Evaluating the effects of reproductive health training on provider behavior

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PROJECT SUMMARY: Training of health professionals in sexual health care is critical to address a broad array of a nation’s sexual and reproductive health concerns. Research evaluating the effects of sexual health curricula on provider behavior is rare. In sub-Saharan Africa, an environment with the world’s highest rates of HIV, STIs, and multiple sexual and reproductive health challenges, training of health students in sexual health care is almost non-existent. Consequently, a rigorous study of its effects is needed if such education is to be widely adopted. In our “Training for Health Professionals” (THP-1) study, at Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania, we conducted formative research to identify the most common sexual health concerns. We then tailored a sexual health curriculum training for healthcare providers to the African context and conducted the world’s first single-blind, randomized controlled trial of its effects. Participants were 412 nursing, midwifery, and medical students at MUHAS. Post-test evaluations with the intervention arm showed the curriculum to be highly acceptable, culturally appropriate, needed, and feasible. At 3-month follow-up, as compared to controls, intervention arm students had moderate-to-large increases in sexual health knowledge, improved attitudes, and improved clinical skills. As required in a renewal application (THP-2), our long-term objective remains “to improve the sexual health outcomes for individuals in Tanzania by building the sexual and reproductive healthcare delivery skills of the health workforce.” We have three new specific aims. Aim 1 will assess the medium and long-term effectiveness of an African-centric, sexual health curriculum. We will conduct a single-blinded RCT of the curriculum against a waitlist control arm, to assess the effects on sexual health knowledge, attitudes, and counseling skills at 6-, 12- and 24-month follow-up (n=155 students per arm; 310 in total). In Aim 2, we will develop a train-the-trainer curriculum. We will conduct a training needs assessment of faculty at the ten other health universities in Tanzania, develop training materials, and pilot the training to faculty at two other health universities: University of Dodoma (UDOM) and Kilimanjaro Christian Medical College (KCMC). In Aim 3, we will conduct a Phase IV trial. This will be an observational study of the curriculum being taught by their faculty at the two new sites with 3- 6- and 12-month follow-up. MUHAS, KCMC, and UDOM are the largest health universities in Tanzania. This curriculum has high potential to be widely adopted as a new standard of training across Tanzania. These results also have high potential to inform the adaptation of sexual health curricula across Africa and beyond the continent, to other LMICs.