As HIV, TB and other treatments are updated in South Africa’s public health-care system, it is critical that health-care workers and counsellors stay on top of the latest developments.
One innovative programme makes use of short lessons delivered over WhatsApp to provide such training. Over her years working as an information pharmacist at the University of Cape Town’s Medicines Information Centre (MIC), Briony Chisholm noted that many health workers in rural clinics face difficulties accessing training in crucial aspects of their work.
“The lack of easy access to training was in areas where it was really needed, such as the HIV (treatment) guidelines that are constantly being updated,” said Chisholm. “It’s not enough to have training sessions when new guidelines come out; you ideally should be training all the time.”
Drug-drug interactions
At the end of 2019, government introduced new standard first-line HIV treatment that includes an antiretroviral medicine called dolutegravir. As we previously reported, by 2023 about 4.7-million people in South Africa were taking dolutegravir-based treatment. But the introduction of a new medicine in the public health-care system, especially at this scale, is rarely straight-forward.
“Dolutegravir is considered as a ‘wonder child’ in ARV treatment, because it provides a high barrier to resistance, is easier to take, and has far fewer side effects than older ARVs. However, it also has interactions with other key drugs, particularly those used for the treatment of TB, diabetes and some anti-epileptic medications,” she said.
Through numerous queries received on the MIC’s National HIV and TB Healthcare Worker Hotline, Chisholm and her colleagues became aware that some health-care workers were struggling with managing drug interactions.
“Some health-care workers didn’t know about these interactions; others knew about them but not how to deal with them. For example, if a patient is on the TB drug rifampicin, but also needs to take dolutegravir, there’s a need to adjust the dose of dolutegravir. Similarly, adjustments are needed with the diabetes medicine, metformin.”
We saw that most South African healthcare workers are dedicated and keen to learn. You hear all this terrible news about health and corruption, and then you go to these clinics which are ticking along under sometimes difficult conditions, doing amazing work. It’s inspiring!
— Briony Chisholm
Chisholm now lives in the Eastern Cape village of Nieu Bethesda. When dolutegravir was introduced, she had just completed her part-time post-graduate diploma in HIV and TB management through UCT and signed up for her Masters. She and a colleague had, in 2016, done a road trip to about 200 clinics in seven provinces to promote the MIC’s Hotline.
“We saw that most South African health-care workers are dedicated and keen to learn. You hear all this terrible news about health and corruption, and then you go to these clinics which are ticking along under sometimes difficult conditions, doing amazing work. It’s inspiring!”
A key realisation was the challenges experienced by health workers at these rural clinics to access much-needed training.
“Getting nurses to a central point for training and the need for transport, accommodation and food, as well as having them absent from the clinic for anything between one and five days, is challenging. It’s expensive and involves a great deal of organising,” said Chisholm.
Doing the research
Chisholm then started conducting research on what health-care workers know about dolutegravir-related drug interactions. Her study, published in 2022, found that about 70% of respondents understood that dolutegravir interacts with other drugs, but there were gaps in people’s knowledge of specific interactions and the dosing changes needed to manage those interactions.
The study found that access to guidelines and training were positively associated with knowledge of drug-drug interactions. “There was a clear indication that we needed more accessible training,” Chisholm added.
“The department of health offers online training through live webinars, and recordings of these, but they are often one or two hours long. Nurses in busy clinics don’t necessarily have this time to sit through training sessions.”
Testing the efficacy of short training sessions
Chisholm then designed a project to test the efficacy of short training sessions focusing on teaching one or two learning points from the national guidelines in 10- to 15-minute live lessons using WhatsApp.
“I thought, ‘we’re in a country where not everyone has access to big computer screens, but they all have a cell phone and use WhatsApp — so let’s go as simple as we can’,” she said.
“The idea was not to teach the entire set of guidelines but to pick out important parts of them and ensure that if something changes in the guidelines, you get it out to people, quickly.”
Chisholm tested the feasibility of WhatsApp-based microlearning with health workers and counsellors at 50 clinics around Nieu Bethesda. “I ran a range of short case-based lessons on WhatsApp groups and then measured the changes in knowledge and patient care, as well as other factors like uptake, feasibility and accessibility,” she explained.
She found that WhatsApp-based microlearning for health-care workers is “effective, feasible and well received” and 98% of those who participated said they would take part if training sessions were held weekly throughout the year.
While using WhatsApp for medical interactions is not new, Chisholm says a structured syllabus using microlearning for short, punchy sessions is a first.
“This type of learning is equally accessible to a rural clinic as to one in central Hillbrow. We can access people wherever they are. Nobody has to spend money getting anywhere and clinical services are not disrupted. And it doesn’t matter if they’re not in the live session: when they have a moment, they can go into their WhatsApp and read back on the lesson,” she said.
Working with the department of health on 6MMD
Chisholm has been working with the national department of health on their Six-Month Multi-Month Dispensing (6MMD) programme. The programme allows people living with HIV who are doing well on treatment and have suppressed viral loads to get a six-month supply of ARVs in one go. This makes life considerably easier for people, since they only need to go to the clinic twice a year, whilst also reducing workloads in the clinics. The programme started in August and is still being phased in across the country.
It’s no secret that the waiting times in clinics are quite extensive, so we are trying to enrol all those qualified for 6MMD as quickly as possible to ease the burden on the clinic.
— Daniel Canham, facility team lead at TB HIV Care at Idutywa Village Community Health Centre in the Eastern Cape
“In the pilot phase, the department of health did some really good online training and they used our WhatsApp training as an add-on to the longer form training,” said Chisholm.
“We started with one group and ran an eight-week course of 15-minute lessons once a week on WhatsApp. Sessions were case-based and included which patients are eligible for 6MMD, and which patients are not,” she explained. By the end of 2025, about 2,000 healthcare workers had been reached through these sessions.
Lynne Wilkinson, a technical expert with the International AIDS Society which supports the department on 6MMD, said the microlearning is “a great way to ensure we get to all the clinicians in the country and explain how the 6MMD programme works”.
“When a new policy comes out, it takes a long time for implementation to be scaled because ground-level clinicians aren’t always aware of the changes or don’t have an opportunity to engage with how to implement the changes.”
Daniel Canham, a professional nurse and facility team lead for the NGO TB HIV Care at Idutywa Village Community Health Centre in the Eastern Cape, said they’ve found the microlearning sessions for 6MMD very useful.
“It’s no secret that the waiting times in clinics are quite extensive, so we are trying to enrol all those qualified for 6MMD as quickly as possible to ease the burden on the clinic,” he said.
“The microlearning on 6MMD has been very helpful. Our staff don’t have to be out of the facility to attend it. They can run their normal activities and attend sessions of ten minutes maximum,” said Canham.
“Our professional nurses joined the WhatsApp microlearning sessions in September last year,” said Faith Maseko, a nurse lead based at Phola Park Clinic in Thokoza in Gauteng who works for the Wits Research Health Institute (RHI). The RHI supports the health department in the management of HIV and employs more than 30 nurses.
“When nurses are trained virtually, some of the information is forgotten, but when you’re on WhatsApp, you can go back and access the information that was shared. The scenarios provided are very useful. If you see a patient with a similar scenario, you can go back and see what was discussed and apply it to your own situation,” she said.
Department of health backing
Foster Mohale, spokesperson for the national department of health, said the WhatsApp-based microlearning has been “an effective low-cost, high-reach supplement to formal 6MMD training”.
He added: “Training gaps translate directly into service gaps, affecting quality, retention, and progress toward epidemic control. Microlearning addresses this risk by enabling continuous, bite-sized reinforcement of policy and implementation guidance, rather than relying solely on once-off training events. This approach supports front-line health-care workers in applying 6MMD consistently under real-world service pressures.”
Mohale said evidence from the department’s broader capacitation strategy shows that lifelong, continuous learning, rather than episodic training, is essential for resilient health systems.
“WhatsApp microlearning aligns with this principle by supporting rapid dissemination of updates, peer learning, and sustained mentorship. When integrated with structured models and aligned to national guidelines, it can be effectively applied across HIV, TB, maternal and child health, non-communicable diseases, and health systems strengthening more broadly,” he said.
• This piece was published by Spotlight — health journalism in the public interest.
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