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    © 2007 Baylor College of Medicine

    The Botswana-Baylor Children’s Clinical Centre of Excellence (COE)

    Camp Hope Community Partners Presentation

    Presented By: Edward D. Pettitt II Fundraising & Development Coordinator, Teen Club Coordinator

    Botswana-Baylor Children’s Clinical Centre of Excellence

    Presentation Outline

    � Background

    � Current Adolescent Services/Initiatives

    � Forthcoming Adolescent Initiatives

    � Conclusions & Recommendations

    © 2007 Baylor College of Medicine

    Photo courtesy of Molly Waite

  • 2

    © 2007 Baylor College of Medicine

    “Among the challenges that lay ahead, the need to prepare for the care of the ever increasing

    population of adolescents and young adults who are living with HIV and AIDS stands out most. We

    must pool our resources and discover better methods to help these most vulnerable members of

    our community. This is the challenge of our time; it is also the opportunity of our age.”

    Professor Gabriel Anabwani, Executive Director, Botswana Baylor Children’s Clinical Centre of Excellence (COE)

    2008 Annual Report

    Background

    © 2007 Baylor College of Medicine

  • 3

    The ‘Center of Excellence’ Model: Catalyzing Access of HIV-Infected Children to Care and Treatment

    � Build clinical infrastructure

    � Build critical human capacity

    � Create replicable models of care & treatment strategies

    � Generate knowledge to inform the care & treatment of HIV-infected children

    � Spring-board for community outreach services/activities

    � HIV Testing & Counselling Clinic � >10,000 children screened

    � Overall: 2000 (± 22%) HIV positive � PMTCT participants: 2000 in total

    � ± 600 BANA Study Clinic

    Clinical Care Services

  • 4

    Annual Pediatric HIV/AIDS Death Rate: Botswana COE

    4.7%

    2.1%

    1.1%

    0.4%

    0%

    1%

    2%

    3%

    4%

    5%

    2003 2004 2005 2006-2007

    AfterBefore

  • 5

    Clinical Care Services:

    Special Clinics � Family Care Model Clinic

    � Conceived 2001; Started 2002

    � Children stepping stone into the family

    � Parents are seen same visit by the same doctors &

    nurses

    � Challenge Clinic: Since July 2008

    � Patients failing second/third line regimens: ±±15 pts.

    � Adolescent HIV Care Services

    � Care provider continuity; Teen Club; Camps

    © 2007 Baylor College of Medicine

    Mean: 9.3 years Std. Dev.: 4.15

    N = 1,366

    Source: Botswana-Baylor Children’s Clinical Centre of Excellence, PIDC Database (May 2009)

  • 6

    © 2007 Baylor College of Medicine

    Source: Botswana-Baylor Children’s Clinical Centre of Excellence, PIDC Database (December 2008)

    © 2007 Baylor College of Medicine

    Source: Botswana Ministry of Health, MASA ARV Programme, Monthly Report Statistics (December 2008)

    205

    306

    412

    511

    1206

    1800

    2400

    3006

  • 7

    Considerations for Adolescent Population

    � With HAART, infants who were born with HIV are now entering into adolescence and adulthood

    � “Not quite children; not yet adults”

    � Highest risk of therapeutic failure with HIV and other chronic diseases

    � Adolescent risk-taking behaviors may encourage HIV transmission

    � Entering childbearing years

    � Unique psychosocial challenges

    Current Adolescent Services/Initiatives

    © 2007 Baylor College of Medicine

  • 8

    Adolescent Clinic � Adolescent-focused treatment clinic

    � Started with 23 teenagers in 2005

    � Currently, over 350 adolescents in PIDC aged 12-19 years

    � Adolescent-focused physicians: continuity of care

    � Full-time Social Workers and Clinical Psychologist

    � Address adolescent-specific medical and psychosocial needs

    Teacher Training Programme � In collaboration with the Ministry of Education.

    � Designed after realization that many school-aged

    COE patients were receiving inaccurate information from teachers.

    � Aims to improve the HIV/AIDS knowledge and

    attitudes of primary and secondary school staff and to improve teachers’ ability to support HIV-infected and affected children.

    � Two-day workshop curriculum delivered at individual

    schools, involving COE physicians, nurses, dieticians, and outreach staff.

    � Initial pilot sites in vicinity of Gaborone with plans to roll-out to other educational districts.

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    Other Training Programmes � KITSO Pediatric HIV Treatment and Care Training

    for Health Professionals

    � Pediatric/Adolescent HIV Care & Support Training

    for Non-Medical Professionals

    � Leadership and Communication Strategies

    Training for Teen Leaders and Peer Educators

    � Fundraising & Marketing Training for Non- Governmental Organizations (In Development)

    � Adherence Training for Caregivers of Adolescents (In Development)

    Psychosocial/Educational Interventions at

    Botswana COE

    © 2007 Baylor College of MedicineInterventions

    A g

    e (

    Y e

    a rs

    )

    0

    5

    10

    15

    20

    Morning Play

    Group

    Camp Hope

    Teen Club

    Older Teens

    Younger Teens

  • 10

    Camp Hope � Week-long camp held annually since

    2005 for HIV+ children ages 10-12

    � Particularly beneficial for children who

    struggle with medication adherence,

    family problems and stigma issues

    � Includes sports, recreation, life skills,

    drama, art, a game drive and other

    activities.

    � Older campers transition into adolescent care and Teen Club

    � Teen Counselors included in Camp Hope 2009

    � Camp Hope Ya Chesa!

    © 2007 Baylor College of Medicine

    Botswana Teen Club Mission

    � “To empower HIV-positive adolescents to build positive relationships, improve their self-esteem and acquire life skills through peer mentorship, adult role- modeling and structured activities, ultimately leading to improved clinical and mental health outcomes as well as a healthy transition into adulthood.”

    � Enrollment Criteria: 13-19 years old, fully disclosed, guardian consent obtained

  • 11

    © 2007 Baylor College of Medicine

    Map of Satellite Teen Clubs

    Key

    Operational Satellite

    Satellite in Development

    Gaborone Teen Club

    Photo source: http://www.african-safari-and-travel-advisor.com/images/african-maps-botswana-political.jpg

    © 2007 Baylor College of Medicine

    Source: Botswana-Baylor Children’s Clinical Centre of Excellence, Teen Club Attendance Database (April 2008)

  • 12

    Botswana Teen Club Botswana Teen Club Botswana Teen Club Botswana Teen Club Monitoring & Evaluation Logic Model

    Problem Statement: There is a lack of psycho-social support, life skills education and peer support group interventions for the fast-growing HIV-positive adolescent population in sub-Saharan Africa generally and Botswana

    specifically.

    Donor Funding:

    •Barclays

    •UNICEF

    •Private Individuals

    Adult Volunteers:

    •Professional

    •Medical

    •Social

    Work

    •Mental

    Health

    •Lay

    •NGO

    Staff

    •Lay

    Counselo

    rs

    •Other

    COE* Staff:

    •Physicians

    •Nurses

    •Administration

    Teen Leaders

    COE Infrastructure &

    Resources

    Curricula & Toolkits:

    •Training

    •Life Skills

    •Satellite Site

    Development

    Partnering

    Organizations

    Parents/Caregivers

    INPUTS ACTIVITIES

    Monthly Teen Club Events:

    •Gaborone

    •Satellite Sites

    Life Skills Camps

    (Ages 13-19)

    Camp Hope (Ages 10-12)

    One-on-one Counseling

    and Referrals

    Satellite Site Development

    Curricula & Toolkit

    Development

    Trainings:

    •Pediatric/Adolescent HIV

    Care & Support

    •Fundraising & Marketing

    for NGOs

    •Teen Leader/Peer

    Educator Training

    Caregiver Support

    Workshops/Trainings

    OUTPUTS OUTCOMES IMPACT

    # of monthly events

    implemented

    # of teens attended monthly

    events

    # of teens attended camp

    # of pre-teens attended

    camp

    # of teens counseled

    # of teens referred (for

    counseling or services)

    # of curricula developed

    # of toolkits developed

    Indicators of change in

    knowledge/behavior from

    baseline

    # of new satellite sites

    developed/active

    # of health professionals

    trained

    # of NGO staff trained

    # of other lay volunteers

    trained

    # of Teen Leaders/Peer

    Educators trained

    # of caregivers trained

    Increased access to

    psychosocial support

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