Serious Fungal Diseases: Assessing the Impact of Training Clinicians and Laboratory Scientists in Nigeria.

BACKGROUND: Surveillance for serious fungal diseases (SFDs) relies on the capacity to recognize them and request and accurately perform diagnostic investigations. However, knowledge in resource-limited settings is suboptimal. This study evaluated the impact of a training intervention on the diagnosis and management of SFDs among clinicians and laboratory scientists in Nigerian tertiary hospitals. METHODS: Clinicians in 6 hospitals were purposively selected and trained in 6 SFDs using standardized modules developed by international medical mycology experts. A quasi-experimental design assessed performance using a pretest and posttest. Designated laboratory scientists received hands-on training with pretraining and posttraining assessments. Paired t tests were used to assess differences in mean scores. An impact assessment of the laboratory mycology records was performed 1 year after intervention using analysis of variance. RESULTS: A total of 149 clinicians and 8 laboratory scientists participated. Mean performance scores of participants improved significantly after training, with the following percentage increases: invasive aspergillosis (25.4%), chronic pulmonary aspergillosis (13.0%), invasive candidiasis (23.8%), Pneumocystis pneumonia (22.6%), mucormycosis (29.5%), and histoplasmosis (20.6%) (all P < .001). There was also a significant improvement in the laboratory scientists' posttraining performance (59.1%; P < .001). The laboratory mycology records reviewed 1 year later indicated a significant increase in the number of samples sent to the laboratory for mycological testing (P < .001) and the number and distribution of fungal isolates identified (P < .001). CONCLUSIONS: Training significantly improved SFD diagnosis and enhanced surveillance and patient care. Expanding this model across other low-resource settings is recommended.