An educational intervention to update health workers about HIV and infant feeding

Abstract Clinical guidelines are used to translate research findings into evidence‐based clinicalpractice but are frequently not comprehensively adopted by health workers (HWs).HIV and infant feeding guidelines were revised by the World Health Organizationto align feeding advice for HIV‐exposed and unexposed infants, and these wereadopted in South Africa in 2017. We describe an innovative, team‐based, mentoringprogramme developed to update HWs on these guidelines. The intervention wasunderpinned by strong theoretical frameworks and aimed to improve HWs' attitudes,knowledge, confidence, and skills about breastfeeding in the context of HIV. On‐siteworkshops and clinical mentoring used interactive participatory methods and a simplelow‐tech approach, guided by participants' self‐reported knowledge gaps. Workshopswere conducted at 24 participating clinics over three sessions, each lasting 1–2 hr.Evaluation data were collected using a self‐administered questionnaire. Of 303 par-ticipating HWs, 249/303 (82.2%) attended all workshops. Achieving high workshopattendance was challenging and“catch‐up”sessions were required to achieve goodcoverage. Common knowledge gaps identified included antiretroviral therapy adher-ence monitoring during breastfeeding and management of viral load results (173 par-ticipants), management of breast conditions (79), and advice about expressing andstoring breastmilk (64). Most participants reported all their knowledge gaps wereaddressed and anticipated that their practice would change.We describe a feasible, sustainable approach to updating HWs on HIV and infantfeeding guidelines and improving skills in breastfeeding counselling in resource‐constrained settings. This approach could be adapted to other topics and, with furtherevaluation, implemented at scale using existing resources. KEYWORDS breastfeeding, clinical practice guideline, health worker, HIV, infant feeding, primary health care,South AfricapublishedVersio