Since the beginning of 2014, the COE has been the coordinating centre for a study of genetic factors that affect the progression of HIV and TB in children living in sub-Saharan Africa. The COE received a research grant of $3.64 million from the U.S. National Institutes of Health (NIH) to coordinate the Collaborative African Genomics Network (CAfGEN), made up of the Botswana-Baylor Children’s Clinical Centre of Excellence, the University of Botswana, the Baylor Uganda Children’s Foundation, Makerere University and Baylor College of Medicine.
The grant is part of the Human Heredity and Health in Africa (H3Africa) Initiative that facilitates cutting-edge research on the genetic and environmental determinants of common diseases with the goal of improving the health of African populations. The mission of CAfGEN is to create, as part of the H3Africa Consortium, a collaborative, multi-disciplinary, multi- institutional, inter- and intra-country network of African scientists, clinicians and researchers who use genomics to study gene/pathogen interactions for HIV/AIDS, its co- morbidities and other diseases among diverse paediatric African populations.
Progress to-date includes receipt of all 5 IRB approvals for research commencement; finalization of standard operating procedures (SOPs) in line with H3Africa guidelines; hiring of research staff and completion of preparatory training; purchasing of genomic sequencing equipment; and commencement by six candidates (three from Botswana and three from Uganda) of a two-year graduate-level Genomics Research Training Program (GRTP) at Baylor College of Medicine, Houston, Texas, USA, in part fulfillment of their PhD degrees. Patient recruitment is at an advanced stage, with all of the samples acquired for the retrospective study, most of which have been processed and quality controlled at the University of Botswana. Sample shipping to Baylor College of Medicine commenced in March 2015. A community advisory board was activated in August 2014 and currently has 12 active members representing a broad range of human rights, youth advocacy, religious, media, health, and legal/ethics organizations that meet monthly to review progress and provide feedback to the researcher.
In October 2014, CAfGEN received additional funding from Wellcome Trust to implement a community engagement project in Botswana utilizing capacity building workshops, educational comics, and social media to engage community stakeholders, media practitioners, and the general public - especially the youth - in genomics and biomedical research. Attendees of our community stakeholders and media workshops, held in December 2014 and March 2015 respectively, demonstrated substantial knowledge increases. Two educational modules on genetics, including ethical scenarios, were designed and delivered for adolescents enrolled in our Teen Club support groups, also resulting in a substantial knowledge increase. Characters and storylines were developed for a 4-part comic book series, the first book of which will be printed and distributed nationwide in August 2015. With additional supplemental funds from the NIH, plans are currently underway to translate the comic books into several languages for a broader reach throughout Africa.
The COE has partnered with MACAIDS Foundation, a local NGO - Young 1ove - , Evidence Action and the Jameel Poverty Action Lab (J-PAL) to conduct a randomized impact evaluation of an educational intervention which aims to reduce teen pregnancy and HIV, illustrating the COE’s commitment to safeguarding the health of both HIV- positive and HIV-negative adolescents across Botswana.
The goal of the study is to evaluate a one-hour “sugar daddy” awareness class adapted from a curriculum that was shown to reduce teen pregnancy by 28% in Kenya. In 2014, the COE conducted baseline surveys among 42,195 youth aged 11-17 in South East, Southern, Kweneng and Kgatleng regions. The surveys collected data on knowledge, attitude and self-reported behaviour regarding safe sex activities. This data revealed significant gaps in students’ knowledge of risky partners, one key area that the Young 1ove—One Love program aims to address.
Programmatically, the COE’s partner organization Young 1ove refined and piloted the curriculum to ensure its messages were clear, concise, powerful and aligned with proven programming. Young 1ove recruited and trained a team of 15 facilitators, who were deployed to schools, reaching 113 primary and junior secondary schools in four MOESD regions. Over the course of 40 working days, the youth facilitators delivered the curriculum to over 13,000 youth from randomly selected schools. In addition, Young 1ove and the COE held workshops in all four regions of the study to train 106 Guidance and Counseling teachers in the curriculum and its delivery. These teachers are expected to have reached an additional 13,000 students. About 13,000 children serve as controls.
Beginning August 2015, the COE will conduct a one-year follow up with all students reached at baseline. Building on lessons learned through the baseline data collection process, the COE intends to survey approximately 42,000 students in 25 working days. Furthermore, surveyors will track and interview all girls who have dropped out or otherwise left school since program implementation to ascertain if this was due to pregnancy. Collecting this information, in addition to generating one of the largest datasets on adolescent sexual health knowledge and behaviour in Botswana, will enable the COE to evaluate the causal impact of the “sugar daddy” curriculum on teen pregnancy in Botswana.
Three manuscripts were accepted for publication in peer- reviewed journals during 2014/2015:
1. Disclosure of HIV status to HIV-infected children in a large African treatment center: Lessons learned in Botswana. Children and Youth Services Review. ELSEVIER
2. Diagnosis of paediatric tuberculosis using sputum induction in Botswana: programme description and findings. Int J Tuberc Lung Dis.
3. Nevirapine Extended-Release Formulation Tablets in HIV-1 Infected children - Long-term Follow-up. Clinical Infectious Diseases