Training of Health Care Providers on ARV Therapy

Training of Health Care Providers on Anti Retro Viral Therapy

Training of Health Care Providers on Anti Retro Viral Therapy Training Report

Dr. Shabnum Sarfraz Global Fund Project Office Fatima Memorial Hospital, Shadman, Lahore, Pakistan

Fatima Memorial Hospital | Introduction

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Training of Health Care Providers on Anti Retro Viral Therapy Contents Introduction .................................................................................................................................................. 2 Background ............................................................................................................................................... 2 Objective of Training ................................................................................................................................. 2 Specific objectives ..................................................................................................................................... 2 Desired outcome of the training ............................................................................................................... 2 Selection of Audience ................................................................................................................................... 3 Defining content of Training ......................................................................................................................... 3 Selection of Trainers ..................................................................................................................................... 4 Training Methodology................................................................................................................................... 5 Agenda of the Workshop .............................................................................................................................. 7 Work Shop Proceeding ................................................................................................................................. 9 Session Outline.......................................................................................................................................... 9 Session 1: Demystifying HIV and AIDS - A Global Issue by Prof. Dr. Aman Ullah Khan ................................ 9 Session 2: The Psychosocial Impact of HIV/AIDS on Individual, Society and Family By Dr. Ayesha Nauman ...................................................................................................................................................................... 9 Session 3: Drug Adherence and Strategies for Compliance By Dr. Ayesha Nauman .................................... 9 Session 4: Nursing Care for Patients on ART By Ms. Saba Watto ................................................................ 9 Session 5 & 6: Role of Counselling and Adherence in ARV Therapy By Dr. Noreen Hashmi ...................... 10 Session 7: The Multidisciplinary Adherence Team Referral Networking To Enhance ART Adherence By Dr. Shabnum Sarfraz ......................................................................................................................................... 10 Session 8: PPTCT- District Model- An Overview By Dr. Roomi Aziz ........................................................... 10 Session 9: When To Start ARV? What Is The First Line Therapy? When To Switch Art Second And Third Line Regimen? By Dr. Fatima Imran ............................................................................................................ 10 Session 10: Managing The Side Effects And Complications during ARV Therapy Lab Monitoring By Dr. Inam Ul Haq ................................................................................................................................................ 11 Session 8: ART For HIV/Tuberculosis & HIV/HBV Co-Infection By Dr. Fatima Rahman .............................. 11 Comments of Participants........................................................................................................................... 12 Annexure ..................................................................................................................................................... 13 Annexure 1: List of Participants .............................................................................................................. 13 Annexure 2: Trainer’s Evaluation Form .................................................................................................. 14 Annexure 3: Trainers’ Evaluations Actual ............................................................................................... 15 Fatima Memorial Hospital | Introduction

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Training of Health Care Providers on Anti Retro Viral Therapy

INTRODUCTION Background The Training of Health Care Providers is a sequential of Training of Mentors which was aimed to prepare and select five mentors who would take up the future trainings for the health care providers.

Objective of Training The training of Health Care Providers is aimed at building up the knowledge base of the Health Care Providers (that includes doctors, nurses, psychologists and sociologists) about the HIV/AIDS for the effective handling of Patients Living with HIV/AIDS (PLHIVs). The workshop also attempts at developing a network/ liaison of health care providers who will be experts in ART. This workshop has been exclusively arranged for the participants from Punjab and KPK province.

Specific objectives This two-day rigorous training covers all aspects of ARV Therapy. By the end of this training, participants will be expected to have knowledge of following topics: 1.

When to start ARV

2.

What is the first line therapy?

3.

When to switch ART-Second and Third line Regimen

4.

Managing the side effects and complications during ARV Therapy

5.

ART for HIV/tuberculosis co-infection

6.

ART for HIV/HBV co-infection

7.

Counseling for ARV Therapy

Desired outcome of the training At the end of this two-days training, the participants are expected to be fully equipped with the HIV/AIDS as a disease, its implications and the treatment practices which will enable them to manage well while handling PLHIVs.

Fatima Memorial Hospital | Introduction

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Training of Health Care Providers on Anti Retro Viral Therapy SELECTION OF AUDIENCE The selection of participants was critical as all of them were filtered through stringent criteria. The participants had to have a background in medicine, allied sciences, nursing, psychology/sociology, a post-graduate degree or diploma and some experience in HIV/AIDS. Interaction/work experience with health care providers who are working with HIV/AIDS was an additional plus. Invitations were sent via Principal’s Office to the Medical colleges, Heads of Nursing institutions and health academies, and the CHBC centers all over Punjab and KPK. The participants’ portfolio was very rich, including Senior Doctors, Nursing Staff and Counsellors belonging to both the Public and Private Sector Health Institutions and from the Punjab and KPK province. (Annexure: 1 List of Participants).

DEFINING CONTENT OF TRAINING Since the program was meant to inculcate the latest knowledge on management of an HIV-positive patient, through the stages of HIV to AIDS, the content was designed to provide a holistic approach towards the management of PLHIV and hence included the following areas: i.

In-depth knowledge of the HIV regimens

ii.

In-depth knowledge about second and third line regimens, times and indications to switch

iii.

Management of side effects and complications during ART

iv.

ART treatment along with the co-infections

v.

Role of counseling of PLHIVs

vi.

Need of Adherence in PLHIVs

Fatima Memorial Hospital | Selection of Audience

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Training of Health Care Providers on Anti Retro Viral Therapy SELECTION OF TRAINERS The basic ideology of the Training of Health Care Providers was to equip the participants with the latest knowledge about HIV/AIDS through the five mentors who were selected after the successful completion of Training of Mentors. Moreover, two leading experts of Infectious Diseases and Community Medicine were also among the trainers. The trainers were Prof. Dr. Aman Ullah Khan, Technical Advisor, Nur Center for Research & Policy B.Sc., MBBS, DPH, MPH & TM, FCPS, PhD, FRSTM&H, FAPHA Prof. Dr. Aman Ullah Khan had been the dean of College of Physician and Surgeons of Pakistan before joining Fatima Memorial Hospital. He has also served as the Professor of Institute of Public Health Pakistan. He had been involved on miscellaneous research activities on HIV/AIDS in Pakistan and abroad. He is the author of many publications.

Dr. Noreen Rahat Hashmi, Head - Community Medicine Department, Rahbar Medical & Dental College MD, Diplomate American Board of Internal Medicine, MPH Dr. Noreen Rahat Hashmi is an expert of Internal Medicine and had been managing PLHIVs back in USA. She recently moved to Pakistan and is currently serving Rahbar Medical & Dental College.

Dr. Ayesha Nauman, Consultant Gynaecology and Director HR, Fatima Memorial Hospital MBBS, MBA Dr. Ayesha Nauman is currently a practicing gynaecologist at Fatima Memorial Hospital. Moreover, she is serving FMH as Director Human Resources Department as well. She was ranked top among the five mentors selected from Training of Mentors.

Ms. Saba Watto, Nursing Instructor, Saeeda Waheed FMH College of Nursing M.Sc. Nursing Ms. Saba Watto is currently working as Nursing Instructor at Saeeda Waheed FMH College of Nursing. She has a post graduation qualification from Agha Khan University with a special interest in HIV/AIDS. Ms. Watto was ranked fifth in the selection of mentors.

Fatima Memorial Hospital | Selection of Trainers

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Training of Health Care Providers on Anti Retro Viral Therapy Dr. Shabnum Sarfraz, Health Specialist & COO (NCRP), Fatima Memorial Hospital MBBS, MBA Dr. Shabnum Sarfraz is a leading health specialist in the country with a vast experience of managing local and international health projects with different funding agencies like WHO, USAID, The Global Fund, UNICEF, Health Ministry Pakistan, Punjab Education Foundation and many more. Currently she is working in the capacity of Chief Operating Officer, Nur Center for Research and Policy, a sister concern of Fatima Memorial Hospital.

Dr. Roomi Aziz, Health Specialist & SPM (NCRP), Fatima Memorial Hospital MBBS, MBA Dr. Roomi Aziz is serving as Senior Manager Strategy and Planning at NCRP. She has conducted miscellaneous trainings under different international and local donor agencies’ projects as trainer.

Dr. Fatima Imran, Senior Registrar, Paediatrics, Fatima Memorial Hospital MBBS, FCPS (Paediatrics) Dr. Fatima Imran opted for medicine with a major in Paediatrics in her post graduation certification. She was ranked fourth in the selection of mentors. She is currently working as Senior Registrar at Paediatrics Department, Fatima Memorial Hospital.

Dr. Inam ul Haq, In charge Special Clinic for HIV/AIDS, Mayo Hospital Lahore MBBS, Post Graduation Trainee Dr. Inam ul Haq is currently working as In charge Special Clinic for HIV/AIDS at the Mayo Hospital Lahore and has the hands on experience of dealing PLHIVs. He secured third position among the selection of mentors. He is also appearing in his final examinations for specialization in internal medicine.

Dr. Fatima Rahman, Registrar, Paediatrics Department, Services Hospital Lahore MBBS, Post Graduation Trainee Dr. Fatima Rahman is a Post Graduate Trainee in the Department of Paediatrics at Services Hospital Lahore. She has the hands on experience of managing PLHIVs especially children. She was ranked second among the five mentors selected.

TRAINING METHODOLOGY Fatima Memorial Hospital | Training Methodology

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Training of Health Care Providers on Anti Retro Viral Therapy The training sessions were interactive and participants were encouraged to reflect on the concepts and knowledge shared by the trainers. The trainers rigorously covered all the aspects of HIV/AIDS in two days time. The participants were persuaded to actively involve in the presentation and Q/A sessions for the improvisation of their knowledge and skills.

At the end of each day, the participants were asked to fill an anonymous evaluation form, evaluating the trainers for the day. At the end of the second day, the participants were also asked to evaluating the entire workshop as well as give suggestions and recommendations. The recommendations have been noted down for future workshops.

Fatima Memorial Hospital | Training Methodology

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Training of Health Care Providers on Anti Retro Viral Therapy AGENDA OF THE WORKSHOP Day 1 FOCUS

19-Oct-12 Basic information on adherence and ARV Therapy

TIME 09:00 - 10:00

SESSIONS Inaugural Ceremony & Group Photograph Session 1: Demystifying HIV & AIDS - A Global Issue

10:00 - 10:45 Facilitator Prof Aman Ullah 10:45 - 11:00

11:00 - 11:45

Tea Break Session 2: The Psychological impact of HIV/AIDS on Individual, Society and Family Facilitator Dr. Ayesha Nauman Session 3: Drug Adherence and Strategies for Compliance

11:45 - 12:30 Facilitator Dr. Ayesha Nauman Session 4: Nursing Care for patients on ART 12:30 - 01:15 pm Facilitator Ms Sabba Watto 01:15 - 02:00

Lunch & Jumma Prayers Session 5: Role of Counselling and Adherence in ARV Therapy-1

02:00 - 02:45 Facilitator Dr Noreen R. Hashmi

02:45 - 03:30

Session 6: Role of Counselling and Adherence in ARV Therapy- Group Activity Post- Exposure Prophylaxis Facilitator Dr Noreen R. Hashmi

Fatima Memorial Hospital | Agenda of the Workshop

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Training of Health Care Providers on Anti Retro Viral Therapy Day 2 FOCUS

20-Oct-12 Management of patients on ARV Therapy

TIME

09:00 - 09:45

SESSIONS Session 7: The Multidisciplinary Adherence Team Referral Networking to enhance ART Adherence Facilitator Dr Shabnum Sarfraz

Session 8: An introduction to the PPTCT Model 09:45 - 10:30

Facilitator Dr Roomi Aziz

10:30 - 11:00

11:00 - 11:45

Tea Break Session 8: When to start ARV? What is the first line therapy?

When to Switch ART Second and Third line Regimen?

Facilitator: Dr Fatima Imran Session 9: Managing the side effects and complications during ARV Therapy

11:45 - 12:30 Facilitator: Dr Inam ul Haq Session 10: ART for HIV/Tuberculosis & HBV co-infection 12:30 - 1:15 Facilitator Dr. Fatima Rahman 01:15 - 02:00 pm

Lunch

02:00 - 02:45

Closing Ceremony

Fatima Memorial Hospital | Agenda of the Workshop

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Training of Health Care Providers on Anti Retro Viral Therapy WORK SHOP PROCEEDING Session Outline

SESSION 1: DEMYSTIFYING HIV AND AIDS - A GLOBAL ISSUE BY PROF. DR. AMAN ULLAH KHAN The session focused on the global and local spread of the disease till today. The disease stages along with the modes of transmission were also discussed briefly. The stigmas associated with PLHIVs were also shared in detail and the ways to remove such taboos were identified.

SESSION 2: THE PSYCHOSOCIAL IMPACT OF HIV/AIDS ON INDIVIDUAL , SOCIETY AND FAMILY BY DR. AYESHA N AUMAN The psychological management of PLHIVs were brought up for discussion in this session. The trainer shared the counselling aspects like listening, respect for the client, confidentiality, questioning, self decisions and help for other services, in relation to PLHIVs. The confidentiality and privacy of a PLHIV was also discussed in detail. Moreover, the psychological impact of HIV/AIDS on society and family were also the part of discussion.

SESSION 3: DRUG ADHERENCE AND STRATEGIES FOR COMPLIANCE BY DR. AYESHA NAUMAN The session primarily highlighted various aspects of drug adherence and strategies to compliance. The role of adherence support workers was emphasized upon. Their role in improvement of patient adherence, knowledge, and understanding; provision of education and counselling in the patient's own language allows nurses and doctors to focus on other technical and clinical aspects of the patients’ treatment.

SESSION 4: NURSING CARE FOR PATIENTS ON ART BY MS. SABA WATTO This session was aimed at the nursing care of the patients who on ART. As nurses have to perform a pivotal role in managing the PLHIVs, all the aspects like counselling, drug adherence were discussed in detail.

Fatima Memorial Hospital | Work Shop Proceeding

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Training of Health Care Providers on Anti Retro Viral Therapy SESSION 5 & 6: ROLE OF COUNSELLING AND ADHERENCE IN ARV THERAPY BY DR. NOREEN HASHMI The session primarily focused on the importance of level of commitment towards adherence and the consequences in case of non-compliance. Effective strategies to encourage adherence and ways to counsel patients about adherence were also discussed in detail. Adherence issue of PLHIVs in Pakistan were also the part of discussion. The session also included a group activity where participants were asked to present on various dimensions of ARV adherence and counselling.

SESSION 7: THE MULTIDISCIPLINARY ADHERENCE TEAM REFERRAL NETWORKING TO ENHANCE ART ADHERENCE BY DR. SHABNUM SARFRAZ The session primarily highlighted various aspects of ART adherence with respect to team referral networking. The role of adherence support workers was emphasized upon. Their role in improvement of patient adherence, knowledge, and understanding; provision of education and counselling in the patient's own language allows nurses and doctors to focus on other technical and clinical aspects of the patients’ treatment.

SESSION 8: PPTCT- DISTRICT MODEL- AN OVERVIEW BY DR. ROOMI AZIZ This session focused PPTCT - District Model as the common modes of HIV/AIDS spread in females were the point of discussion. The trainer further elaborated about the functioning and impact of PPTCT – District Model adapted by Punjab AIDS Control Program in Punjab Province. The achievements to date of this model were also shared.

SESSION 9: WHEN TO START ARV? WHAT IS THE FIRST LINE THERAPY? WHEN TO SWITCH ART SECOND AND THIRD LINE REGIMEN? BY DR. FATIMA IMRAN The session conferred evidence-based recommendations for ARV Therapy, identification of most effective first-line, 2nd line and subsequent regimens. The time of initiation of treatment and the importance of careful decision making for ARV initiation with evidence based timing and regimen selection were also discussed. The access of ARV Therapy in low-income countries like Pakistan was also the part of the session.

Fatima Memorial Hospital | Work Shop Proceeding

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Training of Health Care Providers on Anti Retro Viral Therapy SESSION 10: MANAGING THE SIDE EFFECTS AND COMPLICATIONS DURING ARV THERAPY LAB MONITORING BY DR. INAM UL HAQ The clinical and laboratory monitoring of drugs, important toxicities, complications and adverse effects of ARV Therapy was the core of this session. Management of drug toxities were also shared by the trainer in detail.

SESSION 8: ART FOR HIV/TUBERCULOSIS & HIV/HBV CO-INFECTION BY DR. FATIMA RAHMAN This first part of the session was primarily focused on HIV/TB co-infection as TB is responsible for 13% of deaths in HIV patients. The progression of HIV infection from latent to active TB was discussed in detail along with the clinical approach of TB co-infected PLHIV. The application of latest drug regimens for such co-infection was shared. The second part of the session aimed for the finding of HIV/HBV co-infection.

The aspects of counselling the patient for avoidance of alcohol, vaccination against hepatitis A (if not immune), advice on methods to prevent HBV transmission and evaluate severity of HBV infections were the main highlights of this session. The recommended testing for such co-infected patients was also discussed in detail along with the latest regimens for treatment.

Fatima Memorial Hospital | Work Shop Proceeding

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Training of Health Care Providers on Anti Retro Viral Therapy COMMENTS OF PARTICIPANTS Following are the comments of the participants on the concluding day, collected anonymously:

It was a really nice experience to be here, which I was not expecting. All facilitators were very cooperative and tried their best to import their knowledge.

It is important to bring these types of workshops to professionals like barbers and beauticians and compounders, who are the source of such infections and can play an active role in stopping the spread of HIV.

Fatima Memorial Hospital | Comments of Participants

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Training of Health Care Providers on Anti Retro Viral Therapy

ANNEXURE Annexure 1: List of Participants Name Dr Idrees Afridi

Designation Doctor

Department Family Care Center

Organization CHBC, HMC, Peshawar

Dr Saima Afridi

Doctor

Family Care Center

CHBC, HMC, Peshawar

Ms Saima Bibi

VCT Nurse

Family Care Center

CHBC, HMC, Peshawar

MS Sana Parveen

Counselor

Family Care Center

CHBC, HMC, Peshawar

Ms Malika Tahir

VCT Nurse

Family Care Center

CHBC, HMC, Peshawar

Ms Maria Sadiq

ORW

Family Care Center

CHBC, HMC, Peshawar

Service Delivery Officer

Family Care Center

CHBC, Kohat

VCT Nurse

Family Care Center

Ms Seraphine Majid

Senior Instructor

Faculty

Ms Asifa Shahzadi

Senior Instructor

Faculty

Dr Anis Fatima

Consultant

Gynaecology

CHBC, Kohat Saida Waheed FMH College of Nursing, Lahore Saida Waheed FMH College of Nursing, Lahore Fatima Memorial Hospital, Lahore

Dr Farah Nadia

Medical Officer

Medicine

Sir Ganga Ram Hospital, Lahore

Registrar

Medicine

Sir Ganga Ram Hospital, Lahore

Dr Naeem Amin

Registrar

Medicine

Sir Ganga Ram Hospital, Lahore

Dr Farah Sadiq

Senior Registrar

Medicine

Mayo Hospital, Lahore

Dr Umar Aftab

Post Graduate Trainee

Medicine

Jinnah Hospital, Lahore

Dr Naila Altaf

Post Graduate Trainee

Medicine

Jinnah Hospital, Lahore

Associate Professor

Medicine

Punjab Medical College, Faisalabad

Ms Uzma Azam

CO&SDO

Field Work

CHBC - PakPlus Society, Lahore

Mr Samiuallah

CO&SDO

Field Work

CHBC - PakPlus Society, Lahore

Ms Naseem Abdullah

Manager Nursing

Emergency

Jinnah Hospital, Lahore

Ms Rukhsana William

MS Shamsa Kanwal Ms Farhat Naz

Dr Zia ul Haq

Dr Anwar Sulehri

Manager Nursing

Medicine

Jinnah Hospital, Lahore

Ms Farrukh Yousaf

Senior Nurse

Medicine

Mayo Hospital, Lahore

Ms Riffat Zahid

Senior Nurse

Pediatric Medicine

Mayo Hospital, Lahore

Dr Bushra Noor

Registrar

Medicine

Sir Ganga Ram Hospital, Lahore

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy Annexure 2: Trainer’s Evaluation Form

TRAINERS EVALUATION FORM Training Title: Training of Mentors

Dates: October 19, 20, 2012

Venue: Conference Room, 4th Floor, FMH College of Medicine & Dentistry, Shadman, Lahore Training

Training of Mentors on Anti Retro Viral Therapy

Venue

Fatima Memorial Hospital, Lahore

Date

October, 2012

We are interested in developing and honing the training for future use.

Please take a minute to rate Dr. XYZ as a trainer.

Strongly

Statement

Agree

Agree

Disagree

Strongly Disagree

The trainer was knowledgeable about the subject The trainer was well-prepared about the subject Explanations were clear and concise The trainer solicited questions and had the answers The trainer was interested in sharing information and knowledge The trainer’s presentation style was interesting and effective The trainer motivated, inspired and instilled confidence Comments if any:

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy Annexure 3: Trainers’ Evaluations Actual

Prof. Dr. Aman Ullah Khan 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Dr. Ayesha Nauman 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Ms. Saba Watto 20 15

Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy

Dr. Noreen R. Hashmi 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

20 15

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Dr. Shabnum Sarfraz

10 5

Strongly Agree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

20

The trainer motivated, inspired and instilled confidence

Agree Disagree Strongly Disagree

Dr. Roomi Aziz

15 10

Strongly Agree

5

Agree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Disagree Strongly Disagree

Fatima Memorial Hospital | Annexure

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Training of Health Care Providers on Anti Retro Viral Therapy

20 15

Dr. Fatima Imran

10 Strongly Agree

5

Agree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Disagree Strongly Disagree

Dr. Inam Ul Haq 20 15 Strongly Agree

10

Agree

5

Disagree

0 The trainer was The trainer was Explanations The trainer The trainer was The trainer’s knowledgeable well-prepared were clear and solicited interested in presentation about the about the concise questions and sharing style was subject subject had the answers information and interesting and knowledge effective

The trainer motivated, inspired and instilled confidence

Strongly Disagree

Fatima Memorial Hospital | Annexure

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