Improving access to HIV/AIDS care through effective use of NP: the case of a Primary Hospital in Botswana

L Chite, RN, FNP

28 June 2006

Presentation Content

• Introduction

• The Health Care System

• HIV / AIDS background in Botswana

• Government’s intervention

• The ARV Programme at Letlhakane Primary Hospital (LPH)

• Challenges

• Successes of the programme

• Way forward

Maun

Ghantsi

Lobatse

Mopipi

Orapa Letlhakane

SerowePalapye

Selibe-Phikwe

Mahalapye

GaboroneJ waneng

Sekoma

K anye

Molepolole

Francistown

Shoshong

Central K alahariGame reserve

MakgadikgadiPans National Park

OkavangoDelta

ChobeNationalPark

K asane

B O T S W A N A

K galagadi TransfrontierPark

Botswana

AngolaZambia

Namibia

South Africa

Zimbabwe

Moz

ambi

que

Mad

agas

carM

ala

wi

Tanzania

Republic of Botswana

Geographical Location

NORTH

Southern Africa (SADC)

Damtshaa

Serule

Motloutse river

Foley

Shakawe

K angHukuntsi

Tshabong

Letlhakeng

MoremiWildlifeReserve

J ohannesburg

Pretoria

Introduction

• Botswana has a population of about 1,6 million

• The economy is dependent mainly on diamond mining

• Botswana ranks among the highest in HIV prevalence rate in the world

• AIDS is the biggest killer in Botswana, followed by road accidents

HIV prevalence by Health District – 2004 BAIS II

0%

5%

10%

15%

20%

25%

30%

35%

Prevalence Average

HIV prevalence among pregnant women

0%

10%

20%

30%

40%

50%

60%

15-19 20-24 25-29 30-34 35-39 40-49

Age groups

HIV Prevalence

The Health Care System

• Based on the Primary Health Care (PMC) model

• Comprises mobile stops, health posts, clinics, primary hospitals, district

hospitals & referral hospitals

• Designed to be accessible, affordable for all Batswana

• Partnered by mine and private hospitals

HIV / AIDS Background in Botswana

• Life expectancy fell from 65yrs in 1995 to 39,7yrs in 2005

• About 270,000 were living with HIV in 2005, with a

prevalence rate of 17% (Adults 24%) [BAIS II 2004]

• About 160,000 children orphaned mostly by AIDS in 2003

HIV / AIDS Background in Botswana cont…

• 1985 - First diagnosed case of HIV

• Rapid spread of disease

• 1993 – Government introduced the National Policy on HIV / AIDS

– formation of National AIDS Coordinating Agency (NACA)

– NGOs, Tebelopele VCT centres etc.

HIV / AIDS Background in Botswana cont…

• HIV prevention initiatives

– Public education & awareness

– Condom distribution

– Prevention of Mother to Child Transmission of HIV (PMTCT)

– Voluntary Counselling & Testing

– Routine testing for HIV

• 2002 – Rollout of ARVs to selected hospitals

• 2003 – Start of rollout of ARVs countrywide

The ARV Programme at LPH

• 2004 – Rollout of ARVs to Letlhakane Prim. Hospital (LPH)

• Management team comprised 2 Medical Officers (MOs), 1

Family Nurse Practitioner (FNP) and 2 Registered Nurses

(RNs)

• FNP assists the MOs to run the ARV clinic and also runs the

Outpatient Department (OPD)

• LPH services a catchment area in the Boteti sub-district

Challenges for the team

• Waiting periods for patients due to 2 year backlog

• Limited skills on ARVs

• Adherence to ARVs

• Patients missing reviews

• Alcohol abuse

• Language and literacy

• Pregnancy of infected people

Challenges for the FNP

• Lack of recognition for the FNP

• Lack of understanding of the FNP’s role

• Working extended hours

• Split roles between ARV clinic and OPD

Successes

• Community mobilisation

– Stigma has reduced

– More HIV + people coming out & living positively

• FNP-client relationship

• Leadership commitment

– Government, NGOs & private sector have all played a positive role

Way Forward

• Review Botswana’s National Policy on HIV / AIDS to re-consider

– mandatory HIV testing for spouses before they marry?

– publicly reveal causes of death at funerals?

– Alcohol trading times?

– Spouses to work and live in the same place

• Better recognition of FNPs

• FNPs to run ARV clinics

• Upgrade and adequately resource HIV / AIDS care centres

Thank You