Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia

3 January, 2022

Dear HIFA and HIFA-Zambia colleagues,

Citation, abstract and comment from me below. Full text: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260571

CITATION: Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia

Carlos Pineda-Antunez, David Contreras-Loya, Alejandra Rodriguez-Atristain, Marjorie Opuni, Sergio Bautista-Arredondo

Published: December 2, 2021

https://doi.org/10.1371/journal.pone.0260571

ABSTRACT

Background: Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics.

Methods: We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58)...

Results: The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels.

Conclusions: HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.

COMMENT (NPW): It's interesting that the data for this study are 7-8 years old. Can anyone comment on why there is often a delay of several years bewteen research and publication? Also, assessment of knowledge as 'high, medium or low' is dependent on the measures/scores that are used to make the assessment, which will vary from one study to another. Can anyone comment on the feasibility of a more standardised and replicable approach to knowledge assessment?

Many thanks, Neil

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Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org