In 2009, Botswana BIPAI received the Vision 2016 Award for making “a significant contribution toward building a compassionate, just and caring nation.”
The Botswana-Baylor Children's Clinical Center of Excellence was opened and officially dedicated by His Excellency Mr. Festus Mogae, President of the Republic of Botswana, on June 20, 2003. The facility, the first of its kind on the African continent, provides and supervises state-of-the-art care and treatment for more than 4,000 HIV-infected children and families from around Botswana, both at the center and through its decentralized clinical mentoring program.
Staffed by Botswana and U.S. health professionals, the COE provides comprehensive primary and specialty medical care and social services for HIV-infected infants, children and their families, health professional training and clinical research. Although majority of patients receiving care at the centre were adolescents, as of January 2015, BIPAI Botswana had annualized mortality and lost to follow-up rates of 0.2% and 2.2% respectively, with 92% of patients exhibiting undetectable viral load, indicating sustained and superlative quality care and patient retention.
A future where all children are living longer and healthier lives.
To provide high quality comprehensive family centred health care, education and clinical research.
Paediatric Infectious Diseases Clinic (PIDC)
The PIDC continues to be busy with average daily attendance exceeding 100 patients, yet it continues to provide unsurpassed care and treatment to all clients. There are currently 2,404 patients on our active follow up list, 55% of whom fall under WHO clinical stage 3 or 4 – meaning moderate or severe HIV disease. The population under our care is composed of 962 young patients aged 12 years and below, 935 patients between the ages of 13 and 18, and 507 patients over 18 years. Our annual mortality rate remains low at 0.2%, due in part to the fact that 92% of our patients on HAART have an undetectable viral load.
We continue to offer our patients comprehensive, multidisciplinary, world class care under one roof, with specialties including endocrinology, haematology, oncology, and neurology. The staff in the PIDC continue to assist in the mentoring of visiting scholars, paediatric residents from the University of Botswana, trainee nurse prescribers, and other professionals—e.g. social workers, psychologists, and nutritionists—who come for their attachment in the clinic.
The COE runs the Challenge Clinic for patients who are failing treatment. The clinic has enrolled 60 patients at the COE and more than 100 patients at outreach sites. Through our multidisciplinary team composed of social workers, psychologists, dieticians, nurses and doctors, we explore factors that pose barriers to ARV adherence in individual patients. We then offer extensive counselling and, if the need arises, we carry out home visits to assess social circumstances that may interfere with adherence to ARV therapy. The retrospective analysis of our data has shown that the home visits favourably impact the adherence. All challenge cases at the COE are discussed with our experienced Attending Physicians and members of the multidisciplinary team.
The Nurse Prescribers have been the backbone of the clinic since the inception of the nurse prescriber programme five years ago. The programme has compensated for the shortage of doctors in the clinic. We currently have 9 nurses trained in the provision of paediatric HIV/AIDS screening, care, and treatment. These nurses see more than half of our stable patients, and patient satisfaction remains high.
Paediatric TB/HIV Project
The year 2014 marks the end of the piloting of the Paediatric TB Project, which was funded by the PEPFAR programme since 2007. In the past six years, the project has made serious strides in three fundamental areas geared towards improving the diagnosis of tuberculosis in children in Botswana: i) improved sputum collection in children, ii) the expansion of information, education and communication materials, and iii) and the development of a monitoring and evaluation system, resulting in the compilation of evidence which supports the Paediatric TB diagnostic algorithm. A total of 999 health care workers have been trained in the past six years through sputum induction training workshops. The Paediatric TB Project also produced 15,000 pamphlets and 1,500 posters, all of which were distributed to health care facilities around Botswana by the Botswana-Baylor Clinic in collaboration with the Botswana National TB Programme. In addition, our experience and expertise in paediatric sputum induction was shared with other BIPAI COEs in Lesotho and Tanzania through the training of their physicians and nurses.
Since its inception in 2008, the psychology department integrated well with other departments and health professionals at the COE. The department is making significant contributions in providing holistic care and treatment to COE patients, more so because of the rapid growth in the population of adolescents, who are often faced with psychosocial challenges. Services provided include assessment, diagnosis and treatment of psychological disorders.
Diet and Nutrition
As the COE patient population shifts from infancy to childhood and adolescence, the majority of patients now attend schools where they are provided with two meals a day through the Government School Feeding Programme. For some children, school meals may be their main source of food, therefore during routine dietetic consultation at the COE, caregivers of such children are advised to encourage their children to eat at school in order to safeguard their nutritional health. The COE also continues to provide nutritional supplements to all children who qualify and are registered with the dietician, even though the clinic experienced some challenges relating to consistent supply and cost of supplements, most of which are sourced from the Republic of South Africa.
Adolescent Program Highlights
As the cornerstone of Baylor’s pioneering adolescent support services for HIV-positive youth, Teen Club continues to unite our teen patients. Every month, approximately 125 teenagers congregate at the COE in Gaborone, as well as an additional 142 at our eleven satellite sites around the country. Together, they build support networks and develop life skills to prepare for a healthy and productive adulthood. In addition to covering HIV-related topics such as medication adherence, stigma and disclosure, Teen Club has developed teen-oriented activities that focus on financial literacy, budgeting, and career preparation.
Annual week-long residential camps are provided to our patients in partnership with SeriousFun.
Since the introduction of the supplemental tutoring programme in 2010, 153 students have been enrolled and 45 tutors (mostly volunteers from the University of Botswana) have generously dedicated their time to supporting our patients with their academic studies.
Teen Mothers Support Group
The Teen Mothers Support Group is intended to help pregnant adolescents develop appropriate parenting skills through monthly meetings dedicated to topics including family planning, medication adherence, feelings and emotions, sexual and reproductive health, baby care, financial literacy and gender based violence prevention. There are currently 45 teen mothers enrolled in the support group.
Education and Training Highlights
Education and training are major components of all COE programs. Our aim is to expand the pool of health, education, and other professionals with the necessary knowledge and skills to effectively identify, treat and care for HIV infected children. During the reporting period, training was provided at pre-service and in-service levels with financial support from the Ministry of Health, the Ministry of Education and Skills Development, and CDC-PEPFAR. The main activities were Paediatric KITSO Training, the COE Visiting Scholars Program, Continuing Medical Education series (CMEs) and the national rollout of Teacher Training workshops.
Paediatric KITSO Training
Paediatric KITSO targets physicians, nurses, pharmacists, social workers and other health professionals. The course is conducted over a period of 5 days at ART sites across Botswana. In 2013-2014, 11 paediatric KITSO courses were delivered in target ART sites, reaching 320 professionals drawn mainly from government hospitals and clinics. In collaboration with the Ministry of Health, the Botswana-Baylor COE evaluated the performance of KITSO trained health workers in ten health districts, which demonstrated a need for continued training and refresher training to respond to frequent staff transfers and the evolving treatment needs of children as they transition into adolescence and adulthood.
The COE Visiting Scholars’ Program
During 2013-2014, 110 medical students, residents, fellows and other health professionals visited the COE as visiting scholars from various training programs in Botswana and from around the globe. Visiting scholars spent most of their time in the COE shadowing and working alongside experienced providers. They also participated in a lecture series, which is a condensed version of the week-long paediatric KITSO Training. Some scholars presented articles at Journal Club or helped with ongoing studies and quality improvement activities. Visiting scholars are afforded opportunities to participate in Teen Club activities, work at outreach sites alongside the outreach team, and/or spend time in wards at Princess Marina Hospital.
The COE has continued to carry out research in several aspects of HIV care and treatment in order to inform practice and policies. In response to ever increasing number of research projects taking place at the COE, the Management has formed an Institutional Review Board (IRB) to oversee research conducted at the COE and to ensure adherence to the ethical requirements for conducting research using the human subjects. The IRB is composed of seven members, among them two physicians, a psychologist, a dietician, a nurse, a lab technician and a public health specialist. The IRB has recently developed standard operating procedures to guide its work and for conducting research at the COE and has reviewed three protocols.
The COE Management has also formed the Writing and Publications Committee to spearhead the writing of abstracts for scientific meetings and the writing of scientific manuscripts for publication into peer reviewed journals. The committee is also expected to contribute to writing proposals in response to requests for applications (RFAs). The committee is made up of four members: two physicians, a public health specialist and a development officer. The committee has overseen the successful submission of 13 abstracts to the 16th BIPAI Network Meeting.
All research projects are audited by the Research Audit Unit which has also been formed by the COE Management in compliance with BIPAI policies. Four large studies are currently ongoing:
1. The Collaborative African Genomic Networks (CAfGEN) Study (see additional information below)
2. Medical Audit of Patients Registered at the Botswana-Baylor Children’s Clinical Centre of Excellence
3. The Public Health Evaluation (PHE) –Adherence to HAART among HIV positive adolescents
4. The impact of providing relatively high risk information by ages and partnership network on sexual behaviour of Botswana youth.
Highlight: Collaborative African Genomics Network (CAfGEN)
Currently, the COE is the coordinating centre for a study of genetic factors that affect the progression of HIV and TB in children living in sub-Saharan Africa. The COE received a research grant of $4 million from the National Institutes of Health (NIH) of the United States to coordinate the Collaborative African Genomics Network (CAfGEN), made up of the Botswana-Baylor Children’s Clinical Centre of Excellence, the University of Botswana, the Baylor Uganda Children’s Foundation, Makerere University and Baylor College of Medicine. The grant is part of the Human Heredity and Health in Africa (H3Africa) Initiative that aims to facilitate cutting edge research approaches to the study of genomics and environmental determinants of common diseases with the goal of improving the health of African populations.
The mission of CAfGEN is to create, as part of the H3Africa Consortium, a collaborative, multi-disciplinary, multi-institutional, inter- and intra-country network of African scientists, clinicians, and researchers to use genomics approaches to study gene/pathogen interactions for HIV/AIDS, its co-morbidities, and other diseases among diverse paediatric African populations. In addition to an active Community Advisory Board representing diverse stakeholder groups, the COE incorporates genomics and research ethics concepts into the Teen Club adolescent life skills education curriculum; conducts educational workshops for community members and the media; and is in the process of publishing a series of comic books as part of the Wellcome Trust-funded Genome Adventures project to help educate lay people and youth on the essentials of genomics and biomedical research.