Adherence challenges and depression remain the highest reported cases, indicating a strong relationship between the two. Patients, especially adolescents who are referred for persistent adherence challenges, report some signs of depression. This highlights the importance of depression and other mental health screening for all patients with adherence challenges. Therefore, mental health support for HIV infected youth is important not only for quality-of-life concerns but also regarding HAART adherence and biomedical and health outcomes.
The social work department at the COE provides counselling, care, and support services to Botswana-Baylor patients and their families. Home visits for emergency cases, Lost to follow up patients, and adherence and supportive counselling are the main services provided by our social worker, Ms. Tapiwa Tembwe. With the support of a trained intern, Ms. Tembwe managed to multi- task in different spheres of work, including assisting clients referred through the PCI projects and participating in COE-run studies. Other services that Ms. Tembwe provided included conducting counselling sessions and home visits, mentoring Camp hope activities, leading caregiver training for PCI and UNICEF, and coordinating the annual children’s Christmas Party. The social work office also serves as a liaison with relevant community-based stakeholders, such as the community social workers, the police, the magistrate, and community-based organizations, to identify and refer families with at-risk children for HIV testing and enrolment in care, address the needs of children and families living in difficult circumstances, and engage all family members including children in adherence counselling sessions at home.
Botswana has a growing population of orphans, estimated at 6.28% of its entire population, according to the 2011 National Population Census. Children who are categorized as vulnerable in Botswana include those who are orphaned, living in abusive environments, living with a sick parent or guardian, living with HIV, living with a disability, or living outside of family care. These cumulative risk factors may result in illness; withdrawal from services, including schooling and healthcare; emotional distress; trauma; abuse; neglect; and exploitation. Other challenges facing orphans and vulnerable children with HIV infection include adherence to medication and a lack of emotional support. Botswana-Baylor implemented the Botswana Comprehensive Care and Support project in six PEPFAR priority districts (Kweneng East, Gaborone, South East, Mahalapye, Kgatleng, Southern, and Kanye) with the PCI-Botswana serving as the main implementer. The project aims to improve the health, well-being, and safety of these children and their families through direct service delivery, referral, and networking, and through capacity building for orphan and vulnerable children service providers. Botswana-Baylor’s role in this project is to provide care and support services to OVC living with HIV, from birth to 17 years old, and their families. The project covered just over 4,000 clients comprising an average of 2,250 people living with HIV per quarter between July 2019 and June 2020. An average of 950 children and adolescents living with HIV were assisted during this period. Major challenges encountered included children without birth certificates, low rates of referral completion, and parents unable to supervise their children’s medication. To address these challenges, Botswana-Baylor continually crafts quality improvement initiatives.