DOI: 10.7272/q6wq021n
title: STRIPE training data set

description: Objective: To assess the impact of an interprofessional case-based
 training program to enhance clinical knowledge and confidence among
 clinicians working in high HIV-burden settings in sub-Saharan Africa (SSA)
 Setting: Health professions training institutions and their affiliated
 clinical training sites in 12 high HIV-burden countries in SSA.
 Participants: Cohort comprising pre-service and in-service learners, from
 diverse health professions, engaged in HIV service delivery. Intervention:
 A standardized, interprofessional, case-based curriculum designed to
 enhance HIV clinical competency, implemented between October 2019 and
 April 2020. Main outcome measures: The primary outcomes measured were
 knowledge and clinical confidence related to topics addressed in the
 curriculum.  These outcomes were assessed using a
 standardized online assessment, completed before and after course
 completion.  A secondary outcome was knowledge retention
 at least six months post-intervention, measured using the same
 standardized assessment, six months after training completion. We also
 sought to determine what lessons could be learned from this training
 program to inform interprofessional training in other contexts. Results:
 Data from 3027 learners were collected: together nurses (n=1145, 37.9%)
 and physicians (n=902, 29.8%) constituted the majority of participants;
 58.1% were pre-service learners (n=1755) and 24.1% (n=727) had graduated
 from training within the prior year. Knowledge scores were significantly
 higher, post -participation compared to pre-participation, across all
 content domains, regardless of training level and cadre (all
 p&lt;0.05). Among 188 learners (6.2%) who retook the test at &gt;6
 months, knowledge and self-reported confidence scores were greater
 compared to pre-course scores (all p&lt;0.05).  Conclusion:
 To our knowledge this is the largest interprofessional, multi-country
 training program established to improve HIV knowledge and clinical
 confidence among HCP workers in SSA. The findings are notable given the
 size and geographical reach and demonstration of sustained confidence and
 knowledge retention post course completion. The findings highlight the
 utility of interprofessional approaches to enhance clinical training in
 SSA.
description: The study was conducted using data from the STRIPE HIV
 program.  The program was launched across 20 health professions training
 institutions in 14 countries in October 2019. All learners who completed a
 pre and post-test assessment for an in-person training conducted between
 October 1, 2019 and March 31, 2020, were included in the study. After
 April 2020, all training transitioned to online format given widespread
 restrictions on in-person learning related to the COVID-19 pandemic; these
 learners were excluded from this analysis. As previously described,
 training included 17 case-based modules, typically presented over two
 days, and was designed to foster interprofessional discussion and
 facilitate learning related to HIV clinical management, quality
 improvement and interprofessional collaborative practice. Training content
 included required modules on initiating HIV therapeutics in women of
 childbearing age (“HIV and Women”), management of opportunistic infections
 (“HIV-TB”), prevention of mother to child transmission (“PMTCT”) and
 pediatric HIV (“Paediatric Care”), in which all learners participated
 regardless of the stage of their career or professional cadre. These
 modules were all created by the study team which included local HIV
 practitioners and international and local educational experts. In addition
 to creation of the learning materials, the study team provided local
 educators at each partner institution with training resources to implement
 the course. These local partners were encouraged to ensure that each
 training course included a diverse mix of professional cadres and, where
 feasible, a mix of health professionals at different stages of their
 career (pre-service, post-graduate but within 12 months of graduation, and
 greater than 12 months post-graduation). The study team also provided
 training resources to facilitate training of local facilitators. The
 frequency of training courses offered, the ratio of learners to
 facilitators, mix of cadres and course timing were all determined by local
 partner institutions. Given scarcity of training resources, some health
 professions training institutions had to decline access for eligible
 candidates; in such circumstances, participation of early career
 professionals was prioritized over pre-service learners. 
 Cohort: This was a convenience sample, including all learners who
 participated in the STRIPE HIV training program and had completed both
 pre- and post-training assessments during the study period.  In addition
 to capturing learner demographic information, the assessment assessed
 learner (1) clinical and technical knowledge related to the learning
 objectives outlined in the program and (2) self-reported confidence in
 skills and abilities covered in the program, including (a) confidence to
 participate in HIV service delivery, specific to each cadre’s scope of
 practice, in the domains addressed in the course, (b) confidence to employ
 quality improvement tools and (c) confidence to practice as part of an
 interprofessional team. Knowledge was assessed using a series of
 domain-specific multiple-choice questions; all questions were the same for
 all participants regardless of training context, participant cadre,
 training institution, and country. Confidence was assessed on a four-point
 Likert-type scale, ranging from 1= “I feel uncomfortable with this
 topic/need supervision from my supervisor” to 4= “I feel very comfortable
 with this topic/without supervision as though in independent
 practice.” (Supplemental digital appendix). All
 learners completed the initial assessment at the time of program
 enrollment, typically within 24 hours of starting training. They then
 completed the same assessment immediately after completing the course,
 typically within 48 hours. For most participants, these pre and post
 program assessments were accessed on the training program’s website.
 However, for a small subset that did not have internet or computer access,
 assessments were completed on paper, and subsequently uploaded into the
 project database by local research staff. Starting in October 2020, we
 invited all participants to retake the same assessment at least six months
 after when they had participated in the program. This repeat assessment
 was administered electronically via email (Qualtrics, version XM; Provo,
 Utah; 2013). To increase uptake of this repeat assessment, all individuals
 who completed it were entered into a lottery to receive a US $50 prize
 voucher for internet data or airtime.  Analysis: We
 only included data on learners for whom we had both pre-course and
 post-course assessment data, excluding those participants for whom we did
 not have both data points. For these eligible learners, we used
 descriptive statistics to summarize demographic characteristics of program
 participants, stratifying results by gender, health profession cadre and
 professional career stage (RStudio Version 1.3.1093). We separately
 analyzed (1) differences in pre-course and post-course knowledge and
 self-reported confidence using Wilcoxon signed-rank tests and (2)
 differences in knowledge and self-reported confidence between cadres and
 career stage using ANOVA and Tukey’s HSD test. For the subgroup of
 learners for whom both pre- and post-course assessment results were
 available, and who had also completed the post-course assessment &gt;6
 months after completion of the course, we calculated the change in levels
 of knowledge and self-reported confidence between the post &gt; 6
 months assessment and the pre-course assessment sores using Wilcoxon
 signed-rank test. We applied Wilcoxon signed-rank tests because
 distributions of assessment response variables were not normally
 distributed. All reported P values were two sided.