camp hope community partners presentation · 8 adolescent clinic adolescent-focused treatment...

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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 IIFundraising & 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


Photo courtesy of Molly Waite

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“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


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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: <5% now test +ve

� Non-PMTCT participants: 28% test +ve for HIV

� Provision of Anti-Retroviral Treatment� >2000 in total

� ± 600 BANA Study Clinic

Clinical Care Services

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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

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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


Mean: 9.3 yearsStd. Dev.: 4.15

N = 1,366

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

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


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

205

306

412

511

1206

1800

2400

3006

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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


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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

Ag

e (

Ye

ars

)

0

5

10

15

20

MorningPlay

Group

Camp Hope

Teen Club

Older Teens

Younger Teens

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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!


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

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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


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

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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 and

services

Increased life skills acquisition

Improved physical health:•Increased CD4 count•Decreased Viral Load

Improved mental health:•Decreased depression symptoms•Increased strategies for healthy disclosure•Increased strategies for dealing with stigma and discrimination

Improved health behaviors:•Decreased risky sex•Improved adherence•Improved clinic attendance

•Improved nutrition

•Decreased alcohol/drug abuse

Improved non-health

behaviors:•Improved school attendance

•Improved academic performance

Increased competence in

areas trained

Increased mobilization of

satellite sites

Increased utilization of

curricula & toolkits

Increased provision of peer

counseling/education

Decreased treatment failure

Decreased morbidity

Decreased mental health

problems

Reduced HIV-related stigma

and discrimination

Increased healthy disclosure

Decreased HIV transmission

and re-infection

Increased replication within

Botswana and internationally

Decreased teen pregnancy

Increased healthy

relationships (family, peer,

romantic, etc.)

Improved educational and

occupational prospects

Improved capacity to provide

care and support for HIV+

adolescents:•Parents/caregivers

•NGO staff

•Medical/psychosocial

professionals

•Lay staff/volunteers

•Peer Educators

ALL

ALL

ALL

ALL

ALL

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


http://botswanateenclub.wordpress.com

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http://botswanateenclub.wordpress.com

[email protected]

Photo courtesy of Ed Photo courtesy of Ed PettittPettitt

Forthcoming Adolescent Initiatives


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Teen Drop-In Centre

� Currently procuring plot and/or modular buildings

� Safe and welcoming environment for teens to visit

during:

� Monthly clinic appointments

� Weekends

� Holidays

� Services provided will include:

� Individual counseling

� Life skills and health education

� Recreational activities

� Tutoring

� Caregiver support

Teen Drop-in Center


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Caregiver Adherence Guide� A Caregivers’ Guide to

Adherence

� Includes tips on how to

involve teenagers in their

own care

� Includes advice for

caregivers on how to

support adolescents

� Caregiver-oriented trainings and workshops to follow

� “Caregiver Days” at Teen Club

Teen Talk Guide� Undergoing extensive

adaption - with permission -

from US-based publication

� Question & Answer model directed towards teens

� Includes modules on reproductive health,

emotions, relationships, stigma, ARV adherence,

and other issues specific to HIV+ adolescents

� Consultations ongoing with MoH IEC Dept.

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Conclusions & Recommendations


Public-Private Partnerships:

Why Companies Partner

� Corporate Social Responsibility

� Philanthropy

� Reputation/Corporate Image

� Public Relations

� Employee Attraction

� Market Access

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The Botswana-Baylor COE:

A Strong Partner

� Public-private partnership between BCM and GoB/MoH

� Registered NGO� Long-term country presence� Network of local and global partners� Policy influence� Credibility� Sound financial procedures & regular

external auditing� Strategic M&E

Adolescent Programme

Funding Needs

� Teen Sponsorship for Teen Club

� Satellite Site Development

� Camp Hope Sponsorship

� Modular Buildings for Satellite Teen Clubs

� 4x4 Programme Vehicle

� Plot for Teen Drop-In Centre

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Adolescent Programme

In-Kind Needs

� Meals� Transport� Venues� Sports Equipment� Art Supplies� Airtime� Vehicles� Adult Volunteers� Consultants

Conclusions� Increasing numbers of HIV+ adolescents

create unique challenges for health care providers.

� Comprehensive, adolescent-focused services can help to foster successful transitions to adulthood for HIV+ youth.

� Our achievements so far are:

� Not solely our own;

� Not an end in themselves;

� Not even the beginning of the end

� Need your support to sustain & do more..

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Acknowledgments

1. Botswana-Baylor COE Patients and their Families

2. The GoB: MoH and PMH

3. CDC-PEPFAR: Training, Staffing

4. Barclays: Teen Club, Camp Hope

5. UNICEF: Training, Teen Club, Camp Hope

6. The Baylor International Paediatric AIDS Initiative

(BIPAI)

7. Botswana-Baylor COE Management and Staff

8. Maruapula School, Seabelo’s Express, Mokolodi

Game Reserve: Camp Hope 2009

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