Under the THRIVE project, Penta is advancing critical evidence to inform trainings, guidance, and best practices to strengthen care for children living with advanced HIV disease (AHD). A key activity is a comprehensive Training Gap Assessment across participating countries. The aim was to better understand the current capacities and unmet needs of health staff directly involved in the implementation of the AHD package of care, including pediatricians, nurses, lab technicians, counselors, and others, to optimize its implementation. The results are providing valuable insights that will directly inform the development of targeted training modules within the THRIVE project.
The assessment was co-designed by Penta and the Paediatric Expert Advisory Group (PEAG) as an inclusive and collaborative process, with inputs from Nigeria, Mozambique, Kenya, Zimbabwe and Uganda. The survey was structured to capture both global and country-specific training and implementation needs, and results were later discussed with paediatric field experts, Ministry of Health representatives, and community representatives through the PEAG during a face-to-face meeting held in Kampala, Uganda.
The Training Gap Assessment revealed several important insights into the current knowledge, practices, and barriers faced by healthcare workers involved in the management of AHD in children and adolescents across participating countries:
- Mixed working profiles and paediatric experience: While most respondents had held their current roles for at least two years, only 35% reported working specifically with children and/or adolescents. Nearly half cared for patients of all ages, a scenario that often leads to difficulties in the clinical management of children by treating them as small adults, rather than recognising their unique needs.
- Gaps in knowledge of AHD: Alarmingly, only 55% of respondents reported being familiar with the term Advanced HIV Disease (AHD), and less than 70% were able to correctly identify the definition in the pediatric context. This highlights a pressing need to reinforce foundational concepts as part of future training efforts.
- Implementation challenges: Respondents identified several recurring barriers to the effective implementation of the STOP AIDS Package of Care. These included:
- Limited awareness or understanding of the new guideline
- High rates of loss to follow-up among paediatric patients
- Difficulty in identifying appropriate screening tools or approaches for opportunistic infections in children living with HIV (CLHIV)
- Challenges in managing drug interactions and overlapping treatments in cases of TB-HIV co-infection in children
- High demand for practical, contextualised training: Respondents across all countries expressed a clear need for training that is practical, hands-on, and applicable within their specific health system contexts. There was a strong emphasis on strengthening skills related to screening, treatment, and care for children and adolescents with AHD. Specific areas identified for improvement included the clinical management of malnutrition, optimizing antiretroviral therapy (ART) counseling, and reinforcing the role of vaccination in preventing infections.
Based on these findings, the Penta team, in collaboration with the PEAG and two external expert advisors, Dr. Lisa Frigati and Dr. Helena Rabie, are developing a modular training package on AHD in children that will be adapted to both face-to-face and online formats. This package will be tailored to the realities of each country while ensuring alignment with global best practices in AHD management. Key next steps will include:
- Co-developing the content of the training modules in consultation with national stakeholders to ensure relevance and ownership.
- Conducting two face-to-face training sessions in Mozambique and Zimbabwe informed by the results of the survey.
- Developing an interactive online course in English, French, Portuguese, and Spanish to reach a wide audience to improve the management of children and adolescents living with AHD worldwide.
This Training Gap Assessment has reinforced the critical role of capacity building in ensuring the successful scale-up of AHD services for children. By directly involving Ministry of Health staff and conducting thorough assessments on gaps and opportunities to inform training approaches, we are laying the groundwork for more sustainable, tailored, and country-led improvements in paediatric HIV care.
Author: Laura de la Fuente Soro, MSc, PhD – THRIVE Implementation Scientist for Penta