Rapid tenofovir-lamivudine-dolutegravir transition in Papua New Guinea: a virtual approach to antiretroviral prescriber refresher trainings during a global pandemic

BACKGROUND: The rates of pre-treatment HIV drug resistance among first-line antiretroviral therapy (ART) initiators in Papua New Guinea (PNG) have been alarmingly high. In response, the National Department of Health (NDoH) planned a rapid transition of first-line ART to dolutegravir-based regimens in 2019'2020 in all high-burden provinces. When the COVID-19 pandemic reached PNG in March 2020, refresher training for ART prescribers on the revised treatment guidelines could not be conducted as planned. To ensure that patients could safely transition to new regimens, the NDoH, supported by PEPFAR and partners, facilitated the development of a virtual training platform for country-wide prescriber trainings.
DESCRIPTION: The USAID HIV Support in PNG project implemented by FHI 360 played a critical role in the development, facilitation, and implementation of the first virtual training for ART prescribers in PNG. This involved establishing a virtual training platform using Google Classroom and creating 21 video lectures with more than six hours of content covering all aspects of HIV care and treatment, including revised care-and-treatment guidelines and tenofovir-lamivudine-dolutegravir (TLD).
The virtual training, launched in May 2020, reached 108 prescribers (33.3% nursing officers, 30% health extension officers, 23.3% community health workers, 13.3% doctors) from all 22 provinces. Among the training participants, 76.7% had not attended an HIV refresher training in the previous three years; 83.4% rated the training as four (out of five) or higher, and training evaluation scores averaged more than 80%. This resulted in safe, rapid rollout of TLD, with more than 64% of ART clients transitioned to dolutegravir-based regimens within three months of the training and more than 93% transitioned by September 2021.
LESSONS LEARNED: Despite initial concerns that virtual training would not be feasible in PNG due to limited connectivity and low computer literacy, free platforms such as Google Classroom and the widespread availability of smartphones allowed successful training of health care workers in PNG.
CONCLUSIONS: Virtual training of health care practitioners was viable for highly-effective, low-cost capacity building in resource-constrained environments during the COVID-19 pandemic. Similar approaches may be considered for other capacity-building initiatives instead of regular in-person trainings.

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