Post on 08-Jul-2020
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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
© 2007 Baylor College of Medicine
Photo courtesy of Molly Waite
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© 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
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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
© 2007 Baylor College of Medicine
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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© 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
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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
© 2007 Baylor College of Medicine
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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!
© 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
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© 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)
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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)
© 2007 Baylor College of Medicine
http://botswanateenclub.wordpress.com
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© 2007 Baylor College of Medicine
http://botswanateenclub.wordpress.com
botswanateenclub@gmail.com
Photo courtesy of Ed Photo courtesy of Ed PettittPettitt
Forthcoming Adolescent Initiatives
© 2007 Baylor College of Medicine
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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
© 2007 Baylor College of Medicine
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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
© 2007 Baylor College of Medicine
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