A new approach to frontline training is gaining traction in South Africa’s HIV response. It is built around a simple idea. Most clinicians and counsellors may not have time for long online webinars, but they do have phones and use WhatsApp.
Briony Chisholm, an information pharmacist at the University of Cape Town’s Medicines Information Centre (MIC), says rural clinics often struggle to access ongoing training. This matters most when guidance changes frequently, as with HIV treatment guidelines. One-off training events are not enough. Staff need regular refreshers that fit into busy clinic days.
The urgency increased when South Africa introduced dolutegravir as part of standard first-line HIV treatment at the end of 2019. Dolutegravir is widely praised. It has a high barrier to resistance, is easier to take, and has fewer side effects than older antiretrovirals. But it can interact with commonly used medicines. That includes drugs for TB, diabetes and epilepsy.
Guidelines Change Fast, but Clinic Reality Moves Slower
Through the MIC’s National HIV and TB Healthcare Worker Hotline, Chisholm and colleagues noticed a pattern. Many clinicians called with questions about drug interactions and management strategies. While some healthcare workers didn't recognise the interactions at all, others identified the risks but struggled to adjust dosages correctly.
Two examples came up often. Rifampicin, a key TB medicine, can require a dolutegravir dose adjustment. The diabetes medication metformin may also require adjustments. These are not academic details. They affect patient safety and treatment success.
Chisholm’s 2022 research revealed that roughly 70% of respondents recognised that dolutegravir interacts with other drugs. However, participants still showed significant knowledge gaps concerning specific drug pairings and the necessary dosing adjustments. The study further demonstrated that access to official guidelines and consistent training directly boosted clinician knowledge. The takeaway was clear: training needed to be easier to access.
WhatsApp Microlearning Delivers Bite-Sized Lessons
Chisholm designed a microlearning model featuring 10 to 15-minute live lessons delivered via WhatsApp. Rather than teaching exhaustive guidelines, the program focuses on delivering one or two key learning points in rapid bursts and reinforcing them through repetition. This agile format allows Chisholm to share updates instantly whenever clinical guidance changes.
She tested the approach with healthcare workers and counsellors at 50 clinics in Nieu Bethesda, Eastern Cape. She ran case-based lessons in WhatsApp groups and subsequently assessed how the programme changed clinicians' knowledge, impacted patient care, and influenced practical factors such as uptake and accessibility.
Her conclusion was firm. WhatsApp microlearning was effective, feasible, and well-received. Almost all participants said they would join weekly sessions throughout the year. The format also solves a core operational problem. Staff do not need transport or accommodation. Clinics do not lose staff for days at a time. Learners can read the lessons later if they miss the live session.
6MMD Roll-Out Shows how Fast Training can Scale
The National Department of Health has begun using this model to support the Six-Month Multi-Month Dispensing (6MMD) programme. 6MMD allows stable patients with suppressed viral loads to collect a six-month supply of ARVs, reducing clinic visits and easing workloads. The programme started in August 2025 and is still being phased in.
During the pilot phase, the team integrated WhatsApp microlearning as an add-on to longer training sessions. They conducted an eight-week course consisting of 15-minute weekly sessions. By the end of 2025, the programme had reached approximately 2,000 healthcare workers.
Supporters say the approach speeds up implementation. The International AIDS Society’s Lynne Wilkinson notes that policy rollouts often stall because clinicians do not receive changes quickly enough or lack practical support. In clinics, the benefit is immediate. TB/HIV Care nurse team lead Daniel Canham says staff can keep services running while attending short sessions. Wits RHI nurse lead Faith Maseko adds that WhatsApp allows nurses to revisit guidance when they face similar real-life cases.
Health department spokesperson Foster Mohale calls the model a low-cost, high-reach supplement to formal training. He argues that training gaps become service gaps. Continuous, bite-sized learning helps clinicians consistently apply policy in real-world settings.