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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