Baylor College of Medicine Children’s Foundation – Eswatini, known as Baylor Eswatini, is a local not-for-profit child health and development organisation based at the Baylor College of Medicine - Bristol Myers-Squibb Children’s Clinical Centre of Excellence - Eswatini. Operating as a public-private partnership between BIPAI and the Ministry of Health of the Kingdom of Eswatini, the Centre was founded in 2005 and officially opened by His Majesty King Mswati III on February 24, 2006. Our main centre is based in the Mbabane Centre of Excellence (COE), which opened in 2006. We also operate two satellite clinics: the Baylor-Raleigh Fitkin Memorial Hospital (RFM) Satellite Centre of Excellence (SCOE) opened in 2009, and the Baylor-Hlathikhulu SCOE opened in 2010. Baylor Eswatini is affiliated with Baylor College of Medicine and Texas Children’s Hospital in Houston, Texas, U.S.A.
As the national leader in paediatric HIV/AIDS and TB care and treatment in the country, Baylor Eswatini cares for almost half of all children on antiretroviral therapy (ART) in Eswatini. Our mandate is to provide child-focused and family-centred HIV/AIDS prevention and treatment services; tuberculosis (TB) screening, control, and treatment; and treatment for other concurrent diseases. We also offer mother and child health services, health professional training, and conduct clinical research.
● Location: Mbabane with two satellites in Manzini and Hlatikhulu.
● State of the art pediatric TB Center of Excellence located in Mbabane.
● Services: tuberculosis screening, control and treatment; HIV and AIDS treatment and care services; integrated child health care services; adolescent care services; maternal health including cervical and breast cancer screening and treatment of precancerous lesions.
The COE based in Mbabane serves as the largest pediatric antiretroviral (ARV) provider for children in Eswatini, dispensing antiretroviral therapy (ARVs) for approximately 40% of all child patients on ARVs in Eswatini. We are the only country’s referral centre for pediatrics third line regimen program, whereby we enroll children failing second line ART regimen into the third line program.
From 2009-2010, satellite clinics at Raleigh Fitkin Memorial Hospital in Manzini and Hlathikhulu Hospital in Hlathikhulu opened and became fully functional, increasing access to healthcare across the nation. Each satellite location is staffed with a physician, nurses and support staff.
The Baylor Eswatini TB Center of Excellence in Mbabane opened in 2015 in order to provide high-quality TB care for families, and continues to operate as Eswatini’s only pediatric MDR contact clinic. 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.
Early infant diagnosis
Baylor Eswatini is a lead partner with the Eswatini Ministry of Health in the country-wide HIV early infant diagnosis program. Our staff diagnoses infants and trains local health professionals for the program. Mothers and babies with positive results are followed to ensure they return to the clinic for appropriate care.
Adult Services In Eswatini
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 Eswatini 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 Eswatini 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 our clinics. 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 patients 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, encourages the patients and instructs them as needed.
In 2015, Baylor Eswatini initiated the Challenge Clinic programme in order to provide intensified adherence counselling and psychosocial interventions for adolescent patients. During a Challenge Clinic visit, patients with chronic poor adherence and those who are failing second-line antiretroviral therapy are seen by a multidisciplinary team including a doctor and a social worker. The intervention recognises that it is important to address both medical and psychosocial factors in the provision of clinical care.
Identifying and treating TB
Eswatini has the highest incidence of tuberculosis (TB) in the world. In collaboration with the Global TB Programme at Texas Children’s Hospital and Baylor College of Medicine, Baylor Eswatini serves as the national referral paediatric TB clinic for the country. We provide high-quality, integrated TB/HIV care through a family-centred approach that attends to both patients with TB and their family members at risk of TB. We strive to screen for TB symptoms in all patients visiting the clinic, and if diagnosed, they are enrolled in our TB treatment and care program. We also offer TB preventive therapy (TPT) to all TB contacts to prevent them from acquiring it. We have about 50 patients enrolled in our TB treatment and care program.
Multi-drug resistant tuberculosis is also a growing problem and Baylor Eswatini’s TB COE continues to operate Eswatini'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 Work
In 2019, under the leadership of the Ministry of Health, Baylor Eswatini began implementing a 3 year project called BMSF Collaborative Cancer Grant: Educate to Prevent and Care for Cancer; Delivering as One as part of a consortium including the Eswatini Breast and Cervical Cancer Network (EBCCN), and the Federation of African Women Educationalists in Eswatini (FAWEESWA) in collaboration with the Lutsango Lwaka Ngwane (Women’s Regiment). 23 million Emalangeni was received from the Bristol Myers’ Squibb Foundation (BMSF) in order to sensitize 320 key stakeholders on cancer, create community cancer awareness for 29,731 individuals, screen 12,366 patients for breast and cervical cancer, and vaccinate 1000 eligible adolescents aged 9-14 years with the HPV vaccine. In addition, 1374 women will receive treatment for pre-cancerous lesions through this grant.
In the first 6 months of the project, 7170 community members (average of 1195 community members per month - surpassing the monthly target of 874) were reached through direct community awareness with 1579 members from corporate institutions and 5591 members sensitized through direct awareness. The consortium also screened a total of 6483 patients for cancer, surpassing the target of 1080 women each month and treated a total of 235 patients for cancer, above the target of 39 women each month. Investing in the sustainability of the project, the consortium also hired 30 cancers educators and trained a total of 31 health care professionals, including 6 doctors and 23 nurses from public and private facilities in our target sites. Baylor Eswatini looks forward to seeing the growth and continued positive impact of this project in the coming years.
It is important to provide services beyond the clinical treatment of HIV and TB, including arming teens with the sexual and reproductive information and services, life skills, and career guidance that will allow them to overcome challenges to their adherence.
Since 2010 Baylor Eswatini has been implementing adolescent support groups known as Teen Clubs, to empower HIV-positive adolescents to live positively and successfully transition into adulthood. Teen Clubs provide fun educational activities focusing on life skills, healthy relationships and building confidence. This forum allows teenagers to learn how 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 Eswatini regularly runs and manages teen clubs and teen camps, trains teen leaders to assist in the facilitation of teen club meetings, and manages retention to care of adolescents and strengthen adherence counseling. We also provide technical support to other implementing partners and assisted in standardizing a curriculum that can be used across the country 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 Support Services
Baylor Eswatini has a functional social work unit, which works with the Deputy Prime Minister’s Office. This unit addresses the psychosocial needs of all patients attending Baylor Clinics. Several services are offered as per the mandate, with an emphasis on adherence counselling to make sure the 95-95-95 goal is reached. We offer stepped-up adherence counselling to patients who showed detectable viral loads. Our social workers also provided disclosure counselling, particularly to children and adolescents, given the strong correlation between properly disclosing HIV status and future ART adherence. We counsell parents and caregivers on the importance of disclosure and support them as they explained to their children that they had HIV. Patients who recently learned their HIV status are offered follow-up disclosure counselling.
Training & Education
Baylor Eswatini actively supports the Ministry of Health in building the capacity of health-care workers in the areas of paediatric HIV and TB management. This is done through training, refresher trainings, onsite mentoring, and having healthcare workers from various health facilities affiliated with Baylor Eswatini’s Centre of Excellence in order to transfer paediatric HIV/TB management skills nation-wide.
In the past year, Baylor Eswatini supported 18 facilities with 151 mentorship visits; working with social workers, nurses, doctors, phlebotomists and other cadres in the Hhohho and Shiselweni regions. A total of 28 nurses, doctors, and phlebotomists from facilities in the same regions have also been affiliated with Baylor Eswatini in order to hone their skills in PMTCT, HTS, phlebotomy, provision of psychosocial care and support, as well as HIV care and treatment. We also affiliated 26 healthcare workers of various cadres at the COE in Mbabane. The purpose of the affiliation experience was to build participants’ skills in paediatric HIV and TB management over four days of clinical activity that exposed the healthcare workers to all levels of care provided to clients within the scope of each cadre.
Further, Eswatini Technical Working Groups (TWGs) are an ad hoc group of clinical and research experts who work together on specific goals. TWG meetings are often meant to encourage stakeholders to discuss how different community implementation activities fit into the Ministry of Health strategic plan as well as give updates on quality improvement projects and identify gaps in research. The members convene quarterly. The Baylor Clinical team participates in 19 national TWGs, of which the Paediatric TWG, PMTCT TWG, Cancer Control TWG, TB/DRTB TWG Care and Treatment TWG align with our mission and vision as a Clinic.
Wait times at Baylor Eswatini clinics are also used for educating our patients. Each morning begins with a health talk on topics such as medication adherence, identifying tuberculosis (TB), family planning, oral hydration or water hygiene.
To influence and document change in health policy, medical practice, standards of care and models of care, Baylor Eswatini conducts research in pediatric care and treatment. An Institutional Review Board is maintained and is 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.
The Collaborative African Genomics Network (CAfGEN) with Baylor Eswatini, Baylor Uganda and Baylor Botswana was formed to help redress the imbalance of research on non-African, HIV+ adults by working with a special focus on African children. In 2019, the CAfGEN Network began researching Host Genomic Factors Associated with HIV and TB Progression in African Children (CAfGEN II), a multicentre study which entails a genomic approach to understanding HIV and associated comorbidities specifically in African children. The aims of this study are to identify host genetic factors associated with HIV disease progression among the same peadiatric population, explore diagnostic and identify molecular mechanisms of TB infection among the same peadiatric population, and establish an extended peadiatric cohort in Eswatini, Uganda and Botswana.
In 2018, we published findings from research initiatives describing new diagnostic advances for tuberculosis, using stool as an accessible specimen for people unable to produce sputum. This technology may make TB testing more accessible for all patients.
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.