of improved access to quality care on the part of PLWHA’s in Ukraine.

He said that the development of the care and treatment model, training of more than 50 multidisciplinary care teams, certification of medical workers – these all were significant results achieved by Knowledge Hub during first year of its work in Ukraine.

James Smith formulated the expected result of the meeting – to develop consensus on HIV/AIDS care and treatment human capacity building priorities and approach to improve the availability and quality of care for PLWHA in the coming year in Ukraine.

He noted that the success of the Knowledge Hub’s activities would not be possible without the input each of the organizations present, who, together with other strategic partners had contributed their human, financial and other resources to the extraordinary success of the Ukrainian human capacity building program.

After the summary of the welcoming session James Smith invited the participants to begin their presentations.

 

National plan of ART scale up in Ukraine: Presentation by Alla Sherbinska.

In her presentation, Alla Sherbinska analyzed the epidemiological situation in Ukraine and gave the official data on the HIV / AIDS prevalence. In the past year the number of oblasts with the expansion of HIV has grown in Ukraine. She said that there are more than 79,000 registered cases of HIV / AIDS in Ukraine as of now, whereas WHO and UNAIDS estimated that more than 1.4% of the population of Ukraine is to be infected.

Alla Sherbinska pointed out that the average death rate among the AIDS patients is 50% in Ukraine. The start of the antiretroviral therapy in Donetsk oblast, for example, helped to low down this rate by 9%, in Odessa oblast by 19%. The fact that patients still die is accounted for the fact that most of them were in terminal stage when ART was initiated.

Alla Sherbinska continued to describe the current status of ART in Ukraine (2,700 patients) and about the extension of the scale-up plan – 3,050 patients by the end of 2005 including all children will be on therapy. The data she presented reflected concerns about adherence to ART. She said that strengthening the efforts in social support of the patients on ART should help cope with this problem.

She referred to the Knowledge Hub’s activities as to the one of the most significant achievements in preparation and implementation of the ART scale-up plan in Ukraine. She said that over 100 doctors and 190 nurses from the 6 first-line priority and 9 second-line priority regions received training on ART and other HIV/AIDS related issues.

Alla Sherbinska continued to speak about the comprehensive plan of treatment that the National AIDS Center is working on. It is planned to take 6000 patients on ART by 2008. Alone with the new 4 or 5 regions to be chosen, the therapy will be initiated in the penitentiary system.

Concluding her presentation Alla Sherbinska thanked the participants for their attention.

James Smith thanked Alla Sherbinska for her presentation and invited Serhiy Filippovich to speak about the results and perspectives of the Global Fund’s program in Ukraine on human capacity building on HIV/AIDS care and treatment.

 

Training multidisciplinary care teams on HIV/AIDS. Results and perspectives under “Fighting HIV/AIDS Epidemic in Ukraine” program supported by Global Fund to Fight AIDS, TB and Malaria: Presentation by Serhiy Filippovich.

Serhiy Filippovich started his presentation by saying that the creation of Knowledge Hub had coincided with the start of HIV/AIDS Alliance’s activities on the Global Fund’s (GF) program “Fighting HIV/AIDS Epidemic in Ukraine”. At that time when the Alliance was not ready to finance the ART trainings, the Knowledge Hub had conducted 2 trainings on its own expenses in June 2004. So, by the time the ART program was started in Ukraine in August 2004 the AIDS centers from the 6 first-line priority regions had already trained care teams. Serhiy Filippovich stressed out that without the support from the Knowledge Hub the Global Fund’s plan on ART would not have been successful in Ukraine.

Continuing his presentation Serhiy Filippovich presented the current data on the ARV treatment in Ukraine. As the main results of the treatment component of the GF’s program are the development of the comprehensive plan of ART scale-up in Ukraine, creation of the national protocols on treatment and diagnostics, assessment and provision of technical assistance to AIDS Centers, improvement of qualifications of professionals working with PLWHA.

Speaking about the improvement of qualifications of professionals working with PLWHA Serhiy Filippovich noted 3 main directions and 3 major organizations providing trainings: (1) training multidisciplinary teams on ART and related issues (AIHA/Knowledge Hub in collaboration with KMAPE); (2) on-site clinical preceptorship program (AHF Global Immunity); and (3) training social workers (Public organization “Socium XXI” based at Kiev-Mohyla Academy). He presented the main results of the Knowledge Hub’s training program: establishing a partnership between Knowledge Hub/AIHA, Ukrainian National HIV/AIDS Center and the Alliance to identify training needs; comprehensive training of 6 multidisciplinary care teams in Pediatric ART; training of 38 multidisciplinary care teams in Adult ART from 15 regions of Ukraine; training of 28 lab physicians on Laboratory monitoring of ART; national certification of 49 physicians on improved qualifications.

After speaking about the plan on expanding the capacity of national HIV/AIDS treatment in Ukraine, Serhiy Filippovich outlined the future training needs of the Ukrainian healthcare providers: initiation of ART for health care workers from new regions; ART for people with opportunistic infections; specific issues of ART for IDUs receiving RT; training of national trainers; provision of palliative care; VCT services.

In the end of his presentation Serhiy Filippovich shared with the audience the plans for the multidisciplinary approach-based training for 2005 – 2006. It is planned to train 20 TB doctors (possibly together with infectious diseases specialists); 12 narcologists, 6 infectionists and 6 social workers on RT and ART; continue training for social workers.

Serhiy Filippovich thanked the audience for attention.

 

Report on the Knowledge Hub training activities in Ukraine: Presentation by Zoya Shabarova.

In the beginning of her presentation Zoya Shabarova spoke about the purpose of the Knowledge Hub, its founding partners, start-up operational support, participating institutions, implementing and strategic partners. She pointed out that the focus of the Knowledge Hub’s activities is not just to provide trainings to healthcare practitioners, but to develop and implement national HIV/AIDS care and treatment human capacity building plan which support national care strategy.

Describing the training approach at the Knowledge Hub Zoya Shabarova described the target audience for trainings, faculty, training materials, teaching methods, quality control system, and national certification.

The key results of the of the Knowledge Hub’s successful activities over the last year were defined by Zoya Shabarova as development and adoption of 15 course curricula with related training materials; provision of 21 training courses for Ukrainian caregivers; training over 500 healthcare professionals from 18 Ukrainian regions (52 health care teams providing ARV therapy to over 2,500 PLWHA). She also spoke in detail about the statistics of each course and financial sources of the Knowledge Hub’s activities.

Zoya Shabarova continued her presentation speaking about the challenges of the Knowledge Hub’s activities. In this regard, she stressed upon the development of collaborative approaches among specialists (including TB and narcology specialists); further development of multidisciplinary approach and its on-ground support; expansion of training curriculum based on future training needs; development of national faculty to carry out most training functions.

Zoya Shabarova summarized her presentation by outlining the lessons learned. Among them, she noted the necessity to develop an effective training plan complementing and supporting the national ART scale up plan. She said that the consensus of main national stakeholders on care model and training approach is vital for successful implementation of the plan. The multidisciplinary nature of HIV/AIDS care and treatment defines the need for multidisciplinary training approach, which can effectively address complex issues of adherence, care and treatment for IDUs, providing continuum of HIV/AIDS care. Trained care teams require regular refresh training courses to integrate their experience and to meet new challenges; therefore the training methodology and approaches need further development to address the topics: TB/HIV co-infection, ART for IDUs, mental health issues, etc.

Zoya Shabarova said that strategic partnership with international organizations, national stakeholders and PLWA groups is the key factor for effective implementation of the human capacity building program on HIV/AIDS care and treatment. She thanked the audience for attention and gave the floor to James Smith.

James Smith said that Knowledge Hub had been lucky to work with exceptionally experienced and competent trainers from Ukraine, Germany and the USA. He specially thanked Dr. Antonyak and the competent personnel of the Lavra AIDS Clinic who have unique practical experience in treatment of HIV/AIDS. James Smith stressed further that the Knowledge Hub would not have been so successful without the support from its partners – Lavra Clinic, MSF, AHF-GI, Connect+, IAPAC, German and American HIV/AIDS clinics, All Ukrainian Network of PLWA and international adherence consultant. He thanked all trainers once again for all the work.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation – Faculty feedback: Presentation by Zoya Shabarova.

Zoya Shabarova started her presentation by defining the main principles of the faculty composition at the Knowledge Hub’s trainings, formulated during the stakeholders’ meeting back in March 2004: multidisciplinary approach (HIV physician, nurse/case manager, social worker/ART aid); international and national instructors with proven track record of clinical excellence; pedagogical skills and understanding of adult learning methods. She continued by presenting the faculty’s feedback on the Knowledge Hub ART curricula that included both achievements and challenges.

Speaking about the achievements, Zoya Shabarova presented the summary of the pre/post-training knowledge assessments reflecting the fact that most of the participants made a big step in terms of basic knowledge in ARV and diagnosis and treatment of opportunistic infections, and their increased level of knowledge and competence. Among the challenges pointed out by the faculty were co-infections and addictive diseases (joint training programs for TB and narcology specialists); palliative and end of life care; counseling on risk factors, safer sex, and psychosocial factors; patients’ rights; follow-up of the trainings (ongoing consultations, short-term on-site trainings on specific topics).

Zoya Shabarova also outlined the key factors for building the national faculty. The potential national trainers should possess practical experience of ART management with proven track of good clinical results, advanced clinical knowledge with motivation of regular update, as well as pedagogical motivation with ability to conduct training using adult learning methods.

Concluding her presentation Zoya Shabarova pointed out that the strength of Knowledge Hub human capacity building activities is based on the curricula using the WHO materials, latest evidenced based information and relevant national protocols, multidisciplinary approach to the faculty and trainees’ composition, high quality of training process, effectively implemented and combined with rigorous monitoring system. The lessons learned reflect the need to further develop collaborative multi- and inter-sectoral approaches, further development and on-ground support of multidisciplinary approach, development of new courses to respond to the unmet needs, further development of national faculty.

She thanked the attendees for their attention, finished her presentation and gave the floor to the faculty of the Knowledge Hub’s trainings.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation: Presentation by Christoph Weber.

The first speaker to present the faculty’s vision of the Knowledge Hub’s activities over the year was Christoph Weber. He structured his presentation according to the organizational issues, lessons learned and proposals for future activities.

Speaking about the organization of the trainings Christoph Weber said that the informational material was given to the trainers in advance; the overall organization was done perfectly in terms of travel, accommodation, and technical support, the staff of the Knowledge Hub was competent, dedicated, reliable and friendly.

Among the lessons learned Christoph Weber pointed out the following aspects: the assessment of the training needs must be conducted continuously in order to provide caregivers with important information of high quality (clinical expertise and practical relevance); the concept of combining didactical sessions, breakout groups, bed-side training and role-plays was proved to be an excellent tool to communicate complex medical and social issues.

For future activities Christoph Weber suggested to take into consideration the enhanced networking and interdisciplinary cooperation between infectionists, TB specialists and narcologists, the incorporation of the palliative care into clinical practice, the implementation of the replacement therapy. Speaking about the medical issues that should be considered in future he pointed out the important question of developing standardized diagnostic approaches for opportunistic infections (including TB) as binding guidelines for treatment, diagnostics and laboratory procedures. He also suggested enhancing specific clinical skills (biopsy of superficial lymph nodes, etc.) and provision of further intensive trainings for specific opportunistic infections in small groups.

In the end of his presentation, Christoph Weber thanked the audience for attention and answered a question about the networking raised by James Smith.

Christoph Weber said that based on his experience of training and mentoring for Ukrainian medical workers, AIDS center does not possess enough resources (lab facilities, TB experts, etc.) and experience. To help the regional centers solve this problem he suggested uniting the efforts and sharing the resources by establishing a network between the AIDS centers that allows some degree of specialization and resource efficiency.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation – Faculty feedback: Presentation by Svetlana Antonyak.

Svetlana Antonyak said that the role of the Knowledge Hub has been tremendous in the successful realization of the ART scale-up plan in Ukraine; trainees’ representation from the AIDS Clinics had been optimal and reflected the gradual scale-up plan of ART. She also mentioned that the team approach first in education and then in treatment proved to be very efficient. The quality of education is provided not only by the faculty, but also by the KMAPE as a certification authority.

Svetlana Antonyak provided general comments on the most important issues of the Knowledge Hub’s activities. She noted that notwithstanding the high numbers of patients on ART, visible success of the treatment and high level of adherence, the education needs of the Ukrainian care providers remain high. Svetlana Antonyak said that specific education is needed to treat certain vulnerable groups. Unfortunately, more specialized focus on IDUs has not been adequately covered by the general curricula. She suggested this topic for future training programs.

Svetlana Antonyak noted that the operational planning of the educational activities had been excellent during the last year. She stressed the necessity of a long-term strategic planning based on the determination of the educational needs. On her opinion, Knowledge Hub and the National AIDS Center are able to determine the needs and formulate the strategy based on the AIDS Alliance support.

Svetlana Antonyak pointed out that the Knowledge Hub selected the faculty teams very effectively. There were much cooperation and exchange of expertise between the trainers. With the base in Lavra Clinic, the trainings also helped the personnel of the clinic increase their knowledge and expertise, and improve the clinical skills. She said that the input of the Knowledge Hub into the human capacity building is difficult to underestimate and it will serve the Ukrainian health care system for a long time.

Speaking about the training program and methodology of teaching Svetlana Antonyak noted that the program was based on the WHO and national recommendations, and the methods of teaching represented an optimal combination of didactical and practical sessions.

As a plan for future Svetlana Antonyak suggested not only to replicate the positive experience of Knowledge Hub, but also to deepen the inter-sectoral cooperation between infectionists, TB and narcology specialists. Finishing her presentation Svetlana Antonyak thanked the audience for attention.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation – Faculty feedback: Presentation by Armin Traute.

Armin Traute started his presentation by telling the audience about the activities of Connect+ in Eastern Europe and about the projects of his organization in Ukraine.

Evaluating the Knowledge Hub’s trainings Armin Traute said they were organized on a high level. He appreciated AIHA and Knowledge Hub for the good work, and thanked his trainer colleagues for fruitful and beneficial cooperation. He said that the incorporation of psycho-social issues in the ART trainings in a systematic manner and establishing multidisciplinary teams of trainees and trainers were a big step forward and beneficial for the development of human capacity in the Ukrainian health care system.

Concluding his presentation Armin Traute pointed at the topics that still need to be addressed during the trainings in future. Among them were further development of counseling skills for social workers and health care providers; sexual behavior, safer sex, drug abuse; non-compliance; team building; psycho-social context of ART; patients’ rights and shared decision making; responsibilities within the multi-professional team.

Armin Traute thanked the audience for attention.

James Smith thanked Armin Traute and Connect+ for the cooperation and invited Henry Chang to give his presentation.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation – Faculty feedback: Presentation by Henry Chang.

Henry Chang thanked Knowledge Hub for the invitation to participate in this important meeting and started his presentation by speaking about the quality of trainings. He admitted that the organization and management of the trainings had been exceptional.

Henry Chang said that it is important that the trainings are very effective and give the participants knowledge and ready-to-use practical skills. Speaking from the nurses’ point of view, he suggested several directions for further consideration, among them leadership in a team, care team approach as a means to increase care efficiency and to reduce the burnout syndrome.

He also noted that the necessity to develop an effective staffing model at the clinic level is very important. It should be discussed with national stakeholders whether the quantity of the trained specialists is sufficient, and what other directions of HIV/AIDS care and treatment should be addressed.

In addition, Henry Chang stressed the importance of the national clinical experience and on the necessity to incorporate Ukrainian cases, developed during AHF-GI preceptorship program, into the didactical/clinical part of the Knowledge Hub curricula.

In conclusion, Henry Chang stressed the importance and timeliness of this meeting. He said that the results of a one-year activity on the human capacity building are tremendous and need to be systematically built upon. He thanked once again James Smith and Alla Sherbinska for the invitation to take part in the meeting.

James Smith invited Andriy Styopkin to give his presentation.

 

Trainees’ knowledge and skills evaluation: Presentation by Andriy Styopkin

Andriy Styopkin started his presentation by saying that Knowledge Hub views the knowledge evaluation as a continuous process that is not limited solely to the pre/post-test and daily evaluations during the training. The knowledge is assessed on every stage of the training program during initiation, mentoring and advanced courses. The approach of a time-distanced evaluation gives a more complete vision of the change in the level of the participants’ knowledge, allows to better determine knowledge and performance gaps, and helps to identify further training needs.

Andriy Styopkin presented the results of the operational survey that Knowledge Hub had conducted among the alumni in August 2005. This particular survey aimed at evaluation of the level of knowledge and skills of the training participants BEFORE and AFTER trainings at Knowledge Hub. The participants evaluated 14 statements that reflected their knowledge and skills before and after trainings.

Andriy Styopkin noted that the results of the survey showed a significant increase in the level of the trainees’ knowledge and visible change in performance of their activities. At the same time, he said that there still were topics that needed closer attention during future trainings at Knowledge Hub, among them action of different classes of ARV drugs, adherence promotion, interdisciplinary approach in ART, management of treatment failure, options for pregnant women who need ART, and continued risk reduction measures. He suggested that Knowledge Hub capacity building program addressed the identified needs in future.

The presentation raised several questions from the attendees regarding the methods of the survey. Andriy Styopkin answered them and the floor was given to Yaroslav Zyatyuk.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation – Trainees’ feedback: Presentation by Yaroslav Zyatyuk.

In his presentation Yaroslav Zyatyuk admitted that participation in the series of trainings at Knowledge Hub had significantly improved not only the level of knowledge and skills of the employees of his center, but also changed the structure of care provision. He observed that the multidisciplinary approach helped the personnel restructure their responsibilities and resulted in the reduction of waiting time for patients in the center.

Yaroslav Zyatyuk also said that the human capacity-building program had direct influence on preparation of the cadres in Kherson Oblast. The care teams that had undergone training in Knowledge Hub organized the first training for local specialists on ART. This training was conducted with the support from the International HIV/AIDS Alliance in Ukraine.

Concluding his remarks, Yaroslav Zyatyuk identified HIV – TB co-infection as an acute training need. He thanked all parties involved into organization of the trainings for the excellent work. Afterwards, he answered several questions concerning his vision of the training needs in the spheres of co-infection and substance abuse, social aspects of care and treatment.

James Smith continued the meeting by stressing the importance of a patient satisfaction of the health care they are receiving and its importance with respect to long-term adherence success. He said that one of the objectives of the meeting was to identify training needs from the patient’s point of view and with that as background He invited Artur Ovsepyan to give his presentation.

 

Lessons learned from one year of Knowledge Hub activities to support human resources for national ART scale up plan implementation – Patient’s feedback: Presentation by A. Ovsepyan.

Artur Ovsepyan presented the results of the survey that had been conducted by All-Ukrainian Network of PLWHA in regard of the specific relationships between a patient on ART and a medical staff. He stressed upon the importance of this relationship for both parties, since the treatment is not limited by time.

The purpose of the survey was to learn about services that they receive in Ukrainian AIDS clinics. The participants evaluated 9 statements describing services that they receive from doctors and nurses.

The survey showed that prevailing majority of patients are satisfied with the level of services they receive and by the current state of relationship the medical workers. Alone with the successful practical application of the knowledge received by the medical workers at the Knowledge Hub trainings, Artur Ovsepyan admitted that this survey helped to identify a list of topics that doctors and nurses need to be more proficient in. Among these topics, he named communication skills, stigmatization, side effects of HIV medications, adherence promotion, opportunistic infections, HIV prevention, and psychological/mental problems in ART.

As a recommendations for future activities in the sphere of HIV/AIDS treatment Artur Ovsepyan pointed out the necessity to turn attention to the cooperation between different health service providers (infectionists, GPs, surgeons, etc.) He said that from the patient’s standpoint it would be effective to transfer the multidisciplinary care team model also to other services (e.g. TB). Artur Ovsepyan pointed out that it would be impossible to achieve high results in the TB treatment without the methods of care that are taught at the Knowledge Hub’s trainings.

Another recommendation for future trainings at Knowledge Hub given by Artur Ovsepyan was to include TB specialists into the training process.

In addition, Artur Ovsepyan answered several questions from the participants on the methods of the survey.

The meeting made a break for lunch.

After the lunch the meeting recommenced with a presentation by Igor Oliynyk.

 

WHO normative tools and guidelines update: Presentation by Igor Oliynyk.

In his presentation, Igor Oliynyk described main WHO guidelines on HIV/AIDS care and treatment and their application in the national healthcare system. He said that the guidelines are just recommendations and are often modified according to the needs, local situations and available resources in the countries. He also spoke about the toolkits on different aspects of HIV/AIDS care and treatment that are available online.

Igor Oliynyk said that WHO constantly updates and revises its documentation on the global level. He said that it is very important that the WHO develops the guidelines and protocols together with other organizations, discusses them at first at the international level and then at the national level.

Igor Oliynyk continued by telling the audience about the recent developments regarding the guidelines and technical documentation by WHO. One of the most important consultation facilitated by WHO was the meeting of experts on the revision of the protocols on different aspects of ART.

Another event that Igor Oliynyk drew his attention to was the joint ILO/WHO technical meeting for the development of policy and guidelines on occupational and non-occupational HIV-PEP. He said that the results of these consultations would be soon available at the WHO’s web-site.

As an example of the latest developments, in this regard Igor Oliynyk gave a chart with the updated recommendations of WHO for 1st and 2nd line regiments which will be available in 2006.

Igor Oliynyk answered additional question from James Smith regarding the timing of the new WHO guidelines and their availability in Russian and Ukarainian. He thanked the audience for attention.

 

Round Table Discussion and Summary.

James Smith invited the meeting participants to take an active part in the round-table discussion. He said that the main objectives of the discussion is to determine how Knowledge Hub training approach can better support the further development and implementation of national ART scale up plan; what are the main directions for effective Knowledge Hub training methodology for coming year and achieve the consensus on human capacity building needs for Ukrainian health workers on HIV/AIDS care and treatment.

Based on the information presented by national and international stakeholders, Zoya Shabarova suggested the preliminary list of topics for discussion. It included:

  1. Strategic planning on human capacity building on HIV/AIDS care and treatment.
  2. Development of the inter-sectoral cooperation (infectionists and TB specialists). Training programs for TB specialists.
  3. Development of the inter-sectoral cooperation (infectionists and narcology specialists). Involvement of the narcology specialists into the HIV/AIDS care and treatment.
  4. Keeping track of the trained personnel. Retention of cadres. Training of the replacement personnel.
  5. Strengthening the multidisciplinary team approach in HIV care and treatment. Improvement of the operational issues.
  6. Definition and components of palliative care.
  7. Addressing problems of mental health in the framework of the training programs.
  8. Availability of informational resources for caregivers (update, translation and publication).
  9. Reduction of stigmatization and discrimination in health care institutions.

The results of the round-table discussion is presented below:

ISSUES

SUGGESTED ACTIONS

1. Strategic planning on human capacity building on HIV/AIDS care and treatment
  • A strategic plan should be developed including all components of the human capacity-building program (NAC, all involved parties);
  • There is a need to develop a map of activities to be able to see how different programs meet overall demand on human capacity building (NAC, all involved parties);
  • Evaluation of current components of the capacity building activities should be conducted (NAC, all involved parties);
  • To suggest to include Knowledge Hub representative as observer on the NCC working group on care and treatment .
2. Development of the inter-sectoral cooperation (infectionists and TB specialists). Training programs for TB specialists.
  • A strategy should include the approach to address the problem of the inter-sectoral cooperation (NAC, national TB service, other organizations):
  • TB specialists need to learn basics on TB for patients with HIV/AIDS. TB specialists should be trained on HIV-related issues (NAC, national TB service, Knowledge Hub, other organizations):
    • To establish working groups to define the needs;
    • To organize a joint training for infectionists and TB specialists (introductory course) so that they can begin to work together and “share” cases;
    • To establishing care teams consisting of an infectionist, TB specialist, nurse and social worker;
    • To work jointly on cases and to provide an effective continuum of care that is patient friendly; develop joint case studies.
  • Head Physicians of the TB clinics need to be involved into the training process from the beginning to ensure political support for cooperation. A separate training for TB chief doctors (city / rayon and regional levels) on HIV-related issues and inter-sectoral cooperation should be conducted;
  • TB specialists who successfully completed trainings on HIV-related issues can train other specialist in their region/rayon;
  • Multidisciplinary teams can be established in the TB institutions according to the HIV/AIDS care and treatment model - a TB doctor, a nurse and a social worker, or at least a TB specialist should be included in the existing ART care teams. In the 6 priority regions the new care teams need to be developed in the TB clinics, in other regions the TB specialists may join the existing ART care teams of the AIDS clinics (TB clinics, AIDS clinics, NAC, other organizations);
  • Red Cross and other NGOs involved in the TB support need to upgrade their knowledge on HIV-related issues to be able to provide social support to the patients with HIV/AIDS.
3. Development of the inter-sectoral cooperation (infectionists and narcology specialists). Involvement of the narcology specialists into the HIV/AIDS care and treatment.
  • The plan of the substitution therapy scale up should be developed (NAC, national narcology service, AIDS Alliance, other organizations);
  • The involvement of the narcology specialists into the care and treatment for PLWA should be implemented according to the pattern developed for TB specialists;
  • There is a need to conduct 2 Initiation of ART courses for narcological teams (AIDS Alliance, Knowledge Hub);
  • There is a need to define what topics in addition for Substitution Therapy need to be covered in the training program for narcology specialists and suggestions were made that main topics: ART, team approach, inter-sectoral approach should be included (national narcology service, NAC, AIDS Alliance, Knowledge Hub);
  • The training course ART for IDUs should have a focus on social support and guidance, and substitution therapy (Knowledge Hub);
  • The group taking part in the UNAIDS sponsored exchange program on substitution therapy (Yale) may be potentially considered for inclusion into the national faculty (Knowledge Hub, UNAIDS).
4. Tracking down the trained personnel. Retention of cadres. Training of the replacement personnel.
  • An assessment should be conducted on the number of trained specialists who left the AIDS centers and on the number of replacements needed (NAC);
  • Training needs of the replacement personnel should be identified in the 6 first-line priority and 9 second-line priority regions (NAC);
  • Training of the replacement personnel can be conducted together with the specialists of the new 4-5 regions (NAC, Knowledge Hub, other organizations).
  • A human resource training database should be developed and maintained to insure that needs are fully met and training duplication is minimized.
5. Strengthening the multidisciplinary team approach in HIV care and treatment. Improvement of the operational issues.
  • There is a need to find ways of better utilization of the cadre potential in the AIDS clinics. Doctors are overwhelmed by the workload. There is a need to promote the role of a nurse in a team, taking into account following:
    • Nurses have no incentive to perform new roles and should be motivated for the bigger role;
    • Physicians and nurses do not have enough motivation for improvement of care and ways to approach this should be determined;
    • Simple monitoring of treatment can be done by nurses;
  • The selection of the participants for the Knowledge Hub trainings should be done more targeted and should be based on their motivation, e.g. by means of a pre-training survey (NAC, Knowledge Hub);
  • The experience of Lavra clinic on the nurses’ involvement into the patient management can be replicated in other clinics (Lavra clinic, NAC, Knowledge Hub);
  • Consider to organize the study tour for nurses to other clinics (also in other countries) to get the experience of the HIV care and treatment systems based on the team approach (Knowledge Hub, other organizations).
6. Definition and components of palliative care.
  • Palliative care includes medical and social issues;
  • The suggested main components of palliative care are: pain management, family involvement, hospice care;
  • The defined needs for introduction of the palliative care include hospice/end of life care, pain management, availability of narcotics/pain killers, developed infrastructure;
  • There is a need to develop national concept of palliative care, national protocol (MOH, NAC, other organizations);
  • Technical assistance need to be provided to Ukraine to define the definition and strategy of Palliative care (Knowledge Hub, other organizations).
7. Addressing problems of mental health in the framework of the training programs.
  • Mental health issues should be incorporated into the curricula (Knowledge Hub).
8. Availability of informational resources for caregivers in the regional AIDS centers.
  • A number of materials on ART and HIV-related issues have been translated by Knowledge Hub and are available in the set of training materials (on CDs and in xerox-copies) and on-line (Knowledge Hub web site);
  • A number of materials are available on-line (www.aiha.com; www.aidsknowledgehub.org; www.eurasiahealth.org ) but there is a limited access to internet in regional AIDS centers.
  • New and updated materials by WHO and NAC should be available as soon as possible after development, they should be submitted for translation and distribution (Knowledge Hub, donors organizations);
  • A focused distribution of materials can be conducted (NAC, WHO, AIDS Alliance, other organizations);
  • The best Ukrainian practices and the on-going operational research should be collected and published, e.g. a compilation of Dr. Antonyak’s experience (NAC, other organizations);
  • To build a network of professionals for informational exchange and for referrals of patients (NAC, motivated medical specialists from regional AIDS Centers, donor organizations);
  • Teleconferences and video bridges can be organized between AIDS centers to provide a continuous counselling (NAC, motivated medical specialists);
  • Some translated materials, e.g. books, can be published cost efficiently in Ukraine (AIDS Alliance).
9. Reduction of stigmatization and discrimination in health care institutions.
  • The topic can be broadened in the framework of the existing curricula (Knowledge Hub);
  • New approaches might be considered to address the problem (all involved parties);
  • New workshop might be organized aimed at the development of the non-discriminatory approaches (KMA, other organizations).

James Smith summarized that the meeting archived it’s main objectives: as the result of presented information and related discussion the Knowledge Hub training approach will be better designed to support the further development and implementation of national ART scale up plan; main directions for effective Knowledge Hub training methodology for coming year are determined and consensus on human capacity building needs for Ukrainian health workers on HIV/AIDS care and treatment with main national and international stakeholders achieved, which will be resulted in improvement to the availability and quality of care for PLWHA in Ukraine. These meetings should be conducted on a regular basis and related supportive funding to allow such capacity assessment and resource planning should be allocated within donor’s human capacity building programs (GFATM, World Bank)

James Smith thanked everyone for their active involvement into the discussion and for the participation in the meeting, and adjourned the meeting.

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