Volume 3 Issue 1 SPOTLIGHT Spring 2005 Focus: Lessons Learned in Establishing a Public ARV Treatment Clinic bout one in every three Botswana istrative processes to manage patients and A citizens is HIV-infected. Al- patient information. though the toll of suffering is Once the pilot phase was completed, the tremendous, the country is aggressively first national antiretroviral treatment site fighting the epidemic. In addition to AIDS opened on January 21, 2002 at the IDCC. prevention and care programs, the The clinic was immediately faced with the Botswana government established the first challenges of meeting the needs for space, public antiretroviral treatment clinic in staffing and training. Africa – an unprecedented move initiated The facility’s 4,000-patient capacity for more than three years ago. consultation and counseling was quickly The Botswana government engaged a reached. Additional buildings were erected team of care-givers and researchers for their to accommodate the more than 11,000 The public ARV treatment clinic provides expertise in undertaking this significant adult and pediatric patients now being treat- comprehensive HIV/AIDS care. project. This multisectoral team consisted of ed at the clinic. ARV treatment capacity is members of the Botswana-Harvard School also being established at additional clinics to Several important lessons were learned of Public Health AIDS Initiative Partner- facilitate the comprehensive care for pa- during this project. Significant clinical space ship, the Harvard School of Public Health tients at convenient locations. is needed to provide ARV therapy and care AIDS Initiative, the Princess Marina Hos- Clinic staffing changes were also neces- for HIV-infected people. Governmental fi- pital’s Infectious Disease Clinic (IDCC) sary. Initially, medical personnel were rotat- nancial support and commitment must be and Department of Medicine, and the Min- ed in from inpatient hospital wards in order consistently active in maintaining these istry of Health of Botswana. The team’s to gain outpatient care experience. Howev- services and clinics. Well-trained medical findings, “Establishment of a Public Adult er, to ensure consistent care for clinic pa- staff and standard administrative processes Antiretroviral Treatment Clinic in Urban tients, a core team of HIV specialists was are essential to sustain the infrastructure of Botswana: Lessons Learned,” were recently eventually created to staff the clinic and a clinic. If initiatives in other countries learn published in the journal Clinical and Infec- train junior staff as HIV care providers. from these lessons, then many more lives tious Diseases. In order to ensure that standardized care would be saved. The public clinic was born out of a pilot and treatment were administered, all ARV Sign up for free email updates! program located at the Princess Marina clinic staff members received on-site sup- Hospital. The program enabled local med- portive training. This training provided the Sign-up to receive free email updates from ical officers and HIV specialists to prepare most up-to-date information on HIV treat- HAI. Simply send an em ail to [email protected] for the needs of HIV-infected patients. ment, which was critical in helping patients vard.edu to receive electronic news and details They created standard training and admin- survive advanced stages of the disease. about upcoming events. News & Events Women and AIDS in Africa: AIDS Initiative, and will be held on Thurs- villa on the Italian Riviera, a dazzling pair of Hope for the Future day, May 12 at the Charles Hotel in Cam- South Sea Pearl and diamond earrings by Rap pioneer, Darryl “DMC” McDaniels of bridge, MA. The evening will celebrate the Angela Pintaldi and other exciting items do- Run-DMC, will host Women and AIDS in courage of women living with AIDS in nated by the HAI International Advisory Africa: Hope for the Future, a gala benefit Africa and focus on new research findings Council, HAI friends and supporters. Please dinner and silent auction. The event will that provide hope for a healthy future. The see aids.harvard.edu for more information. benefit the Harvard School of Public Health silent auction includes a week at a lovely (continued on next page) VViieewwppooiinnttss An Interview with Claire Moffatt mothers and their children; to ensure that lack of knowledge fuelled the fear and stigma they received the best possible clinical care that has contributed to the HIV epidemic. and counseling given our available resources. Seeing the potential for change gave me Alongside this I had a responsibility to ensure the desire to acquire knowledge and skills in that the study team in Lobatse reported data public health that could help to improve the accurately and efficiently – without these two health and the lives of a greater number of essential components the quality of the study people in Botswana. To me public health is would have been compromised. about identifying and understanding the Two things made the work most enjoy- cause of health problems (from the basic sci- able. Firstly the daily encounters with the ence to social and even political factors) and many incredible women (and at times, their then using this knowledge to implement families) who had made a decision to live change. There is a need for researchers and positively with HIV and embrace their future scientists, a need for public health policy for the sake of their children– they inspired makers and a need for implementers but im- and humbled me. Secondly the team I portantly there is a need to link these roles so worked with in Lobatse encouraged me with that we all work towards the same end… Dr. Claire Moffat their commitment, dedication and ongoing healthier lives for our communities and Fogarty Fellow good optimism. countries. I would like to be part of that link. Dr. Claire Moffat is a Fogarty Fellow at the Spotlight: How did your experience Spotlight: How do you see yourself Harvard School of Public Health. Before com- working with women in Botswana influ- being involved with issues involving ing to Boston from her home in Gaborone, ence your decision to come study at the women and AIDS in the future? Botswana, she worked as a physician for the Harvard School of Public Health? Mashi Study at the Botswana-HAI Partner- Whatever my future work, the health of ship for HIV Research and Education. Dr. CM: Working with women in Bostwana women and children affected by HIV will al- Moffat is a 2005 candidate for a Master’s De- showed me that there is hope for my country ways be on my agenda. On my return to gree in Public Health. in spite of the devastation AIDS has brought. Botswana I plan to be involved in further re- I saw this at an individual level in the lives of search to reduce mother to child transmission Spotlight: Can you describe your expe- the pregnant women I worked with who had of HIV (with the Botswana- HSPH AIDS rience working on the Mashi study? What the courage to face HIV in their lives and the Initiative Partnership). In the longer term I was your role? stigma associated with it in order to reduce hope to be involved in ensuring that research the risk of passing the infection to their ba- is translated into effective policy and that re- CM: Working on the Mashi study in bies. That was a big step – five years ago there search is driven by a need to find answers to Botswana was a privilege, an opportunity to was no option for a woman in Botswana to improve the health of the people. I think, try to make a difference. My primary re- protect her baby once pregnant and so peo- through the concerted efforts of many, that sponsibility was to the study participants: the ple preferred not to know their status. This this is possible. News & Events (continued from page 1) KITSO AIDS Training Program ment, and collaborating organizations Discussions. The advanced module should The KITSO AIDS Training Program, the gathered for a reference group pilot train- be available to physicians and pharmacists national training program of Botswana has ing to evaluate the sessions of the new experienced in ARV therapy this fall. successfully trained more than 3,000 course. The topics included: Virology and How You Can Help... healthcare professionals in fundamental Pathophysiology, ARV Resistance, ARV HIV/AIDS care in Botswana. In order to Medication, Advanced ARV Therapy, HAI’s efforts depend upon your support. Contributions are tax deductible. enhance their training, a new Advanced Management of Opportunistic Infections To make your contribution to HAI online, HIV/AIDS Care and Treatment module and other Complications of HIV Disease, please visit the Harvard School of Public has been developed. A group of 16 highly Women and HIV, Botswana HIV/AIDS Health giving page at http://www. experienced professionals in HIV/AIDS Research Update/Discussions, Update hsph.harvard.edu/give/. care and treatment from private, govern- from CROI Conference, and Case Study African Students and Researchers Share Their Experiences and Hope for the Future For Joseph Nokolola, and other African re- Claire Moffat from Botswana, Irene Koulin- search fellows and students working in the ska from Mozambique, and Pride Chig- HIV research labs at HAI, the study of HIV wedere of Zimbabwe. is much more than a thesis topic. Living The visit gave the students and fellows an and working as physicians and researchers exciting opportunity to step out of their in countries like Zimbabwe, Zambia, everyday work with experimental vaccines Mozambique, and Botswana, the scholars and drug resistance, and share the commit- could not escape the painful reality of the ment and passion that drives their research to AIDS epidemic. curb the AIDS epidemic in Africa.