{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:24:30Z","timestamp":1790004270741,"version":"4.0.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB","award":["1U01GH000527"],"award-info":[{"award-number":["1U01GH000527"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hum Resour Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Clinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8\u00a0h a week, every 6\u00a0weeks over 9\u00a0months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6\u00a0months (0.6% [95% CI \u2212\u20091.4, 2.6]) or 12\u00a0months (\u2212\u20092.8% [95% CI: \u2212\u20095.9, 0.3]) while scores in the control arm significantly increased at 6\u00a0months (6.6% [95% CI: 4.4, 8.9]) and 12\u00a0months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6\u00a0month (2.8% [95% CI: \u2212\u20091.8, 7.5] and 12\u00a0months (3.7% [95% CI: \u2212\u20092.4, 9.8]) while in the control arm, a significant increase was seen at 6\u00a0months (5.8% [95% CI: 1.2, 10.3] and 12\u00a0months (11.5% [95% CI: 7.6, 15.5]).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Mentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care.<\/jats:p>\n                <jats:p><jats:italic>Trial Registration<\/jats:italic> The study received ethics approvals from 3 institutions\u2014the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board \u201cJCRC\u2019s HIV\/AIDS Research Committee\u201d IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12960-021-00693-x","type":"journal-article","created":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T11:11:23Z","timestamp":1639048283000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Retention of knowledge and clinical competence among Ugandan mid-level health providers 1\u00a0year after intensive clinical mentorship in TB and HIV management"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6052-8980","authenticated-orcid":false,"given":"Dan K.","family":"Senjovu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Naikoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pallen","family":"Mugabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damazo T.","family":"Kadengye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carey","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia L.","family":"Riley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Dalal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,9]]},"reference":[{"issue":"1","key":"693_CR1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1478-4491-8-8","volume":"8","author":"M Callaghan","year":"2010","unstructured":"Callaghan M, Ford N, Schneider H. A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health. 2010;8(1):8. https:\/\/doi.org\/10.1186\/1478-4491-8-8.","journal-title":"Hum Resour Health."},{"key":"693_CR2","unstructured":"Assembly UG. Transforming our world\u202f: the 2030 Agenda for Sustainable Development. UN Gen Assem. 2015; https:\/\/www.refworld.org\/docid\/57b6e3e44.html. Accessed 7 Nov 2019."},{"key":"693_CR3","unstructured":"WHO. PEPFAR & UNAIDS. Task shifting\u202f: rational redistribution of tasks among health workforce teams\u202f: global recommendations and guidelines. Geneva. World Heal Organ. 2007; https:\/\/apps.who.int\/iris\/handle\/10665\/43821"},{"issue":"1","key":"693_CR4","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/1478-4491-7-75","volume":"7","author":"A Vasan","year":"2009","unstructured":"Vasan A, Kenya-Mugisha N, Seung KJ, Achieng M, Banura P, Lule F, et al. Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda. Hum Resour Health. 2009;7(1):75. https:\/\/doi.org\/10.1186\/1478-4491-7-75.","journal-title":"Hum Resour Health."},{"key":"693_CR5","doi-asserted-by":"crossref","unstructured":"Gattellari M, Donnelly N, Taylor N, Meerkin M, Hirst G, Ward JE. Does \u2018peer coaching\u2019 increase GP capacity to promote informed decision making about PSA screening? A cluster randomised trial. Fam Pract. 2005;22(3):253\u201365. http:\/\/academic.oup.com\/fampra\/article\/22\/3\/253\/501323\/Does-peer-coaching-increase-GP-capacity-to-promote","DOI":"10.1093\/fampra\/cmi028"},{"key":"693_CR6","unstructured":"WHO. WHO recommendations for clinical mentoring to support scale-up of HIV care , antiretroviral therapy and prevention in resource-constrained settings. 2005:16\u20138. https:\/\/www.who.int\/hiv\/pub\/guidelines\/clinicalmentoring.pdf"},{"key":"693_CR7","first-page":"1","volume":"9","author":"MB Morris","year":"2009","unstructured":"Morris MB, Chapula BT, Chi BH, Mwango A, Chi HF, Mwanza J, et al. Use of task-shifting to rapidly scale-up HIV treatment services\u202f: experiences from Lusaka. Zambia. 2009;9:1\u20139.","journal-title":"Zambia"},{"key":"693_CR8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2010.03571.x","author":"M Jokelainen","year":"2011","unstructured":"Jokelainen M, Turunen H, Tossavainen K, Jamookeeah D, Coco K. A systematic review of mentoring nursing students in clinical placements. 2011. https:\/\/doi.org\/10.1111\/j.1365-2702.2010.03571.x.","journal-title":"A systematic review of mentoring nursing students in clinical placements."},{"issue":"9","key":"693_CR9","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1001\/jama.296.9.1103","volume":"296","author":"D Sambunjak","year":"2006","unstructured":"Sambunjak D, Straus SE, Maru\u0161i\u0107 A. Mentoring in Academic Medicine. JAMA. 2006;296(9):1103. https:\/\/doi.org\/10.1001\/jama.296.9.1103.","journal-title":"JAMA."},{"key":"693_CR10","unstructured":"WHO. World Health Organization\u2019s Global Health Workforce Statistics, OECD, supplemented by country data. 2015. https:\/\/data.worldbank.org\/indicator\/SH.MED.PHYS.ZS?locations=UG"},{"key":"693_CR11","unstructured":"Uganda MOH. Clinical Mentors Pocket Reference Guide. 2010;1\u201312."},{"issue":"1","key":"693_CR12","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1111\/j.1944-8287.2012.01167.x","volume":"89","author":"A Morrison","year":"2013","unstructured":"Morrison A, Rabellotti R, Zirulia L. When do global pipelines enhance the diffusion of knowledge in clusters? Econ Geogr. 2013;89(1):77\u201396. https:\/\/doi.org\/10.1111\/j.1944-8287.2012.01167.x.","journal-title":"Econ Geogr."},{"issue":"4","key":"693_CR13","doi-asserted-by":"publisher","first-page":"569","DOI":"10.2307\/2297501","volume":"56","author":"B Jovanovic","year":"1989","unstructured":"Jovanovic B, Rob R. The growth and diffusion of knowledge. Rev Econ Stud. 1989;56(4):569\u201382.","journal-title":"Rev Econ Stud"},{"issue":"1","key":"693_CR14","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/1467-8551.00182","volume":"12","author":"H Scarbrough","year":"2001","unstructured":"Scarbrough H, Swan J. Explaining the diffusion of knowledge management: the role of fashion. Br J Manag. 2001;12(1):3\u201312. https:\/\/doi.org\/10.1111\/1467-8551.00182.","journal-title":"Br J Manag."},{"key":"693_CR15","doi-asserted-by":"crossref","unstructured":"Naikoba S, Senjovu KD, Mugabe P, McCarthy CF, Riley PL, Kadengye DT, et al. Improved HIV and TB Knowledge and Competence Among Mid-level Providers in a Cluster-Randomized Trial of One-on-One Mentorship for Task Shifting: J Acquir Immune Defic Syndr. 2017;75(5): e120\u20137. http:\/\/insights.ovid.com\/crossref?an=00126334-201708150-00015","DOI":"10.1097\/QAI.0000000000001378"},{"issue":"1","key":"693_CR16","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12961-018-0405-y","volume":"17","author":"DR Walugembe","year":"2019","unstructured":"Walugembe DR, Sibbald S, Le Ber MJ, Kothari A. Sustainability of public health interventions: where are the gaps? Heal Res Policy Syst. 2019;17(1):8. https:\/\/doi.org\/10.1186\/s12961-018-0405-y.","journal-title":"Heal Res Policy Syst."},{"issue":"1","key":"693_CR17","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13012-017-0707-4","volume":"13","author":"L Lennox","year":"2018","unstructured":"Lennox L, Maher L, Reed J. Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare. Implement Sci. 2018;13(1):27. https:\/\/doi.org\/10.1186\/s13012-017-0707-4.","journal-title":"Implement Sci."},{"issue":"1","key":"693_CR18","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1086\/268432","volume":"42","author":"CS Alexander","year":"1978","unstructured":"Alexander CS, Becker HJ. The use of vignettes in survey research. Public Opin Q. 1978;42(1):93. https:\/\/doi.org\/10.1086\/268432.","journal-title":"Public Opin Q."},{"key":"693_CR19","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1201\/b12318-57","volume":"1","author":"D Keane","year":"2012","unstructured":"Keane D, Lang A, Craven M, Sharples S. The Use of Vignettes for Conducting Healthcare Research. Adv Hum Asp Healthc. 2012;1:451\u201360. https:\/\/doi.org\/10.1201\/b12318-57.","journal-title":"Adv Hum Asp Healthc."},{"issue":"1","key":"693_CR20","doi-asserted-by":"publisher","first-page":"48","DOI":"10.2174\/1876519X01306010048","volume":"6","author":"F Amaral","year":"2013","unstructured":"Amaral F. Retention of knowledge and clinical skills by medical students: a pro-spective, longitudinal, one-year study using basic pediatric cardiology as a model. Open Med Educ J. 2013;6(1):48\u201354.","journal-title":"Open Med Educ J"},{"issue":"11","key":"693_CR21","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1111\/j.1365-2923.2011.04043.x","volume":"45","author":"R Schmidmaier","year":"2011","unstructured":"Schmidmaier R, Ebersbach R, Schiller M, Hege I, Holzer M, Fischer MR. Using electronic flashcards to promote learning in medical students: Retesting versus restudying. Med Educ. 2011;45(11):1101\u201310.","journal-title":"Med Educ"},{"issue":"4","key":"693_CR22","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1067\/mem.2000.109339","volume":"36","author":"G Kovacs","year":"2000","unstructured":"Kovacs G, Bullock G, Ackroyd-Stolarz S, Cain E, Petrie D. A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance. Ann Emerg Med. 2000;36(4):301\u20139.","journal-title":"Ann Emerg Med."},{"issue":"7","key":"693_CR23","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1111\/j.1553-2712.2000.tb02270.x","volume":"7","author":"E Su","year":"2000","unstructured":"Su E, Schmidt TA, Mann NC, Zechnich AD. A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med. 2000;7(7):779\u201386. https:\/\/doi.org\/10.1111\/j.1553-2712.2000.tb02270.x.","journal-title":"Acad Emerg Med."},{"issue":"2","key":"693_CR24","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.ijchp.2014.12.001","volume":"15","author":"SC Evans","year":"2015","unstructured":"Evans SC, Roberts MC, Keeley JW, Blossom JB, Amaro CM, Garcia AM, et al. Vignette methodologies for studying clinicians\u2019 decision-making: validity, utility, and application in ICD-11 field studies. Int J Clin Heal Psychol. 2015;15(2):160\u201370. https:\/\/doi.org\/10.1016\/j.ijchp.2014.12.001.","journal-title":"Int J Clin Heal Psychol."},{"issue":"3","key":"693_CR25","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1027\/1614-2241\/a000014","volume":"6","author":"C Atzm\u00fcller","year":"2010","unstructured":"Atzm\u00fcller C, Steiner PM. Experimental Vignette Studies in Survey Research. Methodology. 2010;6(3):128\u201338. https:\/\/doi.org\/10.1027\/1614-2241\/a000014.","journal-title":"Methodology."},{"issue":"4","key":"693_CR26","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1111\/j.1365-2702.1996.tb00253.x","volume":"5","author":"D Gould","year":"1996","unstructured":"Gould D. Using vignettes to collect data for nursing research studies: how valid are the findings? J Clin Nurs. 1996;5(4):207\u201312. https:\/\/doi.org\/10.1111\/j.1365-2702.1996.tb00253.x.","journal-title":"J Clin Nurs."},{"issue":"3","key":"693_CR27","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1111\/j.1467-9280.2006.01693.x","volume":"17","author":"HL Roediger","year":"2006","unstructured":"Roediger HL, Karpicke JD. Test-enhanced learning. Psychol Sci. 2006;17(3):249\u201355. https:\/\/doi.org\/10.1111\/j.1467-9280.2006.01693.x.","journal-title":"Psychol Sci."}],"container-title":["Human Resources for Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12960-021-00693-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12960-021-00693-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12960-021-00693-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T11:13:31Z","timestamp":1639048411000},"score":1,"resource":{"primary":{"URL":"https:\/\/human-resources-health.biomedcentral.com\/articles\/10.1186\/s12960-021-00693-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["693"],"URL":"https:\/\/doi.org\/10.1186\/s12960-021-00693-x","relation":{},"ISSN":["1478-4491"],"issn-type":[{"value":"1478-4491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"23 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical review of the protocol was conducted by Joint Clinical Research Centre \u2013 Institutional Review Board \u201cJCRC\u2019s HIV\/AIDS Research Committee\u201d IRB#1-IRB00001515 and approval granted. The JCRC-IRB is an active office for human research protections (OHRP) with a Federal Wide Assurance number (FWA00009772) based in Kampala. The protocol was also reviewed in accordance with the U.S. Centers for Disease Control and Prevention (CDC) human research protection procedures and was determined to be research, but CDC investigators did not interact with human subjects or have access to identifiable data or specimen for research purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"150"}}