A capacity assessment of healthcare workers to provide second-line antiretroviral therapy in Malawi: 2016

INTRODUCTION: According to the estimates by the World Health Organisation, Malawi is lagging behind for the number of patients that should have been on second-line ART. In settings like Malawi the low switching is attributable to low knowledge of clinical assessment for first-line antiretroviral treatment (ART) failure. We analyzed the knowledge level of different cadres of health workers on the management of second-line ART. METHODS: This cross-sectional study assessed readiness of first-line ART providers to provide second-line ART in the 26 districts of Malawi. Descriptive statistics were conducted using STATA v15.0. The passing score was 80%. Associations were assessed using Chi-Square tests. Statistical significance was placed at P<0.05. RESULTS: Of the 754 ART providers assessed, 290 (38%) were eligible to prescribe second-line ARVs. We observed significant differences for eligibility by cadre and district (P<0.001). Furthermore, 69% of the ART providers correctly identified second-line ARVs while 9% of the providers correctly chose second-line ARVs for management of different side-effects. Both competencies varied by cadre and district (P<0.001). Of the ART providers, 9% correctly interpreted the VL results which we found to significantly vary by cadre (P<0.001) and not districts. However, 78% of ART providers were able to prescribe correct dose of second-line ART which did not significantly vary by cadre (P=0.27). Spatial analysis showed Thyolo and Chiradzulu as high performing districts. CONCLUSIONS: This assessment found that registered nurses had comparable knowledge to medical doctors and clinical officers in most areas but not in correctly selecting second line ARVs. To strengthen task shifting approaches, capacity building should focus on how to correctly select second line regimen and interpret viral load results. Training activities should also consider regional and district-level variability in capacity.