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Challenge Clinic

Research

The COE has continued to research several aspects of HIV care and treatment to inform practice and policies in Botswana and other countries and has seven on-going studies.

Impact Evaluation Focuses on Adolescents Living with HIV in Botswana

The Impact Evaluation research is a partnership between the Ministry of Health and Wellness (MoHW)/ District Health Management Teams (DHMTs), Botswana-Baylor, UNICEF, and NGOs, and CBOs. The mixed- methods evaluation measures the effectiveness of a multipronged intervention package on clinical, psychosocial, and behavioural outcomes of a cohort of adolescents living with HIV (ALHIV) on antiretroviral living in six DHMTs in Botswana (Selibe-Phikwe, Boteti, Tutume, Serowe, Gaborone, and Kweneng East) for a 24-month follow-up period. Both quantitative and qualitative evidence will be collected to evaluate the intervention package. Botswana-Baylor entered into memorandums of understandings with local Non- Governmental Organisations in BONEPWA and Tebelopele to implement the interventions for some of the activities of the project. UNICEF continued to provide funding and technical support.

The intervention package includes Teen Clubs and healthcare worker and caregiver training. For Teen Clubs to be formed, there was the enrolment of teens aged 13-18 into the study. The baseline data was collected using a study register and ALHIV survey. Pre-enrolment consisted of capturing of general health facility information, identifying the eligibility of all adolescents living with HIV in care at targeted health facilities and documenting basic demographic and clinical information using clinic folders as well as contact details, contacting the caregivers of eligible ALHIV, and inviting them and their child to attend an enrolment day. Multiple factors contributed to over 300 teens not enrolling: caregiver consent could not be obtained, some declined, teens not available either for enrolment and/or for the dates or sessions, contacts being wrong, the family had migrated, and teens not turning up for the enrolment dates. Healthcare worker training, and an important part of Impact Evaluation, was conducted. The training empowers providers with requisite knowledge of appropriate and adolescent-friendly HIV treatment and care and allows healthcare workers to create a conducive environment and procedures for adolescents living with HIV when they visit health facilities. In addition, healthcare workers receive training on effective parenting practices, so that they can equip parents and families to support their adolescent.

Collaborative African Genomics Network (CAfGEN

The mission of the CAfGEN study, part of the H3Africa Consortium, is to create a collaborative, multidisciplinary, multi-institutional, inter- and intra- country network of scientists, clinicians, and researchers who use genomics approaches to study gene/pathogen interactions for HIV/AIDS, its co- morbidities, and other diseases among diverse pediatric African populations. Started in 2014, CAfGEN has accomplished most of its aims during the first phase of funding and now is on the second phase of the project, funded by the U.S. National Institutes of Health.

Training

CAfGEN supports the training of African genomic scientists. For CAfGEN II, there are four Ph.D. trainees from Botswana and Uganda based at Baylor College of Medicine in Houston, Texas focusing on genomics and bioinformatics. CAfGEN awarded a Masters Scholarship in Eswatini to two candidates to study genetics and bioinformatics at Makerere University, Uganda.

Reducing Stigma to Improve HIV/AIDS Prevention, Treatment, and Care among Adolescents Living with HIV in Botswana.

This study is a collaboration of a multidisciplinary team of researchers from the University of Botswana, the University of Pennsylvania, and Botswana-Baylor. The study aims to design and evaluate a theory- based developmentally, and culturally appropriate stigma-reduction intervention for adolescents living with HIV (ALWH) in Botswana. The HIV stigma-reduction intervention will be an adaptation of Teen Club, an existing intervention that has been implemented with ALWH 13 to 17 years of age by Botswana-Baylor since 2005. The two-year program, funded by the NIH, will collect baseline data from adolescents living with HIV, peer educators, and caregivers of ALWH on their experiences and perspectives regarding the effects of stigma on the health and wellbeing of ALWH. We will target the registered adolescents at Botswana- Baylor COE and the Molepolole Satellite Teen Clubs. The findings from this mixed-methods research, conducted in both rural and urban areas (Molepolole and Gaborone), along with input from a Community Advisory Board will be integrated with Social Cognitive Theory to adapt the existing intervention. This will be followed by a randomized controlled trial to determine the adapted intervention’s feasibility and acceptability. Another important goal is to build capacity at the University of Botswana and Botswana-Baylor to develop interventions to improve HIV prevention, treatment, and care. We will also conduct a series of Science of Behavior Change workshops for healthcare workers and other service providers in Gaborone and Molepolole.

Friendship Bench Study

The Friendship Bench study achieved one of the aims, which was to assess the acceptability of the intervention with youth. The study showed that they found the intervention acceptable, and they preferred to participate with younger people. They did not express any specific difficulties around the intervention. We have screened about 1,700 participants in the clinic since the study began about a year ago. We are currently analyzing the data to provide an update of the rates of different categories of mental health diagnoses (mild, moderate, severe depression, etc). We submitted two abstracts for a major conference and had them accepted for the preliminary screening data and a review of the stakeholders’ feedback. They were accepted for poster presentations at Pediatric Academic societies. We have one paper that is currently being reviewed related to stakeholder feedback and another being completed now about setting up the screening program.

The Ntemoga study/PCNB

The introduction of combined antiretroviral therapies has reduced the incidence and severity of HIV-related encephalopathy in youth living with HIV. However, neurodevelopmental delays and cognitive impairment are nonetheless still common in this population. Unfortunately, in resource-limited settings (RLS), where HIV infection impacts millions of children, cognitive and neurodevelopmental disorders commonly go undetected because of a lack of appropriate assessment instruments and local expertise. In this project, we build on the synergistic work of two research groups to (1) culturally adapt and validate the Penn Computerized Neurocognitive Battery (CNB) and examine its validity for detecting both advanced and subtle neurodevelopmental problems among school-aged HIV-infected and HIV-exposed children in RLS; and (2) simultaneously fine-tune a brief screening instrument (Pediatric Symptom Checklist, PSC) to prioritize children most likely to benefit from further cognitive assessments. The CNB is a well-validated battery of neurocognitive tests that assesses all major domains of cognitive functioning in adults and children as young as 5 years of age. It has shown sensitivity to mild cognitive deficits and has been applied in large-scale studies and multiple cultural contexts. We aim to validate the CNB in youth in Botswana, an RLS with high rates of perinatal exposure to HIV and limited neurocognitive assessment tools and expertise, by culturally adapting and then administering the adapted version of the CNB to approximately 200 HIV-infected, 200 HIV-exposed uninfected, and 200 HIV-unexposed uninfected children. If successful, the proposed tools would provide practical screening and streamlined, comprehensive assessments that could be widely used in RLS to identify children with cognitive deficits within programs focused on the care and treatment of children living with or affected by HIV. The utility of such assessments could extend well beyond children affected by HIV and increase general access to pediatric cognitive assessments in RLS. Scholarship in Eswatini to two candidates to study genetics.

Publications

• Murphy-Alford AJ, Prasad M, Slone J, Stein K, Mosby TT. Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research. Adv Nutr. 2019. https://academic.oup.com/advances/advance-article/doi/10.1093/advances/nmz095/5569976
• J. Cobb Scott, Amelia E. Van Pelt, Allison M. Port, Lucky Njokweni, Ruben C. Gur, Tyler M. Moore, Onkemetse Phoi, Ontibile Tshume, Mogomotsi Matshaba, Kosha Ruparel, Jennifer Chapman, and Elizabeth D. Lowenthal; Development of a Computerized Neurocognitive Battery for Children and Adolescents with HIV in Botswana.
• Harriet Okatch, Knashawn Morales, Rachel Rogers, Jennifer Chapman, Tafireyi Marukutira, Ontibile Tshume, Mogomotsi Matshaba, Robert Gross, Elizabeth D.Lowentha; Trends in HIV Treatment Adherence Before and After HIV Status Disclosure to Adolescents in Botswana,2020. https://www.sciencedirect.com/science/article/abs/pii/S1054139X20300975 Abstracts
Slone J, Kaang T, Ketumile L, Beo B, Dunn M, Mantzor S, Chinyundo K. Retinoblastoma in Botswana. International Society of Paediatric Oncology (SIOP), Lyon, France, October 2019
Kaang T, Ketumile L, Beo B, Chinyundo K, Mantzor S, Dunn M, Slone J. R-CHOP for Non-Hodgkins Lymphoma in Botswana. International Society of Paediatric Oncology (SIOP), Lyon, France, October 2019

Abstracts presented at the AIDS 2020 Virtual Conference
• PEC0751 -Community Advisory Boards As A Model For Effective Community Engagement In The Collaborative African Genomics Network In Botswana, Thato Regonamanye, Botswana-Baylor Children's Clinical Centre of Excellence
• PEE1705: Synchronization of appointments for mutual patients of global HOPE Botswana and Botswana-Baylor Infectious Disease Clinic, Lesego Ketumile, Botswana-Baylor Children's Clinical Centre of Excellence
• PEB0329: Beyond survival –strategies to promote the quality of life of HIV infected young adults at Botswana-Baylor, Grace Karugaba, Botswana-Baylor Children's Clinical Centre of Excellence

LATEST ANNUAL REPORT

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