Summary

Baylor-Swaziland operates a clinical Center of Excellence (COE) in Mbabane as well as Satellite Centers of Excellence in Manzini, Bulembu and Hlatikulu. In addition Baylor Swaziland operates a pediatric Tuberculosis (TB) center of excellence. Baylor-Swaziland is the Ministry of Health’s (MoH) primary pediatric HIV/AIDS  and TB (Including MDR TB) care and treatment provider, battling against the highest HIV prevalence in the world (41% among mothers aged 15-49, receiving antenatal care) and caring for almost half of all children on antiretroviral therapy (ART) in the country. Our clinics provide child-focused and family-centered HIV/AIDS prevention and treatment services; tuberculosis screening, control and treatment; and treatment for other concurrent diseases. Baylor-Swaziland also provides integrated, comprehensive women’s health services to women with HIV, including family planning and cervical cancer screening. 
 

Vision

A nation with healthy and fulfilled children, adolescents and their families.
 

Mission

To provide high quality family-centred pediatric and adolescent health care, education and clinical research in Swaziland 
 

Key Facts

  • Location: Mbabane with three satellites in Manzini, Hlatikhulu, and Bulembu
  • Has a state of the art pediatric TB Center of Excellence located in Mbabane.
  • Years in operation: 10 years (2006)
  • Services: tuberculosis screening, control and treatment; HIV and AIDS treatment and care services; integrated child health care services; adolescent care services; maternal health
  • Adolescents in active care: 2,010
  • Total employees: 76
  • Total PAC doctors: 5 
  • Total health professionals trained: 1,524
  • Total budget: $1.8 million
 

Highlights

Clinical

The Baylor College of Medicine- Bristol Myer Squibb Children's Clinical Centre of Excellence (COE), in Mbabane, opened in 2006. The COE serves as the largest pediatric antiretroviral (ARV) provider for children in Swaziland, dispensing antiretroviral therapy (ARVs) for approximately 40% of all child patients on ARVs in Swaziland.
 
During 2009-2010, satellite clinics at Raleigh Fitkin Memorial Hospital in Manzini and Hlathikhulu Hospital in Hlathikhulu opened and became fully functional, with more than 1,500 patients across the two sites. Each satellite location is staffed with a physician, nurses and support staff. These sites also support active teen clubs.
 
The Baylor-Swaziland TB Center of Excellence in Mbabane has been established to provide high-quality TB care for families. The clinic serves as a national pediatric referral center providing digital radiography, pediatric specimen collection and now has an on-site Gene X-pert machine to improve the diagnostic yield of pediatric specimens.
 
The Baylor-Swaziland TB COE continues to operate Swaziland’s only pediatric MDR contact clinic. Children with contact to cases of drug resistant TB are provided with evaluation, careful monitoring and preventative therapy.
 
Cervical cancer services are provided with the main focus to reduce morbidity and mortality related to reproductive system cancers through screening and early detection. These services entails prevention (screening using VIA and pap smear) as well as referrals for recently introduced treatment methods (provision of cryotherapy and LEEP).
 
Mother-baby pair program has been introduced with the objective to lower transmission rate of HIV from mother-to-child and ensures that mothers and babies do not miss key health care interventions throughout the immunization phase of the child.
 
Nutritional assessment and counseling of mother/caregiver on good infant feeding practices is also provided. Children that manifest malnutrition, depending on the degree by classification, are rehabilitated as per the recommended therapy and/or referred for hospitalization.
 
Baylor-Swaziland recently succeeded in transitioning one-third of the government outreach sites it supports to independent functioning, a move that supports the national movement to decentralization of HIV services.
 

Child Services In Swaziland

The Mbanane COE provides quality comprehensive pediatric care to our patients, meeting their primary health care needs in addition to HIV care and treatment. Our staff monitors growth and development, provides immunizations and addresses common childhood health issues. 
 

Early infant diagnosis

Baylor Swaziland is a lead partner with the Swaziland Ministry of Health in the country-wide HIV early infant diagnosis program. Our staff trains local health professionals for the program as well as diagnose babies. Mothers and babies with positive results are followed to ensure they return to the clinic for appropriate care.
 

Adult Services In Swaziland

Many times, a sick child is the entry point for HIV care and treatment for an entire family. That is why it is essential for Baylor-Swaziland to offer high-quality HIV care and treatment to the caregivers of its young patients. Plus, a healthy adult is more likely to stay healthy and be able to better able to provide for their families.
 

Integrated Women's Health Services

Most caregivers of HIV-infected children are women. Therefore, Baylor-Swaziland provides women’s health services, including cervical cancer screening services, family planning services and referrals to local government hospitals for more advanced care and treatment. 
 
We also offer full HIV prevention of mother-to-child transmission (PMTCT) services. Our PMTCT clients include current patients who become pregnant as well as pregnant women new to BIPAI. At any given time, we are currently following approximately 90 HIV-positive pregnant women, taking care of their prenatal and comprehensive health care needs. This serves as a great entry point to care, as we then can provide full services for this HIV-exposed child by keeping them as our client from birth through the infant-feeding period.
 

Monitoring Medication Adherence 

All HIV-positive begin their first visit with a discussion of medication adherence, or as it is known at our center, "Utofundza ngema ARVs." Staff calculates adherence to ARVs with pill counts and encourages and instructs as needed.
 

Identifying and treating TB

Swaziland has the highest incidence of tuberculosis (TB) in the world. Because of this, our clinics screen every patient for TB at each patient encounter since HIV-infected people are susceptible to TB. Our family-care model allows our staff to see the whole family in our consultation rooms so we can ensure all TB-exposed members are treated appropriately. The Baylor-Swaziland TB Center of Excellence in Mbabane has been established to provide high quality TB care for families. The clinic serves as a national pediatric referral center providing digital radiography, pediatric specimen collection and now has an on-site Gene X-pert machine to improve the diagnostic yield of pediatric specimens.
 
Multi-drug resistant tuberculosis is a growing problem. The Baylor-Swaziland TB COE continues to operate Swaziland’s only pediatric MDR contact clinic.  Children with contact to cases of drug resistant TB are provided with evaluation, careful monitoring and preventative therapy.
 
 

Adolescent

 
In 2010 Baylor Swaziland established adolescent support groups, known as Teen Clubs, to empower HIV-positive adolescents to live positively and to successfully transition into adulthood. Teen Clubs provide fun educational activities focusing on life skills, healthy relationships and building confidence. These forums allow teenagers to learn to constructively express themselves and discuss issues regarding their health without fear of stigmatization. Teen Clubs are generally held on Saturdays with a morning snack and lunch provided. To encourage participation, transportation funds are provided for those who need it. Hundreds of teens participate each month at all four clinic locations.
 
Baylor also provides technical support to other implementing partners to establish, run and manage teen clubs and teen camps, train teen leaders to assist in the facilitation of teen club meetings, and manage retention to care of adolescents and strengthen adherence counseling. We also assist in setting up a standard curriculum that can be used in the country as a whole for teen clubs. This ensures a national standard of care and management as well as a sustainable strategy towards the care of adolescents living with HIV.
 

Psycho-Social

Recognizing that many of our clients face not only the challenge of living with a chronic illness but also other issues such as economic disadvantage, loss of loved ones and family strife, our psychosocial department offers counseling and referral services for clients in need. They perform home visits when families need extra support and guidance on ways to care for their children. They also offer a monthly caregivers support group to discuss parenting skills, health topics and ideas for income-generating activities.

 

Training & Education

Capacity building of local clinicians to provide high quality care and treatment to HIV and AIDS patients is one focal area for Baylor – Swaziland. This is done to support the Ministry of Health as it strives to increase awareness of pediatric matters. Through continuous didactic training and clinical mentorship Baylor Swaziland has managed to train 1,382 health care workers and mentored 226 health professionals during the past year. Mentorships are done in such a way that health care professionals, i.e. doctors and nurses working in Ministry of Health facilities, are selected from relevant pediatric services to shadow Baylor staff and learn from our experience. 
 
Wait times at Baylor-Swaziland clinics are used for education. Each morning begins with a health talk on topics such as medication adherence, identifying tuberculosis (TB), family planning, oral hydration or water hygiene. 
 

Research

To influence and document change in health policy, medical practice, standards of care and models of care, Baylor-Swaziland conducts research in pediatric care and treatment. They still maintain an Institutional Review Board responsible for streamlining all research projects. There has been a marked enthusiasm and engagement among staff on research issues from many departments in the clinic.
 
 
Volunteer

Client experts help others

Clients who are motivated, stable on the ARTs and interested in volunteering may be asked to become an “expert client.” These patients perform a variety of important tasks, such as translation from SiSwati to English, and helping with reception, HIV screening, triage, pill counts, adherence counseling, TB screening and dispensing medication. Some of our expert clients have gone on to obtain diplomas through national training programs in HIV testing and counseling, phlebotomy, data management and laboratory technical assistance. 
 
Volunteers from our Teen Club also lead our Sunshine Club, a group for children ages 4-11 years old. Sunshine Club activities include songs and games, as well as time on the playground.