The MPHATSO pilot mentorship program began in 2009 in partnership with the Ministry of Health and Clinton Foundation. MPHATSO means "gift" in Chichewa, highlighting our mission to help Malawi's HIV-positive children realize their fullest potential for a healthy generation to come. As of December 2008, there were over 17,800 children on life-saving antiretroviral (ARV) therapy in Malawi. (Malawi HIV Unit) However, the average age of treatment initiation remains high, indicating that much work lies ahead in order to save the many children who suffer early and rapidly progressing HIV/AIDS.
Missed opportunities for starting children on ARV therapy often occur due to low healthcare provider comfort in the relatively more complex methods of pediatric HIV diagnosis, care and treatment as compared to adults. MPHATSO creates two multi-disciplinary pediatric HIV mentorship teams consisting of the following staff:
- Clinical officer
- HIV testing counselor
- Health surveillance assistant
- Data clerk
- Pediatric AIDS Corps pediatrician
Teams will visit each clinic twice monthly, focusing on antiretroviral clinic and mother-infant follow-up clinic for HIV-infected mothers. A peer-to-peer mentorship approach is used to encourage open communication that may be limited within the context of medical staff hierarchy. Though more frequent visits may hold greater impact, the need for a sustainable and feasible approach for integration within the Ministry of Health support framework is essential. Following World Health Organization recommendations, we aim to incorporate mentorship as a distinct capacity building approach apart from regulatory site supervision visits.1
The MPHATSO mentorship philosophy is based on the following principles:
- Partnership. Above all we move forward in a spirit of partnership with the Ministry of Health. We aim to find mentorship solutions that are integrated within the national HIV/AIDS treatment framework.
- Respect. Local healthcare providers know their community and patients best. Their input and guidance are highly valued.
- Empowerment. We aim to mentor the skills and resources needed for quality pediatric HIV care at the local level. We are not a long-term staffing addition and expect local staff to remain dedicated to providing HIV services.
- Celebrating Success. Families who leave illness behind and discover a hopeful future inspire us. We celebrate the smiles of children who can play again. We will use our successes to move us through difficult times.
MPHATSO mentors receive comprehensive training on pediatric HIV management and four target areas for site mentorship: Registration, Nutrition Assessment, Clinical Management and ARV Adherence.
Each of these domains contain a set of activities which represent a checklist of quality pediatric HIV care:
- There is a specific clinical home for HIV-exposed and infected children
- Exposed and infected children are identified throughout the health facility (Ward, Under-5, etc.) and referred for care
- Pediatric HIV testing is offered to children, including those less than 18mo of age
- Routine follow-up care is provided for all HIV-exposed or infected children whether or not they are taking ARV medications
- Height, weight and MUAC are obtained for children at each visit
- Nutrition status is assessed and documented
- Clinical assessment is made
- Cotrimoxazole preventative therapy (CPT) is provided
- Opportunistic infections are recognized and treated
- Children are initiated on ARVs based on current national guidelines
- Precise number of ARV pills dispensed is recorded and interpreted for an adherence assessment
- Disclosure counseling is provided as age-appropriate
- Care is clearly documented in the health passport
Through on-site mentorship we aim to achieve increased access to pediatric HIV care with achievement of core quality services. Improving facility linkages between entry points of care is an essential step. Local health facilities are challenged by healthcare worker shortages, staff movement and limited supplies, requiring a focus on sustainable and grassroots solutions. MPHATSO utilizes a mentorship toolkit to achieve the goals above while implementing a feasible monitoring & evaluation approach.
||Sample Outcome Measurements
|1. Increased access to pediatric HIV services
- Median age of children initiated on ARVs
- % of patients on ARVs who are children
- Reason for AVR initiation
- Number and median age of children tested for HIV
|2. Core quality pediatric HIV services provided
- ARV elgibility correctly implemented
- Nutritional assements made
- % of children provided with CPT
As of mid-2009 MPHATSO has entered the mentorship phase. Baylor Children's Foundation - Malawi is looking forward to the design of a successful mentorship program that will achieve a long lasting impact for Malawi's children.
1 WHO Recommendations for Clinical Mentoring to Support Scale-Up of HIV Care, Antiretroviral Therapy and Prevention in Resource-Constrained Settings. World Health Organization, Geneva. 2006.