Addressing human resources for health needs to support HIV epidemic control: prioritizing site-level interventions in Democratic Republic of the Congo, 2018-2020

Introduction: The United States President's Emergency Plan for AIDS Relief (PEPFAR) in Democratic Republic of the Congo (DRC) continues to fund programs aimed at achieving epidemic control in three provinces where 30 percent of people living with HIV/AIDS in the country reside. Challenges around human resources for health impede the delivery of quality HIV/AIDS services in DRC. Methods: In partnership with the United States Health Resources and Services Administration (HRSA), PEPFAR, and DRC Ministry of Health (MoH), Columbia University's International Center for AIDS Prevention (ICAP at Columbia University) worked with 16 PEPFAR-identified high-priority health facilities and developed specific interventions to address challenges in achieving PEPFAR 95-95-95 targets. Once interventions were selected and prioritized using a collaborative, criteria-driven approach, implementation of these human resources for health improvements began alongside care and treatment efforts already underway. This study began in October 2018, and high-priority interventions were launched in July 2019. Monthly reporting of key PEPFAR metrics continues for evaluation purposes. Results: All 16 high-priority health facilities participated fully. Of several hypothesized interventions, 12 were selected as highest priority, and budgets and task plans were developed for each. The interventions were launched for implementation and evaluation within six months of Ministry of Health approval. Conclusion: This assessment delineated necessary interventions to address site-specific human resources for health challenges/deficiencies. Downstream reporting of key PEPFAR 95-95-95 metrics, including Monitoring, Evaluation, and Reporting indicators, will allow intervention teams to conduct program evaluations and their impacts on targets

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

Background Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be “master trainers”. These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018–2019 school year and 285 in 2019–2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. Conclusions With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution

From easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortality

CITATION: Nachega, J. B. et al. 2021. From easing lockdowns to scaling up community-based coronavirus disease 2019 screening, testing, and contact tracing in Africa-shared approaches, innovations, and challenges to minimize morbidity and mortality. Clinical infectious diseases, 72(2):327–331. doi:10.1093/cid/ciaa695The original publication is available at https://academic.oup.com/cid/The arrival of coronavirus disease 2019 (COVID-19) on the African continent resulted in a range of lockdown measures that curtailed the spread of the infection but caused economic hardship. African countries now face difficult choices regarding easing of lockdowns and sustaining effective public health control measures and surveillance. Pandemic control will require efficient community screening, testing, and contact tracing; behavioral change interventions; adequate resources; and well-supported, community-based teams of trained, protected personnel. We discuss COVID-19 control approaches in selected African countries and the need for shared, affordable, innovative methods to overcome challenges and minimize mortality. This crisis presents a unique opportunity to align COVID-19 services with those already in place for human immunodeficiency virus, tuberculosis, malaria, and non communicable diseases through mobilization of Africa's interprofessional healthcare workforce. By addressing the challenges, the detrimental effect of the COVID-19 pandemic on African citizens can be minimized.https://academic.oup.com/cid/article/72/2/327/5849218?login=truePublishers versio

From easing lockdowns to scaling-up community-based COVID-19 screening, testing, and contact tracing in Africa : shared approaches, innovations, and challenges to minimize morbidity and mortality

CITATION: Nachega, J. B. et al. 2020. From easing lockdowns to scaling-up community-based COVID-19 screening, testing, and contact tracing in Africa : shared approaches, innovations, and challenges to minimize morbidity and mortality. Clinical Infectious Diseases, ciaa695, doi:10.1093/cid/ciaa695.The original publication is available at https://academic.oup.com/cidThe arrival of COVID-19 to the African continent resulted in a range of locally relevant lockdown measures, which curtailed the spread of SARS-CoV-2 but caused economic hardship for large sections of the population. African countries now face difficult choices regarding easing of lockdowns and sustaining effective public health control measures and surveillance. Control of the COVID-19 pandemic will require efficient community screening, testing, contact tracing, and behavioral change interventions, adequate resources, and a well-supported, community-based team of trained, protected personnel. We discuss COVID-19 screening-testing-contact tracing approaches used in selected African countries and the need for shared, affordable, innovative methods to overcome challenges and minimize mortality rates. This crisis presents a unique opportunity to align COVID-19 services with those already in place for HIV, TB, Malaria, and other non-communicable diseases (NCDs) through mobilization of Africa's inter-professional healthcare workforce to contain the pandemic. By addressing the challenges, the detrimental effect of the COVID-19 pandemic on African citizens can be minimized.https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa695/5849218Post-prin