Education and training are major components of all of our COE programs. Our aim is to expand the pool of health, teaching and other professionals with the necessary knowledge and skills to effectively identify, treat and/or care for HIV infected children, adolescents and young adults. During the reporting period, training was provided at pre-service and in-service levels with financial support from the Ministry of Health, the Ministry of Education and Skills Development and CDC-PEPFAR. The main activities were Pediatric KITSO Training, the COE Visiting Scholars Program, Continuing Medical Education series (CMEs) and finalization of Teacher Training workshops.
Pediatric KITSO targets physicians, nurses, pharmacists, social workers and other health professionals. The course is conducted over a period of five days at ART sites across Botswana.
Over the past year, 10 pediatric KITSO courses were delivered reaching 298 professionals drawn mainly from government hospitals and clinics. In collaboration with the Ministry of Health, the Botswana- Baylor COE reviewed the pediatric KITSO curriculum content to match changes in national treatment guidelines and the evolving treatment and care needs of HIV infected children as they transition into adolescence and young adulthood. Future trainings will highlight the role of health workers in the achievement of the UNAIDS 90-90-90 global treatment target to end the AIDS epidemic by 2020.
During 2014/15, 122 medical students, residents, fellows and other health professionals visited the COE from various training programs in Botswana and from around the globe. These visiting scholars spent most of their time in the COE shadowing and working alongside experienced care providers. They also participated in a lecture series, a condensed version of the week-long Pediatric KITSO Training. Some scholars presented articles at Journal Club or helped with ongoing studies and quality improvement activities. Visiting scholars were also afforded opportunities to participate in Teen Club activities, in pediatric KITSO training, or work at outreach sites alongside the outreach team, and/or spend time in wards at Princess Marina Hospital.
The mission of the Botswana-Baylor outreach mentorship programme is to strengthen the capacity of non-Baylor healthcare facilities across Botswana to provide quality HIV treatment and care services to children, adolescents and young adults. During monthly visits, a Botswana-Baylor pediatrician or medical officer and a nurse prescriber provide clinical care services to patients alongside the local medical staff. The also lead outreach team also conducts didactic educational sessions structured around the fundamentals of pediatric and adolescent HIV treatment and care.
Over the reporting period, the outreach programme covered 10 large ARV sites, mentoring 126 healthcare workers and seeing 712 patients. Of these, 288 patients were on treatment but their HIV viral loads were not suppressed. The majority of the patients who experienced virological failure (when ART fails to suppress and sustain a person’s viral load below a certain threshold) at outreach sites achieved viral suppression within three months following interventions by the outreach team. Almost all those patients had been switched to a newly introduced drug, Dolutegravir, which is known to suppress the virus quickly. Botswana-Baylor plans to expand its outreach activities to more ART sites in an effort to further reduce failure rates among children, adolescents and young adults nationally.
The COE continues to upgrade and expand its services for tuberculosis care for children in collaboration with the Ministry of Health. Major components of that effort include improved diagnostic capacity, health worker education, mentorship, enhancing collaborative partnerships and patient education. During the reporting period, 62 clinicians were trained in Mahalapye, Selibe-Phikwe, Francistown and Palapye. In Botswana, 3 new sites were provided with sputum induction and started to provide this vital service. On invitation by the BIPAI centre in Swaziland, our team trained a group of 30 clinicians from the centre and other health facilities. The post training evaluation results shows high appraisals including relevance of content (94.4%); presenter knowledge/expertise (92.6%); and presenter’s ability to make points clearly (96.8%). With the end of CDC-PEPFAR support, there are plans for the project to be continued and expanded under a new funding mechanism by Botswana National TB Program.