Building communities of practice through case-based e-learning to prevent and manage TB among people living with HIV–India

Abstract Background: Addressing TB among people living with HIV (PLHIV) is a key priority for the Government of India (GoI). In 2016, GoI implemented single-window services to prevent and manage TB in PLHIV. To strengthen HIV-TB service delivery, case-based e-learning was introduced to health care providers at ART centres (ARTc). Methods: We implemented a hub and spoke model to deliver biweekly, virtual, case-based e-learning at select ARTc (n=115), from four states of India-–Delhi, Uttar Pradesh, Andhra Pradesh and Tamil Nadu. We evaluated feasibility and acceptability of case-based e-learning and its impact on professional satisfaction, self-efficacy, knowledge retention using baseline and completion surveys, session feedback, pre-and post-session assessments. We reviewed routine programmatic data and patient outcomes to assess practices among participating ARTc. Results: Between May 2018–September 2020, 59 sessions were conducted with mean participation of 55 spokes and 152 participants. For 95% and 88% of sessions≥80% of respondents agreed that topics were clear and relevant to practice, and duration of session was appropriate, respectively. Session participants significantly improved in perceived knowledge, skills and competencies (+8.6%;p=0.025), and technical knowledge (+18.3%;p=0.04) from baseline. Participating ARTc increased TB screening (+4.2%,p<0.0001)), TB diagnosis(+2.7%,p<0.0001), ART initiation(+4.3%,p<0.0001) and TB preventive treatment completion (+5.2%,p<0.0001).Conclusion: Case-based e-learning is an acceptable and effective modus of capacity building and developing communities of practice to strengthen integrated care. E-learning could address demand for accessible and sustainable continuing professional education to manage complex diseases, particularly co-morbidities and thereby enhance health equity.