The health worker mentorship scheme improving HIV services in Zambia

In Zambia, a programme that paired health workers with mentors from the medical field resulted in more people with HIV being diagnosed, starting treatment and achieving viral suppression. 

What is the research about? 

In 2018, the Zambian Ministry of Health and the US Centers for Disease Control and Prevention (CDC) started a mentorship programme for health workers. The aim was to improve HIV services in Eastern, Western, Southern and Lusaka provinces. 

The mentors were a mix of experienced nurses, clinical officers and medical officers. Each one supported between 2 and 10 health facilities, staffed by around 15 health workers. 

Why is this research important? 

Zambia has increased the number of people on HIV treatment in recent years. But progress toward UNAIDS 95-95-95 targets is inconsistent. 

A recent evaluation found a key reason for this was the lack of training and mentorship for healthcare workers from more experienced HIV clinicians.  

What did they find out? 

Researchers compared data from 2018, before the mentorship scheme began, and 2019 after it was implemented.  

The proportion of people with HIV out of those tested increased from 4% to 7%. This equates to 38,500 people diagnosed with HIV, compared to 37,200 before the mentorship scheme started.  

HIV testing efficiency (the reduction of unnecessary testing) also improved. The number of HIV tests performed went from 880,000 to 565,200, despite more people with HIV being diagnosed. 

The number of people diagnosed with HIV included 9,000 people identified through index case testing, an increase from 4,100.  

The number of people on HIV treatment increased from 492,600 to 521,800.  

Viral load test coverage increased from 41% to 74%. The proportion of people on treatment who were virally suppressed increased from 85% to 90%. 

What does this mean for HIV services? 

It shows that health worker mentorship programmes can be very effective. The study justifies support for the mentorship programme in Zambia. And it makes the case for introducing similar programmes in other countries. 

Key things that made the mentorship programme a success: 

• It was government led, which ensured authority and sustainability. 
• The mentors were also mentored. Experienced public health managers at the Ministry of Health and CDC provided sessions about the latest HIV innovations. The mentors used this learning to mentor facility staff. 
• It used video-conferencing, so mentors could meet with mentees on a regular basis. 
• Mid-year certificates of achievements were awarded for exceptional performance, which incentivised participants. 
• It made mentors accountable by monitoring their performance. 

These factors are important to consider if you plan to design or propose a similar scheme. A key lesson learned is that mentors also need ongoing mentoring, which is an extra cost.