1. 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

2. Presentation Content Introduction The Health Care System HIV / AIDS background in Botswana Governments intervention The ARV Programme at Letlhakane Primary Hospital (LPH) Challenges Successes of the programme Way forward

4. 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

5. HIV prevalence by Health District – 2004 BAIS II

6. HIV prevalence among pregnant women

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. Challenges for the FNP Lack of recognition for the FNP Lack of understanding of the FNPs role Working extended hours Split roles between ARV clinic and OPD

14. 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

15. Way Forward Review Botswanas 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

16. Thank You