BACKGROUND : Insufficient training in infection control and occupational health among healthcare workers
(HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens
requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health
and Infection Control conducted in Free State Province, South Africa in an international partnership to
empower HCWs to become change agents to promote workplace-based HIV and TB prevention.
METHODS : Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and
Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations,
and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon
signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick
RESULTS : Participants recruited (n ¼ 32) were mostly female (81%) and nurses (56%). Pre-to-post-program
mean scores improved in knowledge (12%, p ¼ 0.002) and skills/practices (14%, p ¼ 0.002). Preprogram
attitude scores were high but did not change. Participants felt empowered and demonstrated
attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful
projects were indeed implemented. However, participants encountered considerable difficulties in trying
to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with
inadequate staffing and insufficient management support.
CONCLUSION : Training is essential to strengthen HCWs’ occupational health and infection control
knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield
impressive results. However, the considerable mentorship resources required for such programs and the
substantial infrastructural supports needed for implementation and sustainability of improvements in
settings without pre-existing experience in such endeavors should not be underestimated.
Particular thanks are due to Karen Lockhart
for her contributions throughout this study.