Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce

Leonard Bikinesi, Directorate of Special Programmes, Namibian Ministry of Health and Social Services (MoHSS), Ministerial Building Harvey Street, Windhoek, Namibia
Gillian O'Bryan, International Training and Education Center for Health (I-TECH), University of Washington, 908 Jefferson Street, Seattle, WA, USA
Clay Roscoe, US Centers for Disease Control and Prevention (CDC) Windhoek, Namibia, Florence Nightingale Street, Windhoek, Namibia
Tadesse Mekonen, Avacare Health, 8 Skietlood Street, Isando, South Africa
Naemi Shoopala, US Centers for Disease Control and Prevention (CDC) Windhoek, Namibia, Florence Nightingale Street, Windhoek, Namibia
Assegid T. Mengistu, Directorate of Special Programmes, Namibian Ministry of Health and Social Services (MoHSS), Ministerial Building Harvey Street, Windhoek, Namibia
Soulemane Sawadogo, US Centers for Disease Control and Prevention (CDC) Windhoek, Namibia, Florence Nightingale Street, Windhoek, Namibia
Simon Agolory, US Centers for Disease Control and Prevention (CDC), Lusaka, Zambia, Independence Avenue, Lusaka, Zambia
Gram Mutandi, US Centers for Disease Control and Prevention (CDC) Windhoek, Namibia, Florence Nightingale Street, Windhoek, Namibia
Valerie Garises, Namibian National Institute of Pathology (NIP), Ooievaar Street, Windhoek, Namibia
Rituparna Pati, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Laura Tison, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Ledor Igboh, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Carla Johnson, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Evelyn M. Rodriguez, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Tedd Ellerbrock, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Heather Menzies, US Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA, USA
Andrew L. Baughman, US Centers for Disease Control and Prevention (CDC) Windhoek, Namibia, Florence Nightingale Street, Windhoek, Namibia
Laura Brandt, International Training and Education Center for Health (I-TECH), 4 Storch Street, Windhoek, Namibia
Norbert Forester, International Training and Education Center for Health (I-TECH), 4 Storch Street, Windhoek, Namibia
John Scott, Departments of Medicine, Division of Allergy and Infectious Diseases, University of Washington, 410 9th Avenue, Seattle, WA, USA
Brian Wood, Mountain West AIDS Education and Training Centre (MWAETC), University of Washington, 908 Jefferson Street, Seattle, WA, USA
Kenton T. Unruh, Mountain West AIDS Education and Training Centre (MWAETC), University of Washington, 908 Jefferson Street, Seattle, WA, USA
Sanjeev Arora, ECHO Institute, University of New Mexico, 1650 University Boulevard NE, Albuquerque, NM, USA
Michelle Iandiorio, ECHO Institute, University of New Mexico, 1650 University Boulevard NE, Albuquerque, NM, USA
Summers Kalishman, ECHO Institute, University of New Mexico, 1650 University Boulevard NE, Albuquerque, NM, USA
Sarah Zalud-Cerrato, ECHO Institute, University of New Mexico, 1650 University Boulevard NE, Albuquerque, NM, USA
Jutta Lehmer, ECHO Institute, University of New Mexico, 1650 University Boulevard NE, Albuquerque, NM, USA
Stephen Lee, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), 1140 Connecticut Avenue NW, Washington, DC, USA
Mohammed A. Mahdi, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), 1140 Connecticut Avenue NW, Washington, DC, USA
Samantha Spedoske, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), 1140 Connecticut Avenue NW, Washington, DC, USA
Alexandra Zuber, Ata Health Strategies LLC, 55 M Street NE #1012, Washington, DC, USA
Brigg Reilley, NW Tribal Health Board (NPAIHB), 2121 SW Broadway STE 300, Portland, OR, USA
Christian B. Ramers, Family Health Centers of San Diego, University of San Diego School of Medicine, 823 Gateway Center Way, San Diego, CA, USA
Ndapewa Hamunime, Directorate of Special Programmes, Namibian Ministry of Health and Social Services (MoHSS), Ministerial Building Harvey Street, Windhoek, Namibia
Gabrielle O'Malley, International Training and Education Center for Health (I-TECH), University of Washington, 908 Jefferson Street, Seattle, WA, USA
Bruce Struminger, ECHO Institute, University of New Mexico, 1650 University Boulevard NE, Albuquerque, NM, USA

Document Type

Article

Publication Date

2020

Abstract

Background:

The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy.

Methods:

MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes.

Results:

Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2–23.5%) and 22.3% (95% confidence interval 13.2–31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV.

Conclusions:

Similar to other Project ECHO evaluation results in the United States of America, Namibia’s Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.

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