title: Training clinicians treating HIV to diagnose cytomegalovirus retinitis.
abstract: OBJECTIVE
  Acquired immunodeficiency syndrome (AIDS)-related cytomegalovirus (CMV) retinitis continues to be a neglected source of blindness in resource-poor settings. The main issue is lack of capacity to diagnose CMV retinitis in the clinical setting where patients receive care and all other opportunistic infections are diagnosed.
  
  
  METHODS
  We developed and implemented a four-day workshop to train clinicians working in human immunodeficiency virus (HIV) clinics how to perform binocular indirect ophthalmoscopy and diagnose CMV retinitis. Workshops comprised both classroom didactic instruction and direct clinical eye examinations in patients with advanced AIDS. Between 2007 and 2013, 14 workshops were conducted in China, Myanmar and the Russian Federation.
  
  
  METHODS
  Workshops were held with local clinicians at HIV clinics supported by nongovernmental organizations, public-sector municipal hospitals and provincial infectious disease referral hospitals. Each setting had limited or no access to locally- trained ophthalmologists, and an HIV-infected population with advanced disease.
  
  
  RESULTS
  Clinicians learnt how to do binocular indirect ophthalmoscopy and to diagnose CMV retinitis. One year after the workshop, 32/38 trainees in Myanmar did systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. In China and the Russian Federation, the success rates were lower, with 10/15 and 3/5 trainees, respectively, providing follow-up data.
  
  
  CONCLUSIONS
  Skills necessary for screening and diagnosis of CMV retinitis can be taught in a four-day task-oriented training workshop. Successful implementation depends on institutional support, ongoing training and technical support. The next challenge is to scale up this approach in other countries.
authors.affiliation: SEVA Foundation, 1786 Fifth Street Berkeley, CA 94710, United States of America (USA).
authors.forename: David
authors.initials: D
authors.lastname: Heiden
authors.affiliation: Medical Action Myanmar, Yangon, Myanmar .
authors.forename: NiNi
authors.initials: N
authors.lastname: Tun
authors.affiliation: Francis I Proctor Foundation, University of California, San Francisco, USA .
authors.forename: Ernest
authors.initials: E
authors.lastname: Maningding
authors.affiliation: SEVA Foundation, 1786 Fifth Street Berkeley, CA 94710, United States of America (USA).
authors.forename: Matthew
authors.initials: M
authors.lastname: Heiden
authors.affiliation: Francis I Proctor Foundation, University of California, San Francisco, USA .
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rose-Nussbaumer
authors.affiliation: Médecins Sans Frontières, Yangon, Myanmar .
authors.forename: Khin Nyein
authors.initials: KN
authors.lastname: Chan
authors.affiliation: The Botkin Hospital for Infectious Diseases, St Petersburg, Russian Federation .
authors.forename: Tamara
authors.initials: T
authors.lastname: Khizniak
authors.affiliation: The Botkin Hospital for Infectious Diseases, St Petersburg, Russian Federation .
authors.forename: Alexandra
authors.initials: A
authors.lastname: Yakubenko
authors.affiliation: Kilamanjaro Centre for Community Ophthalmology, Cape Town, South Africa .
authors.forename: Susan
authors.initials: S
authors.lastname: Lewallen
authors.affiliation: Francis I Proctor Foundation, University of California, San Francisco, USA .
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.affiliation: Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa .
authors.forename: Peter
authors.initials: P
authors.lastname: Saranchuk
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D002681:China; D002983:Clinical Competence; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000175:diagnosis*; D004502:Education, Medical, Continuing / Q000379:methods; D015658:HIV Infections / Q000150:complications; D006801:Humans; D002052:Myanmar; D009885:Ophthalmology / Q000193:education* / Q000379:methods*; D009887:Ophthalmoscopy / Q000379:methods*; D015397:Program Evaluation; D012426:Russia; D014787:Vision Tests / Q000379:methods