title: A novel educational strategy targeting health care workers in underserved communities in Central America to integrate HIV into primary medical care.
abstract: BACKGROUND
  Current educational strategies to integrate HIV care into primary medical care in Central America have traditionally targeted managers or higher-level officials, rather than local health care workers (HCWs). We developed a complementary online and on-site interactive training program to reach local HCWs at the primary care level in underserved communities.
  
  
  METHODS
  The training program targeted physicians, nurses, and community HCWs with limited access to traditional onsite training in Panama, Nicaragua, Dominican Republic, and Guatemala. The curriculum focused on principles of HIV care and health systems using a tutor-supported blended educational approach of an 8-week online component, a weeklong on-site problem-solving workshop, and individualized project-based interventions.
  
  
  RESULTS
  Of 258 initially active participants, 225 (225/258=87.2%) successfully completed the online component and the top 200 were invited to the on-site workshop. Of those, 170 (170/200=85%) attended the on-site workshop. In total, 142 completed all three components, including the project phase. Quantitative and qualitative evaluation instruments included knowledge assessments, reflexive essays, and acceptability surveys. The mean pre and post-essay scores demonstrating understanding of social determinants, health system organization, and integration of HIV services were 70% and 87.5%, respectively, with an increase in knowledge of 17.2% (p<0.001). The mean pre- and post-test scores evaluating clinical knowledge were 70.9% and 90.3%, respectively, with an increase in knowledge of 19.4% (p<0.001). A survey of Likert scale and open-ended questions demonstrated overwhelming participant satisfaction with course content, structure, and effectiveness in improving their HIV-related knowledge and skills.
  
  
  CONCLUSIONS
  This innovative curriculum utilized technology to target HCWs with limited access to educational resources. Participants benefited from technical skills acquired through the process, and could continue working within their underserved communities while participating in the online component and then implement interventions that successfully converted theoretical knowledge to action to improve integration of HIV care into primary care.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland, USA. tflys1@jhmi.edu
authors.forename: Tamara
authors.initials: T
authors.lastname: Flys
authors.forename: Rosalba
authors.initials: R
authors.lastname: González
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
authors.forename: Juana
authors.initials: J
authors.lastname: Suarez Conejero
authors.forename: Edgar
authors.initials: E
authors.lastname: Kestler
authors.forename: Nestor
authors.initials: N
authors.lastname: Sosa
authors.forename: Jane
authors.initials: J
authors.lastname: McKenzie-White
authors.forename: Irma Irene
authors.initials: II
authors.lastname: Monzón
authors.forename: Carmen-Rosa
authors.initials: CR
authors.lastname: Torres
authors.forename: Kathleen
authors.initials: K
authors.lastname: Page
mesh_terms: D000293:Adolescent; D000328:Adult; D002489:Central America; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D020380:Needs Assessment; D011320:Primary Health Care / Q000458:organization & administration*; D055815:Young Adult