To provide high quality comprehensive family-centered health care, education and clinical research.
- Location: Gaborone, Botswana
- Year founded: 2003
- Services: tuberculosis, hematology & oncology, HIV/AIDS, emergency medicine
- Patients in care: 2, 469
- Total employees: 46
- Total health professionals trained: 298
- Total budget: 1.9 million
Pediatric 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 2,469 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 age 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 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, hematology, oncology, and neurology. The staff in the PIDC continue to assist in the mentoring of visiting scholars, pediatric 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 counseling 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 favorably 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 program five years ago. The program has compensated for the shortage of doctors in the clinic. We currently have nine nurses trained in the provision of pediatric HIV/AIDS screening, care and treatment. These nurses see more than half of our stable patients and patient satisfaction remains high.
Pediatric TB/HIV Project
The year 2014 marked the end of the piloting of the pediatric Tuberculous Project, which was funded by the PEPFAR program since 2007. The project 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 pediatric TB diagnostic algorithm. A total of 999 health care workers have been trained through sputum induction training workshops. The pediatric 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 program. In addition, our experience and expertise in pediatric sputum induction was shared with other BIPAI COEs in Lesotho and Tanzania through the training of their physicians and nurses.
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 program. 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.
- Pediatric Infectious Diseases Clinic (PIDC)
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 110 teenagers congregate at the COE in Gaborone, as well as an additional 112 at our six 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.
Our annual week-long residential camps are provided to our patients in partnership with SeriousFun.
Since the introduction of the supplemental tutoring program in 2010, 188 students have been enrolled and 111 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.
Young Adults Support Group
The COE set up the Young Adults Support Group (YASG) in 2013. Modeled after Teen Club, YASG meets once a month to reflect on issues related to this transitional phase in their lives. During the 2014-2015 year, a total of 140 youths attended YASG.
The COE is working in partnership with the Rotary Club of Gaborone to pilot a community medication refill project called Motsweding, which aims to bring services nearer to patients in their community (using local schools and churches) and de-congesting the clinic. Services provided include medical refills, adherence counseling, TB screening, and anthropometric evaluations in non-clinical settings.
Cervical Cancer Screening
As patients with HIV live longer, non-communicable diseases being to take a much more prominent role. Cervical cancer is one such condition that has increased in incidence and prevalence. With support from Rotary Club, we have received equipment to establish a “See and Treat” cervical cancer screening program. Protocols on screening and management of cervical cancer in older adolescent girls and young women are currently under development. This project is expected to create a cohort of patients and to generate important data which will inform researchers, clinicians, and planners on cervical cancer in perinatally infected adolescents.
- Teen Club
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.
The Social Work department continues to coordinate all social welfare and counseling services of the COE. This includes attending to emergency and lost to follow up (LTFU) cases. The department also handles assessment for monetary transport assistance for needy patients.
- Clinical Psychology
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 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.
- 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:
- The Collaborative African Genomic Networks (CAfGEN) Study (see additional information below)
- Medical audit of patients registered at the Botswana-Baylor Children’s Clinical Centre of Excellence
- The Public Health Evaluation (PHE) –Adherence to HAART among HIV positive adolescents
- The impact of providing relatively high risk information by ages and partnership network on sexual behavior of Botswana youth.
Highlight: Collaborative African Genomics Network (CAfGEN)
Training & Resources
Educational Training Summary
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 pediatric KITSO Training, the COE visiting scholars program, Continuing Medical Education series (CMEs) and the national rollout of Teacher Training workshops.
Pediatric KITSO Training
Pediatric KITSO targets physicians, nurses, pharmacists, social workers and other health professionals. The course is conducted over a period of five days at ART sites across Botswana. In 2014-2015, 10 pediatric KITSO courses were delivered in target ART sites, reaching 298 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.
Visiting Scholars Program
Each year medical students, residents, fellows and other health professionals visit the COE as visiting scholars from various training programs in Botswana and from around the globe. Visiting scholars spend most of their time in the COE shadowing and working alongside experienced providers. They also participate in a lecture series, which is a condensed version of the week-long pediatric KITSO Training. Some scholars have the opportunity to present articles at Journal Club or help 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.
- Educational Training Summary
Currently we have 130 active volunteers with new applications rolling in every week. Volunteers are relied upon to run morning play group, serve as tutors, facilitate discussions as part of the “Finding the Leader Within” program, perform important office work duties and assist in organizing Teen Club events. Volunteers are given the opportunity to participate in programs/events that resonate with them, therefore increasing the effectiveness of our volunteer base.