Cascaded clinical mentoring improves health workers selfefficacy in provision of integrated HIV care in rural hospitals in Kenya

Objective : To evaluate cascaded clinical mentorship strategy on access and health-worker’s self-efficacy in delivery of integrated HIV services. Design: A cross sectional survey study design. Setting : Government health facilities in the Coastal region and City of Nairobi, Kenya. Participants : Nurses and clinical officers who were recipients of cascaded mentorship. Intervention: Training of volunteer health-workers on mentorship and the HIV care package by a team of master mentors followed by support to carry out mentorship among fellow health-workers. Outcome measure : Access to HIV services, and health-worker self-reported efficacy in delivering integrated HIV care services based on an anonymous standard self-administered tool that evaluated 9 domains of HIV care. Results : There was an exponential increase in mentorship services, 126 volunteer health-workers were trained, and they formed 22 multidisciplinary District teams who extended mentorship to 231 health facilities. In the 33 months a total of 5503 mentor visits and 7724 mentoring sessions were made. The evaluated 150 health workers self-reported significant improvement in all 9 domains of HIV care compared to baseline (p < 0.001). Health-workers were exposed to a mean of 6 mentor-ship sessions. On controlling for region and cadre of staff, number of mentor-ship sessions were significantly associated with increased competence in 7 of 9 fields (p< 0.01). Compared to volunteer mentors, mentorship and site visits by master mentors were five and twice more costly respectively.  Conclusions : Cascaded HIV mentorship increased staff self-efficacy and access to HIV treatment services. The impact of this cascaded mentorship on patient outcomes should be evaluated.