08.C0702: RPSO - Infection Control (2 Districts)

Infection control is an important aspect of prevention of TB in high HIV settings, such as Infectious Diseases

Care Clinics (IDCC) and wards. Botswana has no dedicated infectious diseases hospital, and none of the

hospitals have TB wards. Recent reports of extensively drug resistant tuberculosis (XDR-TB) from

neighboring South Africa have raised the concern about possible cross-border movement of patients with

similar TB. The current DRS that is being conducted with FY07 funds will provide more accurate data about

the extent of drug resistant TB.

Infection control policies are currently under development with FY07 funds. PEPFAR funds are supporting

the renovation of a TB isolation ward at the HHS/CDC/BOTUSA site in Gaborone, which will be staffed by

PMH personnel. With funding from the GFATM, the MOH is constructing a TB isolation ward at Bamalete

Lutheran Hospital in Ramotswa. FY07 Plus Up funds were requested for the installation of a prefabricated

building at a district hospital that will be selected by the MOH.

2008 Plans

FY2008 funds are requested to procure two prefabricated buildings to be converted into isolation wards for

TB patients. The wards will be located at sites to be determined in consultation with the MOH. Prevention of

TB infection in congregate settings is a major component of collaborative TB/HIV activities. These activities

therefore will support Botswana's Round 5 TB grant from the GFATM, which among other goals, seeks to

strengthen TB/HIV collaborative activities.

08.T1105: RPSO - Construction of Nutrition Unit

In FY2007, USG funds supported the construction of a rehabilitation unit for malnourished children infected

and affected by HIV/AIDS in NRH in Francistown.

The rehabilitation unit would serve several purposes:

1.Affected children would served at the Unit for supportive care and proper nutrition management

2.The unit would serve as a training center for family care givers in the care of malnourished children

3.NGOs/ CBOs/FBOs working with OVC would refer needy cases to the Unit and their staff would get

proper advice and regular training

4.The Unit would provide office space for the Project staff

Due to inflation rates and increase in building materials and other related factors, the amount budgeted for

and approved in FY2007 ($800,000) is insufficient to support the construction of such a unit in PMH in

Gaborone.

It is estimated that the construction of one unit will cost $1million. Furthermore, GOB requested USG if a

similar unit could be supported in NRH in Francistown. Therefore, in this COP08, USG Botswana is

requesting an additional US$1.2million;$200,000 will go towards the completion of the one in PMH and

1million will go towards the construction of the second unit in Francistown.

08.T1108: RPSO - Pediatrics Clinic

USG will construct a new pediatrics building on space adjacent to the pediatrics wards and the Botswana-

Baylor Centre of Excellence for Pediatric HIV Treatment (COE). There are multiple needs for this building,

all of which complement or directly serve PEPFAR implementation for children. When complete, this facility

will provide in its first year of function an access pathway to HIV care and treatment for approximately 200

newly diagnosed HIV-infected children. It will provide care for 3,000 children with HIV and co-morbidities

such as TB and other OIs. It wills erve as a training clinic for 250 HCWs on care and treatment of HIV-

infected and affected children. It will provide a place for followup care for discharged HIV-infected and

uninfected children. It will provide a place for general and HIV-related pediatrics training of medical

students, interns, and residents. It will permit coordinated care at the largest hospital in the country. FY08

funds will be used by the US Department of State (DOS) Regional Procurement Service Organization

(RPSO) for construction.

Some of the challenges of providing adequate HIV care and treatment are those related to geographical

distribution of the population across a large land mass. The COE is working with the MOH to address the

treatment and palliative care needs of children served by health care facilities in the periphery through

training and mentoring activities supported by PEPFAR.

Other challenges result from the fact that most attention to pediatrics HIV care has focused on prevention of

vertical transmission in the PMTCT program and on the early infant diagnosis program with referral to

treatment and care of HIV + babies in the first 2 months of life. Those HIV+ children who have survived

infancy and early childhood are often unidentified and moving through life with suboptimal health. The

system is not actively screening these older children for HIV and OIs to prevent illness through early

identification and care. These secondary prevention activities need a programmatic and facility focus.

Space and staff capacity are two major problems posing a barrier to adequate pediatric care at PMH.

Excellent care and treatment for children with HIV/AIDS is provided for those 1,400 children who have found

their way to the COE at PMH. Aside from the COE and two old pediatrics wards, Princess Marina Hospital

(PMH), the largest referral hospital in the largest population center in the country, does not have any

dedicated space for any pediatrics care. This situation results in inadequate attention to children with HIV

infection as well as inadequate attention to general pediatrics preventive, acute and chronic care and

treatment. For example, children under 5 are at increased risk of acquiring TB when exposed to infectious

adults at home or in other settings. In a country which has approximately the third highest rate of TB and

HIV in the world, it is important to screen children for TB. There is no place for this to take place other than

adult TB clinics, which also serve children once they are identified. Although the PMH is a referral hospital,

people use it for ambulatory acute and chronic care as well as specialty care in the same way that people

do in the US.

A few clinics use borrowed space from other medical services on an intermittent basis. Children with HIV,

who reportedly comprise about 50% of inpatients, are not always registered patients at the COE and thus

are not always seen by COE staff in the inpatient facilities or referred to the COE at discharge. Further, the

COE is at its maximum number of patients so another pathway for HIV screening and referral, followup after

hospital admissions, and chronic management of TB and other OIs needs to be developed.

Medical training in general and HIV-related pediatrics is in urgent need of space and staffing to train medical

students, interns, and pediatrics residents. In 2008, all these training programs will begin simultaneously.

The lack of a pediatrics clinic attached to PMH is a dire deficit for all these training programs.

Nearly half of Botswana's population is under 15 years of age. Thus the need for pediatrics care is critical at

PMH where pediatric care is currently patchy, incoherent, and inadequate.

08.T1202: RPSO - National Health Laboratory Infrastructure Support

MLG: Prefab laboratories for 6 selected clinics in the districts: $600,000

Three prefab laboratories and equipment were provided in FY2007 to Tlokweng clinic (South East district)

and Area W clinic in Francistown. In FY2008 the same activities will continue, and prefab laboratories will

be provided to clinics to improve the diagnostic capabilities of HIV and TB and to reduce the work load of

Primary and Districts laboratories; 6 sites have been identified.

Renovation of Institute of Health Sciences: $100,000

In FY2007 PEPFAR, provided support to the Institute of Health Sciences to improve the intake of laboratory

technicians and pre-service training. The target is to double the number of laboratory technicians trained

from 15 trained every three year to 30.

FY2008 fund will help improve the old classrooms to accommodate the increase of the students. The old

building of the initial school is not used because the classrooms are not adequate.

08.X1508: RPSO - Renovation/Expansion of BOTUSA

The current location of the HHS/CDC/BOTUSA offices is becoming overcrowded. The MOH is in the

process of finding extra space for HHS/CDC/BOTUSA/ PEPFAR which will be provided rent free. It is likely

that MOH space in the recently vacated USAID Regional Office will be provided to PEPFAR. $50,000 is set

aside to make this space ready for PEPFAR occupancy as we co-locate with the MOH.