Abstract:
Clinical guidelines are used to translate research findings into evidence‐based clinical
practice but are frequently not comprehensively adopted by health workers (HWs).
HIV and infant feeding guidelines were revised by the World Health Organization
to align feeding advice for HIV‐exposed and unexposed infants, and these were
adopted in South Africa in 2017. We describe an innovative, team‐based, mentoring
programme developed to update HWs on these guidelines. The intervention was
underpinned by strong theoretical frameworks and aimed to improve HWs' attitudes,
knowledge, confidence, and skills about breastfeeding in the context of HIV. On‐site
workshops and clinical mentoring used interactive participatory methods and a simple
low‐tech approach, guided by participants' self‐reported knowledge gaps. Workshops
were conducted at 24 participating clinics over three sessions, each lasting 1–2 hr.
Evaluation data were collected using a self‐administered questionnaire. Of 303 participating
HWs, 249/303 (82.2%) attended all workshops. Achieving high workshop
attendance was challenging and “catch‐up” sessions were required to achieve good
coverage. Common knowledge gaps identified included antiretroviral therapy adherence
monitoring during breastfeeding and management of viral load results (173 participants),
management of breast conditions (79), and advice about expressing and
storing breastmilk (64). Most participants reported all their knowledge gaps were
addressed and anticipated that their practice would change.
We describe a feasible, sustainable approach to updating HWs on HIV and infant
feeding guidelines and improving skills in breastfeeding counselling in resourceconstrained
settings. This approach could be adapted to other topics and, with further evaluation, implemented at scale using existing resources.
