Summary

There have been remarkable advances in the expansion of pediatric HIV care in Botswana, with almost 8,000 
children under the age of 12 years on antiretroviral therapy (ART). As the largest pediatric HIV care and treatment clinic in the country, BIPAI Botswana provides comprehensive family-centered HIV care to more than 2,000 children. Two of its programs, outreach and inreach, have been particularly successful in 

Outreach Expands Care

  • In 2008, the center launched an Extended Physician Outreach Project to assist in decentralization and expansion of the care and treatment of HIV-infected children. The project's helps build capacity for comprehensive provision of pediatric HIV care in decentralized health institutions across Botswana; supports preventive services; and facilitates the national goal of universal access to HIV care.
  • BIPAI physicians and an outreach nurse conduct monthly visits to decentralized ART sites. These visits consist of didactic training plus side-by-side clinical mentorship. Center staff remain available for guidance both during direct visits and via a special cell phone answered around-the-clock by BIPAI faculty.
  • Since its inception, the project has grown to sustain 28 sites with an average of 257 mentored patient visits monthly, and a total outreach site pediatric enrollment of more than 2,000 HIV-infected children.
  • The Extended Physician Outreach Project supports Botswana's national scale-up of decentralized pediatric HIV services. Near-term plans include implementing an adaptable monitoring and evaluation framework to measure the effectiveness of defined outcome indicators for capacity building, and exploring methods that support and strengthen sites' sustainability as pediatric-capable ART centers. The outreach program is funded by Texas Children’s Hospital.

In-Reach For Challenging Patients

  • The BIPAI Botswana in-reach program was established in 2007 as an intervention strategy for our most challenging patients with difficult home situations and persistently inadequate adherence despite intensive adherence counseling.
  • The in-reach team typically includes a nurse and a social worker. This team visits patients' homes to meet the family and assess the home environment. The goal is simple: to ensure that children and caregivers have all the support needed not only at the clinic level but also at the family and community level. Visits are conducted Monday to Thursday.
  • Working with caregivers in the relaxed and familiar home environment encourages open expression of child and family needs. Our teams have been able to help clients disclose to their families and ensure other family members are able to support the caregivers. They also provide HIV counseling and testing to eligible members of the family. 
  • Education about medication is conducted during home visits, with an emphasis on adhering to ARVs, keeping appointments and maintaining proper hygiene.
  • Family members are also encouraged to attend structured adherence counseling sessions, which are conducted at the center daily, Monday to Friday. To date, we have seen progress among the children and families we have visited, both in terms of adherence to therapy and in their general care.