Skip to main content

Table 1 Summary of modules included in the interprofessional curriculum

From: Developing an interprofessional transition course to improve team-based HIV care for sub-Saharan Africa

Module

Topic

Commonly encountered clinical challenges

Module goal

1

New HIV diagnosis and ART initiation in a woman of child-bearing age

Learners may not be aware that ART is recommended for everyone, regardless of CD4 cell count. In addition, learners may not recognize the urgency of starting ART given the potential for transmission to the fetus. Last, disclosing a positive result to a patient may be challenging.

The goal of this session is to prepare learners to assess and manage a woman newly diagnosed with HIV using a team-based approach.

2

Co-morbidities in a patient with well-controlled HIV

As persons with HIV live longer, learners may overlook chronic disease management, especially cardiovascular disease, given its associations with both HIV and some ART.

The goal of this session is to prepare learners to evaluate for, prevent, and manage cardio- metabolic complications in people with HIV. The session exemplifies team-based approaches to chronic disease management.

3

Management of HIV-TB co-infection

Challenges in the management of HIV-TB co-infection can arise during diagnosis, TB and ART treatment initiation, including drug-drug interactions, side effects, and timing of ART, and recognition of the stigma surrounding TB.

The goal of this module is to prepare learners to provide team-based care and follow up for a patient with HIV and pulmonary TB. This module exemplifies role clarification and use of evidence-based medicine/country-specific guidelines.

4

Prevention of mother-to-child transmission & care of the pregnant woman with HIV

Learners may not recognize the risks of and steps in prevention of HIV transmission during pregnancy and breastfeeding. In addition, selection of ART for a pregnant woman can be challenging.

The goal of this module is to prepare learners to manage the care of pregnant women, new mothers, and newborns with HIV using an integrated approach to service delivery.

5

Care of the adolescent girl at risk for HIV

Challenges include recognition of reasons why young women/adolescents may engage in sexual activity that increases risk for HIV, strategies to prevent HIV acquisition, and tactics to engage youth in their own health care.

The goal of this module is to prepare learners to recognize the unique aspects of caring for adolescent girls at risk for HIV and to provide team-based care for this patient population.

6

Post-exposure prophylaxis

Challenges in post-exposure prophylaxis (PEP) include providing support for a colleague who has had an occupational exposure to a blood borne pathogen, performing a risk assessment based on the exposure, and deciding if PEP is appropriate.

The goal of this module is to prepare learners to assess and manage any colleague who presents with a potential work-related exposure to HIV. This session exemplifies health care professionals caring for each other’s physical and mental health and highlights interprofessional competencies.

7

Care of the patient with cryptococcal meningitis

Common clinical challenges in the care of a patient with cryptococcal meningitis include obtaining a diagnosis, formulating a treatment and follow-up plan, managing increased intracranial pressures, and deciding upon when to start ART.

The goal of this session is to prepare learners to provide team-based care for a patient with cryptococcal meningitis (CCM). In addition, this module will model team members of all levels speaking up and being heard, treating patients and coworkers with compassion and respect, and using evidence-based medicine and guidelines to provide high quality care.

8

Management of sepsis and ART initiation

Common clinical challenges encountered in a patient with bacterial sepsis center on initiation of appropriate therapies in a timely manner and communicating effectively with other members of the healthcare team to do so.

The goal of this session is to introduce learners to the provision of team-based care for a patient newly diagnosed with HIV who is admitted to the hospital with bacterial sepsis.

9

ART adherence and evaluation of virologic failure

Learners may have difficulty eliciting an adherence history and also in counseling a patient on how to improve their adherence. In addition, decisions regarding ART can be difficult when it is unclear if the virologic failure is due to non-adherence or resistance mutations or both.

The goal of this session is to prepare learners to use evidenced-based strategies to provide team-based care for a patient with ART non-adherence. The session will highlight respectful communication and collaborative leadership and employ reflective practice.

10

End-of-life care in a patient with HIV

Learners may not feel comfortable breaking bad news to the patient, nor may they feel confident in how to transition medical care to ensure the comfort of a dying patient. Other common challenges include eliciting patient and family preferences for care, supporting the patient’s family, and addressing the learners’ own feelings about the end of life.

The goal of this session is to introduce learners to practice breaking bad news and to provide com- passionate, person-centered, team-based care for patients with HIV with severe life-threatening dis-eases. This session will focus on use of reflective practice and will explore the ethical dimensions in providing care to someone at the end of life, with hopes to convey the importance of compassion.

11

Pre-exposure prophylaxis and care of men who have sex with men

Common clinical challenges include taking a sexual history and eliciting potential indications for pre-exposure prophylaxis (PrEP) whilst ensuring that the healthcare professional is non-judgmental and is cognizant of stigma the patient may be experiencing.

The goal of this session is to prepare learners to provide and promote equitable HIV services to key populations using a multidisciplinary approach, doing so with empathy and without prejudice, and in the process, acquiring skills in and increasing comfort with taking a sexual history.

12

Care of the adolescent male with perinatal HIV

Learners may not know how to provide psychosocial support to an adolescent patient or a patient with perinatally-acquired HIV, including the potential need to discuss potential mental health issues and substance use. In addition, patients may have drug-resistant HIV, which can pose challenges for ART selection.

The goal of this session is to introduce learners to concepts around care of an adolescent male with perinatally-acquired HIV, so as to recognize contextual factors to best support these patients and promote their quality of life.

13

Health systems in HIV care

Common clinical challenges include managing the logistics of a drug stockout and its effect on patients’ health, including their mental health.

The goal of this module is to enable learners to better understand the building blocks of the health system and how they affect the care of the patient with HIV.

14

Community-based HIV care service delivery

Common clinical scenarios include recognition of challenges patients may face based on the health system level they are engaging with, how to manage that, and how to harness the support of non-governmental organizations and community-based initiatives.

The goal of this session is to empower learners to collaborate with community partners, understand-ing the resources, structures, and processes avail-able to patients with HIV, while also underscoring the important role of community-based, decentral-ized care to ensure patient-centered services.

15

Traditional & complementary medicine & Pneumocystis pneumonia

Common clinical challenges include difficulty in eliciting patient’s history of engagement with traditional and complementary medicines and how to build trust between the healthcare system and the patient.

The goal of this session is to prepare learners to provide person-centered care for a patient with an opportunistic pneumonia who is interested in traditional & complementary medicine (T&CM). The module will model respectful communication and reflective practice.

16

HIV funding mechanisms & donor financing

Common clinical challenges include ensuring the health care workforce stays healthy, through infection control, especially when there are already scarcities in the healthcare workforce. Other clinical challenges include attrition in the healthcare workforce.

The goal of this module is for learners to recognize human resource challenges faced in delivering high quality care, at both clinical and systems levels, and to gain an awareness of ensuring the necessary skills to deliver high quality HIV care. This is exemplified through the vignette of a health care professional with absenteeism due to nosocomial TB, which highlights certain aspects of infection control.

17

Care of the paediatric patient with HIV

Common clinical challenges in the care of a paediatric patient with HIV include diagnosis, ART management and opportunistic infection management. In addition, learners may need training in how to manage disclosure, confidentiality, and stigma.

The goal of this session is to introduce learners

to care for a paediatric patient with HIV, including concepts of medication dosing, interaction with the parent/family, and ethical issues surrounding this key population.