Esther

Professor Joseph Drabo, head of the Internal Medicine Unit at the Yalgado University Hospital in Ouagadougou-Burkina Faso, and involved in
ESTHER projects since 2002, has created the first sub-regional Inter-University Diploma (IUD) in the comprehensive case-management of HIV/AIDS in West Africa. He is the current chairman of the executive board of the RAF-VIH (African Network for HIV-AIDS training).
Interview : Anne Beugny, ESTHER training manager

What is your analysis of the continuing professional education developed over recent years in the field of HIV/AIDS case-management in Francophone Africa?
When AIDS burst onto the medical scene in Africa, the qualitative and quantitative lack of personnel for managing the large number of patients rapidly became evident. In most countries, this resulted in specific training programmes being set up to strengthen the skills
of care-providers. In 2008, a study commissioned by the RAF-VIH identified three categories of training:
- 15 training courses leading to a diploma
- 5 training courses leading to qualification from a university institution
- 15 training courses leading to a qualification from a specialised body (Institute, NGO, Association).
This study resulted in the creation of the RAF-VIH whose aim is to harmonise these different training offers.
It's hard to say exactly how many professionals have been trained since 2002: there are a very large number of actors in the field and coordination is very difficult. However, we estimate that, in the last six years, about one thousand people have received training leading to a diploma. For training leading to a qualification, this number should probably be multiplied by 5 or 10.
In 2009 alone, RAF-VIH training strengthened the capacities of more than 700 health workers (generalist and specialist doctors, pharmacists, nurses, mid-wives and orderlies, and pharmaceutical assistants involved in the case-management of people living with AIDS,
as well as psycho-social staff (social workers, psychologists, counsellors, biologists, Project managers, etc.)
All this training has contributed significantly to scaling up and improving the quality of patient management in the zone covered by the RAF, but we aware that there are still gaps. The needs analysis we carried out in 2009 showed that, in spite of the development
and diversity of training offered over the last three years, there are still considerable needs, and new needs are appearing.

Given the current context of the fight against AIDS in Francophone Africa and the chronic lack of human resources in the health field, what do you see as the biggest challenges in terms of training for health workers in the years ahead ?
There is still a need for «standard» training, given the mobility of personnel and the rapid evolution in our knowledge of HIV. We must therefore continue comprehensive case-management training: clinical, biology, psychological treatment, pharmacy.
But this training needs to be completed with continuing education in specific areas. RAF has identified 8 such areas for which training
should be swiftly introduced:
-Case-management of pregnant women, children and adolescents infected by the HIV virus;
-Long-term monitoring of the HIV infection;
-Understanding and working with vulnerable groups (homosexual men, drug users and sex workers);
-Socio-anthropological aspects of AIDS in Africa;
-Clinical research into HIV;
-Treatment of psychic disorders in the course of HIV infection;
-Good practices in the dispensing of ARV;
-Specific treatment of the main co-infections linked to infection with the HIV virus.
New training courses leading to a diploma, an IUD in pharmaceutics and a nursing specialisation in infectiology are currently being developed. Until now, doctors have benefited most from the training. It is now time to focus on training paramedical staff, pharmacists, therapeutic and community educators as part of task shifting.
A recent UNAIDS study confirms that strategic planning, budget management, expenditure analysis, monitoring & evaluation and the strengthening of community systems are priority training areas for the West and Central Africa region.
The strategies and modalities are varied. Most of the training is on-site. One of the challenges to be met over the medium term is distance or E-learning, already well-developed in certain English-speaking countries. On-site training is very expensive. E-learning would enable us to reach more people and reduce travel costs.

It would now seem vital to include HIV/AIDS modules in the initial training curricula of doctors and paramedics: how far has the sub-region got with this?
The West African Health Organisation is in charge of this. Curricula have been developed and we hope the project will soon be rolled out.

Training paramedics in HIV/AIDS management as part of the task shifting process is one answer to the human resources crisis: what initiatives have been taken in this direction in the sub-region ?
RAF-HIV is in the process of proposing a training repository for paramedics. This repository will be finalised over the coming months and made available to training providers who are members of the RAF.
There is also a need to include HIV/AIDS modules in the training curricula for paramedics, and initiatives are already underway with certain paramedic training schools. Furthermore, certain countries, such as Burkina Faso or Senegal have adapted the generic WHO modules on IMAI (Integrated Management of Adolescent and Adult Illness) and have trained their paramedics in patient management on the basis of these models. The Ouagadougou IUD is the only curriculum that trains paramedics to university diploma
level. So far, 125 paramedics have received this training.

What is the RAF-HIV and what are its objectives ?
The RAF-VIH, African Network for HIV Training, is a non-profit association that has been certified as a Francophone Africa Knowledge Hub by the WHO and GTZ. Its purpose, notably in Francophone Africa, is:
-to harmonise the contents of training for HIV-control actors, especially training in the case-management of people living with HIV;
-to promote high-quality training, especially in the case-management of people living with HIV;
-to set up training programmes and harmonise training curricula, approaches and methods;
-to network training provision in order to set up continuing education that meets the needs of actors in the fight against HIV;
-to coordinate and share experience and scientific knowledge of HIV ;
-to help training providers obtain internationally- recognised university validation (masters,etc.) for their curricula;
-to make training systems sustainable in terms of human and financial resources by pooling programmes;
-to develop a system of monitoring and evaluating training provision.
Today, the RAF-HIV has nine active training courses (IUD - Ouagadougou, IUD - Bujumbura, UD in Retrovirology - Dakar, Masters in Community Management - Dakar, UD- Niger, UD in HIV/TB/Malaria - Cocody, the Ouidah course in Benin, qualifying training courses at the Donya Centre in Bamako and a brand new IUD in Cameroon which has just got underway). IUDs currently being developed in Libreville, Yaoundé and Kinshasa will soon become part of the RAF.