PHP International launches innovative training at top Tanzanian University
By Royce Lin, MD, Guy Vandenberg, RN, and Marc Vincent, MA
(This article reprinted from the Fall-Winter 2009-2010 edition of Positive Spin, official
newsletter of the Positive Health Program).
PHP’s International Program–AIDS Services Prevention Intervention and Education (ASPIRE)–has a distinguished track record of building HIV care and treatment capacity in resource-limited countries, with an emphasis on sub-Saharan Africa. In late 2009, Royce Lin, MD and Guy Vandenberg, MSW, RN built upon this tradition when they presented an ASPIRE-developed HIV/AIDS Continuing Education curriculum and taught the inaugural course at Tanzania’s premier academic medical center – the Muhimbili University of Health Allied Sciences (MUHAS). The course is a one-week comprehensive review of essential elements of clinical HIV care for adults, adolescents and children. It covers topics that range from diagnosing HIV in infants, recognizing opportunistic infections, choosing and switching antiretroviral therapy, learning how to disclose an HIV diagnosis to kids – all of which are tailored to Tanzania’s national guidelines, setting, and cultural norms.
This program is part of the Academic Learning Project (ALP) – a “twinning” initiative that involves PHP as part of a larger collaboration between UCSF Global Health Sciences and MUHAS. This initiative is funded by the Bill and Melinda Gates Foundation, with the overarching aim of fostering exchanges in education innovations between the two universities.
Lin, who is co-Director of ASPIRE has been teaching in Tanzania with Vandenberg and other members of the team since the beginning of the antiretroviral scale-up effort in Africa in 2004. To date, the ASPIRE-Tanzania team has trained more than two-thirds of the doctors and nurses providing HIV care in public hospitals and clinics across four regions in Tanzania, serving a catchment population of over 9 million people. As part of ASPIRE’s efforts to empower African nurses, pharmacists, and doctors to provide optimal HIV care, Lin developed a training course that his Tanzanian colleagues affectionately dub “the Refresher”.
The course has attracted national level attention in Tanzania, and eventually, the notice of ALP co-principal investigators, Drs. Ephata Kaaya and Sarah MacFarlane. Professor Kaaya is Dean of Continuing Education and Professional Development at MUHAS. During a visit to UCSF, Kaaya learned about ASPIRE’s work in Tanzania, and saw an obvious connection between Lin’s creative approaches to HIV education and the aims of the ALP. Lin was invited to participate in the ALP collaboration, by developing and teaching an adult and pediatric HIV/AIDS Continuing Education course for MUHAS, based on methods developed from ASPIRE’s in-field trainings. Professor Kaaya comments that “the aim of this course is not only to give (the participants) skills for HIV care and management, but secondarily and probably the most important aim is to create a corp of trainers who will train other trainers at MUHAS.
“I am truly honored to be invited to participate in such a prestigious project,” says Lin. “It’s a tremendous privilege for ASPIRE to work with our MUHAS colleagues in building HIV education capacity at a national university level. I am really looking forward to exchanging teaching ideas with my MUHAS colleagues in a field that I feel passionate about, and where there is so much need.”
When asked what distinguishes his course or teaching approach, Lin replies: “Well, the training is based on what educators call ‘Adult Principles of Learning’. It’s basically another way of saying that adults learn best when they’re actively engaged, rather than as passive listeners. Yet despite this well-documented observation, medical education is often delivered in lecture format – which limits how much adults actually retain. Because the stakes are so high in HIV education – especially in Africa, where providers have to return to their clinics and provide HIV services for BOTH adults and children, often after a 1-week training – the entire ASPIRE team is constantly looking for ways to innovate and improve clinical HIV education.”
“I am truly honored to be invited to participate in such a prestigious project,” says Lin. “It’s a tremendous privilege for ASPIRE to work with our MUHAS colleagues in building HIV education capacity at a national university level. I am really looking forward to exchanging teaching ideas with my MUHAS colleagues in a field that I feel passionate about, and where there is so much need.”
Lin adds: “I thank Guy and the rest of the ASPIRE team, who challenged me to step outside of my comfort zone, and experiment with creative ways to involve the entire classroom in learning. This course is packed with different interactive teaching methodologies, and includes role playing (to demonstrate how to ask patients about adherence, disclosing HIV to kids), team competitions, audience response cards, and even a HIV care Jeopardy! game show at the end of the course. The strong clinical focus and the interactive approach to teaching is a reflection of the entire ASPIRE team’s creativity, and the reason behind the ALP’s decision to partner with us.”
Guy Vandenberg, RN, who spent years as a consultant teaching nurses and physicians in correctional facilities around the country how to care for HIV+ patients, says “After 25 years in HIV care I feel so happy to be here to see this happen. During the first decade of the epidemic, all we could do was delay our patient’s deaths and attempt to make their last days as comfortable and dignified as possible. In the second decade, the onset of ART signaled hope, but we knew that ART was not available where it was most needed. I was overjoyed and honored to join ASPIRE in 2004 to assist with the rollout of life-saving medications into South Africa, Cote d’Ivoire and Tanzania. They [antiretrovirals] have saved hundreds of thousands of lives on this continent. For me there is nothing more gratifying than to see a child with HIV get better, and grow, and thrive! But I also quickly realized that in order for this rollout to be sustainable it must be owned and operated by Africans, not by Americans.
This training at Tanzania’s premier university marks a huge step in that direction. Because besides training doctors, nurses, dentists and pharmacists, we are also exchanging teaching strategies with some of the key-educators at the university who will go on to teach the next generation of care providers, and train the next generation of HIV educators. Together with our colleagues at MUHAS, we are teaching those who hold the key to hope for the future of Tanzania.”
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