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| KITSO-BHP staff and faculty. |
Mission
Background
Capacity Building
Curriculum & Implementation
Collaborations
Reference Corners & Resource Materials
Accomplishments
Monitoring & Evaluation
The KITSO AIDS Training Program provides quality, multi-disciplinary, sustainable and standardized training in HIV and AIDS care, crafted specifically for Botswana’s health professionals. KITSO is a collaboration of the Botswana Ministry of Health and the Botswana-HAI Partnership for HIV Research and Education, made possible through support from the African Comprehensive HIV/AIDS Partnerships.
The name of this program was designed to incorporate the culture of Botswana and to capture the groundbreaking nature of this collaborative educational effort. While English is the official language of Botswana, the language of Setswana is an important element of the country’s proud heritage. In the title of the program, "kitso" is the Setswana word for "knowledge." KITSO AIDS also stands for "Knowledge, Innovation, and Training Shall Overcome AIDS."
In the face of the growing HIV threat—identified by President
Festus Mogae as a national crisis—in 2001 the Government of
Botswana announced that it would provide antiretroviral (ARV)
therapy free-of-charge to qualifying patients. This initiative, at the
time without precedent in Africa, posed significant challenges
to Botswana’s already overburdened public healthcare system,
especially in terms of personnel, infrastructure, and training.
Conceptualized through private seed funding, the KITSO AIDS
Training Program was established in 2001.
It is the Botswana Ministry of Health’s
national training program for HIV/AIDS
treatment and care. KITSO was initially
conceived, developed, and implemented
through a collaboration between the
MOH and the Botswana–Harvard AIDS
Institute Partnership for HIV Research
and Education (BHP).
In order to offer more training
opportunities for healthcare professionals
in Botswana, the KITSO AIDS Training
Program was expanded in 2004 to
include the expertise of additional partner
organizations. Within this enlarged
framework, BHP’s KITSO program
(KITSO-BHP) continues to provide high
quality, multi-disciplinary, sustainable, and
standardized training to help healthcare
workers understand and apply the Botswana national HIV/AIDS
care and treatment guidelines.
KITSO-BHP’s training efforts are made possible through the
financial and staffing support of the African Comprehensive
HIV/AIDS Partnerships (ACHAP), a collaboration between the
Government of Botswana, the Bill and Melinda Gates Foundation,
and The Merck Company Foundation/Merck & Co., Inc.
Since its inception, KITSO-BHP has worked under the leadership of the MOH to increase local staff capacity within the healthcare sector and ensure the sustainability of HIV/AIDS care and treatment.
When ARV therapy was first introduced in Botswana in 2002,
few physicians in the country had experience in AIDS treatment.
Through KITSO-BHP training and front-line experience in the
ARV clinics, healthcare professionals in Botswana have gained
the expertise and confidence to both provide ARV therapy and
train other healthcare workers at their treatment sites. KITSO–
trained staff now provide ARV therapy at 32 hospital sites and
69 satellite clinics out of the planned 108 clinic sites throughout
the country, and currently serve over 100,000 patients enrolled
in the national ARV program.
KITSO-BHP has developed a module-based training curriculum,
which is tailored to the Botswana National HIV/AIDS
Treatment Guidelines. The curriculum has been collaboratively
developed and is regularly updated by national and international
experts to ensure that healthcare professionals gain competency
and confidence in the latest national standards of HIV/AIDS
care and treatment.
Curriculum development and course implementation have been driven by the immediate need to train Botswana’s healthcare workers in HIV/AIDS care in formats that provide a comprehensive grounding in good clinical practice without requiring long periods of staff release for training.
As mandated by the MOH, KITSO training modules are the national standard of training for HIV/AIDS care and treatment in both public and private sectors. The KITSO- BHP team oversees the standardized training implementation, curriculum development, updating, course examination and certification.
AIDS Clinical Care Fundamentals
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| Course participants discuss clinical cases during AIDS Clinical Care Fundamentals. |
Since its first offering in July 2001, AIDS Clinical Care Fundamentals has served as a gateway course to prepare Botswana’s healthcare professionals to provide basic ARV therapy and other HIV/AIDS care. Training is carried out using either a facility-based or centralized format, depending upon the staffing needs of individual healthcare facilities. Between July 2001 and June 2008, 5871 healthcare workers completed this module. Following four days of lectures, case study discussions, and question and answer sessions, the course concludes with a final examination. Participants who meet course requirements as determined by the MOH receive a certificate of successful completion.
An audio-enhanced CD-ROM of AIDS Clinical Care Fundamentals was produced and distributed in 2006. This CD-ROM has been
used for refresher training and long-distance education. An
updated CD-ROM reflecting the new 2008 national treatment
guidelines will be released by the end of 2008.
Topics covered in AIDS Clinical Care Fundamentals:
1. Introduction to the Botswana National ARV Program
2. HIV Epidemiology and Pathophysiology
3. Laboratory Diagnostics in HIV/AIDS Care
4.
Principles of ARV Therapy in the Botswana National
Program
5.
Pediatric-and Adolescent-Specific Issues in HIV/AIDS
Care
6.
Pediatric-and Adolescent-Specific Issues in HIV/AIDS
Psychosocial Care
7. ARV Drug Side Effects and Toxicities
8. Drug-Drug Interactions in ARV Therapy
9. Treatment Failure and Its Management
10. Adherence in ARV Therapy
11.
Adult and Pediatric Opportunistic Infections and Other
Complications in HIV Disease
12. Mother-to-Child-Transmission and Its Prevention
13. Post-Exposure Prophylaxis (PEP)
14. TB and HIV Co-Infection
15. Summary of the Major Changes in the 2008 Guidelines.
AIDS Clinical Care Fundamentals Refresher/Update
This new two-day Refresher/Update training module was
developed in response to a high demand for refresher training,
as well as the need to update already trained healthcare staff on
the most recent changes to the national treatment guidelines.
Incorporating information from the new guidelines along with
care and treatment fundamentals, the training covers HIV testing,
ARV therapy eligibility, principles of ARV therapy, management
of toxicities, management of treatment failure, PMTCT, and
treatment of TB and other opportunistic infections.
The module has been implemented since January 2008. All
efforts will be made to re-train healthcare workers as quickly as
possible in order to maintain the high standard of HIV/AIDS
care and treatment in Botswana.
Medication Adherence Counseling
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| KITSO trainer conducting chart review as part of clinical mentorting. |
This three-day course is designed to enhance the adherence counseling skills of healthcare workers. Offered as a centralized training for nurses, pharmacy staff, and social workers from ARV treatment centers, Medication Adherence Counseling focuses on strategies to overcome potential barriers to adherence.
A combination of lectures, case discussions, role-playing, and interactive activities are employed to reinforce good counseling techniques and strengthen the participants’ ability to devise and implement successful adherence interventions. Implemented in collaboration with the Botswana-Baylor Children’s Center of Excellence, the course also includes teaching and case discussions about pediatric and adolescent adherence, as well as disclosure of HIV status for children, adolescents, and their families.
Advanced HIV/AIDS Care and Treatment
This advanced training is designed for physicians and pharmacists
providing ARV therapy in Botswana. Course participants must
have previously completed AIDS Clinical Care Fundamentals and be
actively involved in an ARV clinic.
Advanced HIV/AIDS Care and Treatment combines lectures
and interactive case discussions to provide advanced and
comprehensive training in ARV therapy, emphasizing treatment
principles and strategies practiced world-wide and applying them
to the Botswana setting. This course familiarizes participants with
the full complement of ARV drugs and provides strategies for the
management of treatment failure, interpretation of drug resistance
assays, designing of “salvage” regimens, and understanding short
and long-term ARV side effects and toxicities. Course content
equips clinicians with the skills necessary to manage complicated
patients, and provide guidance and support to their colleagues,
thereby strengthening the growing HIV treatment expertise in
Botswana’s healthcare sector.
Advanced HIV/AIDS Care and Treatment covers adult, adolescent,
and pediatric HIV care, with input from the Botswana–Baylor
Children’s Center of Excellence and the pediatric departments
at Princess Marina Hospital and Nyangabgwe Hospital. Special
emphasis is placed on primary care for HIV-infected children and on
disclosure issues, especially in regards to children and adolescents.
Each advanced course features an evening symposium where
relevant research and clinical trials conducted in Botswana
are presented. Summaries of recent international HIV/AIDS
meetings are also included at these evening symposia.
Introduction to AIDS Clinical Care
This one-day satellite training has been developed to provide non-
medical professionals with a basic understanding of identification
and management of HIV/AIDS in Botswana.
Course content includes an introduction to HIV pathophysiology and immunology and information about testing, eligibility and referral for ARV therapy, identification of common ARV side effects, the importance of medication adherence, counseling and referral for PMTCT, and post-exposure prophylaxis. This course is suitable for general health educators, family welfare educators, and lay counselors. Since 2006, Introduction to AIDS Clinical Care has been implemented at ARV sites by the BHP–PEPFAR Master Trainer Program.
HIV and Women’s Health (in development)
To address the high percentage of serodiscordant couples and the
high rate of pregnancy among HIV-infected women in Botswana,
this module for doctors and nurses will focus on family planning
and special care and treatment considerations for women living
with HIV/AIDS.
KITSO-BHP has established “reference corners” in the medical libraries of Botswana’s two referral hospitals, Princess Marina Hospital and Nyangabgwe Hospital. Resources in these reference corners include textbooks, medical reference guides, specialized journal subscriptions, and relevant handbooks and guidelines.
KITSO faculty select pertinent journal articles and other resource materials and forward them to all ARV sites three times a year. In addition, Advanced HIV/AIDS Care and Treatment course participants receive updated resource materials.
KITSO-BHP has also provided each district hospital in Botswana with a laptop computer and an LCD projector for in-service staff education.
KITSO-BHP owes its success both to ACHAP for its financial
support and to the dedicated faculty members from the Botswana
MOH and Ministry of Local Government, the ACHAP Clinical
Preceptorship Program, Botswana-Baylor Children’s Center
of Excellence, BHP, University of Pennsylvania, the PEPFAR
Master Trainer Program, the Private Practitioner Association of
Botswana, and the World Health Organization.
While much remains to be done, KITSO-BHP takes pride in the
work that has been accomplished in training healthcare professionals
in Botswana. KITSO-BHP commends the leadership of the MOH,
the commitment of Botswana’s healthcare workers, the support of
stakeholders and collaborators, and the dedication of the KITSO
faculty and team for making such achievements possible.
Accomplishments include:
• Development, implementation, and updating of standardized
training curricula which reflect Botswana’s current HIV/AIDS
treatment and care guidelines.
• Continued didactic training support for treatment teams from
ARV sites.
• Establishment of KITSO Reference Corners in Botswana’s two
referral hospitals.
• Provision of ARV Resource Readings to all 32 ARV sites.
• Provision of training equipment to all district hospitals.
• Orientation of incoming preceptors and international mentors.
• Development of AIDS Clinical Care Fundamentals CD-ROMs for
distance education.
From its inception, KITSO-BHP has carefully incorporated
monitoring and evaluation tools into its training formats to
assess the quality and integrity of the program’s structure,
content, and implementation. This commitment to assessment
and evaluation has allowed the KITSO-BHP program to
quickly adapt to changing national healthcare guidelines,
stakeholder advice, faculty and participant feedback, and the
recommendations of external evaluators.
A Long-Term Evaluation was conducted in 2006 to assess the impact and reach of KITSO-BHP training. Site leadership from 17 ARV sites were interviewed, and 494 former course participants completed survey questionnaires and knowledge assessments. The final evaluation report was released by the MOH in January 2008.
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