PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
09.P.PM08: I-TECH - Data Quality Improvement
ACTIVITY CONTINUING UNDER PERFORMANCE PASS
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In FY2009, the International Training and Educational Center on HIV/AIDS (I-TECH) is requesting funding
to support the following activities related to technical assistance to the Prevention of Mother to Child
Transmission (PMTCT) Unit:
Human Resources
Funds from FY2009 will continue to support the secondment of a Data Manager to the PMTCT Unit. Funds
will support professional development in the form of informatics training to build the Data Manager's skills
related to data collection, management, and analysis of PMTCT data. Additionally, I-TECH will provide one-
on-one mentoring for building analytic skills within the unit. The Data Manager will also be included in an I-
TECH Training-of-Trainers (TOT) program on mentoring. This TOT will help the Data Manager to develop
and deliver high-quality structured and informal training for others on use of the tool and issues related to
data quality.
Rolling Out Data Collection Tool
I-TECH will continue the activities of FY2008 by continuing the roll out of the revised data collection tool.
Funds are requested to support a national training on the revised data collection tool for 28 PMTCT district
coordinators. In addition, funds will support four regional trainings of five days each for 168 district trainers
(six trainers per district). I-TECH funds will pay for accommodation and per-diem of all participants and eight
facilitators, as well as the training venue costs. I
Ongoing Data Audits
I-TECH will provide support to the PMTCT Unit and the Data Manager to make certain that ongoing data
audits are performed to ensure the quality and completeness of data. The Data Manger will elaborate
protocols for data audits/spot checks. The I-TECH Senior Monitoring and Evaluation (M&E) Officer will
provide support to the Data Manager to identify strengths and weaknesses in the data and to resolve
systems-related problems to ensure data utility. Funds are requested to support the travel of two I-TECH
staff to 28 districts to provide data audits. It is expected that the I-TECH staff will make one visit per district
per year in order to reach all hospitals and some clinics in the FY2009 fiscal year.
From COP08:
In 2005, through USG support, the HHS/CDC/BOTUSA completed the development of a computerized
PMTCT monitoring system and installed it at the national PMTCT offices in the MOH. This system, based
in Epi-Info, was to be rolled out to the districts in FY06 to improve the capacity for monitoring PMTCT
program implementation and quality of care. In anticipation of the roll out of the system,
HHS/CDC/BOTUSA trained 24 PMTCT focal persons and Peace Corps Volunteers (PCVs) in M&E.
However, due to critical human resource shortages at the MOH, including the absence of a data manager,
the rollout was suspended. The absence of a data manager also resulted in a lack of supervision and
guidance on data entry into the database at the MOH, as well as on data collection at the clinic level.
Overall, this resulted in a lack of reliable data for PMTCT program monitoring, and for policy making and
guidance. In 2007 MOH PMTCT Unit was able to hire a Data Manager and the PMTCT Unit was
supported in terms of data quality management. In January 2008, the Data Manager had resigned, leaving
the Unit again without support for activities around implementing, piloting, roll out trainings. This new
activity is intended to improve human capacity and quality of data relating to PMTCT, with the emphasis
areas of strategic information, human resources and local organization capacity building. The activities to
support the PMTCT strategy are:
1. Human capacity development for the PMTCT Unit: Hire and second to MOH/PMTCT a data manager:
Grade: D2 @$40,500 per annum = $54,000 (including salary, benefits, etc)
Justification for the Position
This position will supervise two data clerks and be responsible for the PMTCT information systems, M&E.
The position is stationed in Gaborone at MOH.
2. I-TECH Training Coordinator - $54,000 per annum @ 10% time
This position will contribute to the overall efficacy of the training portions of this project
In collaboration with the entire PMTCT team, I-TECH will provide ongoing mentoring and team building
among the national PMTCT team. In addition, I-TECH will assist the program to establish mechanisms and
procedures for data quality control, and take necessary steps to ensure data reliability. This component will
compliment the Botswana government's effort in building human resource capacity to manage the PMTCT
program both at the national and district levels. Train 16 PMTCT Unit MOH staff in SPSS. ($50,000)
2. PMTCT data quality: Complete, accurate, and timely data are critical in M&E the PMTCT program. I-
TECH will pilot the PMTCT data collection forms in 4 districts with MOH guidance, and based on the
findings revise the tools. I-TECH will roll out the tool in all 24 districts; train health care workers (including
PMTCT District Coordinators) in all the districts on the new tool; Develop and Conduct a data audit,
immediately following the introduction of the new system; Create and maintain a system for regular audits of
data; ($240,500)
3. EID (Early Infant Diagnosis): Starting November 2007, I-TECH is assisting the MH/PMTCT Unit with data
collection for the EIS program- this activity needs to continue as at this point in time, MOH is not ready
given the shortage of human resources to take on this activity. ($50,000)
A portion of these funds will cover technical assistance and management costs for I-TECH in-country.
Activity Narrative:
New/Continuing Activity: Continuing Activity
Continuing Activity: 19624
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
19624 19624.08 HHS/Health University of 7713 1331.08 I-TECH $500,000
Resources Washington
Services
Administration
Table 3.3.01:
09.C.AC07: University of Pennsylvania - Training in Palliative Care
The goal of the Botswana-University of Pennsylvania Partnership is to provide ongoing clinical mentoring to
healthcare workers providing Anti-Retroviral (ARV) and palliative care services in order to improve the
quality of patient care.
In 2008, the Partnership provided palliative care services, healthcare training and clinical mentoring in 15
healthcare facilities, including the two main referral hospitals, Princess Marina (Gaborone) and
Nyangabgwe Referral Hospital (Francistown) in the southern and northern parts of the country, respectively,
as well as at seven regional hospitals and six remote primary and district hospitals. The remote sites were
visited in collaboration with Airborne Life Line. In terms of training, 115 healthcare workers were given direct
training in palliative care and 132 workers indirect training. Additionally, 1319 patients were provided direct
palliative care and 23,645 indirect palliative care. Antiretroviral (ARV) treatment was provided to patients
mainly at the two referral hospitals.
At the end of FY2008, more than 5000 patients will have been started on ARV treatment since 2004. These
services were provided by six specialist physicians, four in Gaborone and two in Francistown. In FY2009,
we propose to continue the same services at the 15 facilities, but decrease the number of physicians to five,
three in Gaborone and two in Francistown. In Gaborone, the physicians will spend most of their time in the
Infectious Diseases Clinic and only a small fraction in inpatient settings, so that they are familiar with the
inpatient services and can provide relevant information at the outreach sites.
We also propose an evaluation of the palliative care program, which has been funded since 2004. This will
enable us to know if the program is meeting its goals and working in the most efficient and effective manner.
The scope and direction of the Penn - Botswana program continues to evolve. At the inception of the
PEPFAR funded program, Penn deployed one Botswana based faculty member in Gaborone with the goal
of providing high quality HIV related palliative care and treatment training to clinicians at PMH and NRH.
The program has expanded to include an outreach program to each district hospital where the goals are to
increase knowledge and improvement in the standard of patient care to those suffering with HIV/AIDS and
opportunistic infections. In 2007 with 6 specialists deployed at both referral hospitals the program will
directly influence the treatment of some 5,000 inpatients at the two referral hospitals and have an indirect
influenced on the care and treatment of some 6,000 patients at the district hospitals by having delivered
some 80 training sessions to 60 doctors under our outreach education program.
During 2007 Penn specialists have also assisted the MOH in developing their guidelines for palliative care
and will, by the end of COP07, have developed with I-TECH the clinical guidelines covering palliative care
for the MOH. In 2008 a curriculum will be compiled for the training and the service will be extended to some
periferal primary hospitals.
In patient services
Penn will have a total staff presence of four internal medicine specialists in Gaborone and two in
Francistown. They will provide inpatient care to the medical department that has a total of some 150 beds
within the two referral hospitals. However with the severe overcrowding of these beds it is expected that
these staff will deliver direct care to some 5000 inpatients suffering with HIV/AIDS and its co -infections.
As well as providing direct inpatient care Penn will also undertake a structured educational training program
aimed directly at affecting the care practices other internal medicine clinicians perform as well as a similar
program given to all clinical staff (doctors and some nursing staff) in the practice of medicine related to
HIV/AIDS. Some 250 clinicians at the 2 referral hospitals will be able to benefit from this education program.
Out patient services
During 2007 Penn started specialized HIV clinics at both referral hospitals. These clinics created a "one
stop shop" idea for patients with HIV and complications such as metabolic problems, co-morbidity issues
and co-infections that can be managed as outpatients. Clinics are run three days a week and during COP08
it is expected that some 2,500 to 3,000 patients will be managed in these specialized clinics.
Outreach services.
Botswana's 2 referral hospitals have patients referred to them by 11 district hospitals and 14 primary
hospitals. With the current HIV/AIDS pandemic, the increasing rate of OIs in patients suffering from
HIV/AIDS, the lack of clinical skills in the primary and district hospitals to manage these opportunistic
infections leads to their subsequent referral to the two referral hospitals. This is in itself is a major cause of
their overcrowding. The Penn outreach program aims at training with both lectures and direct bedside
teaching the management of patients with HIV/AIDS and opportunistic infections.
It is expected therefore that some 180 lectures will be delivered to some 60-70 primary and district hospital
doctors. This will directly affect the care of some 8,000 patients admitted to these primary and district
hospitals with HIV/AIDS and hopefully stop up to 2500 being referred to district and eventually to the main
referral hospitals in FY2008.
Continuing Activity: 17284
17284 10286.08 HHS/Health University of 7713 1331.08 I-TECH $799,000
10286 10286.07 HHS/Health University of 5285 1331.07 ITECH GHAI $798,698
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $600,200
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.08:
09.C.AC08: ITECH - Support of STI Syndromic Management
STI Human Resources and Developing Staff Capacity
I-TECH requests funds in FY2009 to continue to support salaries for the three I-TECH Sexually Transmitted
Infections (STI) Trainers who collaborate with the STI Unit, as well as for travel costs for staff to conduct
clinical mentoring training and visits in the districts. I-TECH will build the capacity of these trainers through
on-going technical assistance and professional development opportunities. The trainers will be included in
an I-TECH Training of Trainers (TOT) on mentoring to build their mentoring abilities to enhance their
training and mentoring in the districts. Based upon the highly positive experience of the STI Unit staff in
FY2008, I-TECH will sponsor one additional Ministry of Health (MOH) employee to attend the University of
Washington (UW) Principles of HIV/STD Research course in July, 2009.
Support of STI Clinical Mentoring
I-TECH requests funds to continue to support the STI Unit in leading a national program in clinical
mentoring for high-quality STI syndromic management in Botswana. Specifically, I-TECH will provide
support to the National STI Training and Research Center (NSTRC) Master Trainers to provide training on
clinical mentoring in the remaining 18 districts, using the revised clinical mentoring guide. Funding is
requested to support the workshop package for four clinical mentoring trainings and one workshop for
clinical mentors trained in previous years, as well as for the travel costs of Master Trainers to conduct follow
-up visits with the clinical mentors. Funds, as mentioned above, will also be used for skill-building and
professional development of Master Trainers by providing technical assistance to the Master Trainers in
developing a plan for the scale-up, monitoring and evaluation of mentoring activities.
For this activity, FY2009 funds will support completion of clinical mentoring rollout that began in FY2007.
Technical assistance will also be provided for developing an exit strategy for I-TECH to ensure that the STI
Unit's capability of carrying out the on-going clinical mentoring activities is sustainable. The MOH, now
having finalized the clinical mentoring guide and developed the mentoring and professional skills of the
Master Trainers, MOH, is currently in the process of planning how to absorb the Master Trainers, and will be
facilitated to do so. Ongoing clinical mentoring activities will be supported by the MOH.
Building Capacity and Systems Strengthening of the NSTRC
The NSTRC was founded in 2002 as a center of STI training and research in Botswana. The center
currently houses an STI clinic and a small training hall, and hopes to expand to include laboratory facilities
and a resource center. The NSTRC also plans to expand from its current training focus to include a
counseling component and clinical and operations research.
In response to NSTRC's plans, I-TECH is requesting funds to build the capacity of the NSTRC through
systems strengthening and data management. FY2009 funds will support Technical Assistance provided by
I-TECH's Senior Monitoring and Evaluation Officer. This individual will build the capacity of the NSTRC in
developing proposals for operations research activities.
FY2009 funds are requested to support the NSTRC in developing an STI resource center for clinicians,
program officers and trainers. The resource center will be housed in the NSTRC. Funds will support
procurement of STI books, manuals and journals, as well as computer equipment. I-TECH will provide
procurement support for basic start-up costs related to the resource center. Future plans will include the
integration of electronic STI resources into the KITSO Training Unit resource center.
Between 2004-2007, the International Training and Education Center on HIV (I-TECH) successfully
supported the MOH National STI Training and Research Center (NSTRC) to implement the revised
Sexually Transmitted Infections (STI) syndromic management training, including the introduction of
acyclovir for genital ulcer disease, to all districts nationwide. Training in syndromic management of STIs
includes routine HIV testing (RHT) of clients as well as risk reduction counseling. In 2007, I-TECH began
supporting the NSTRC to implement clinical mentoring among their district trainers and health care
providers.
In 2008, I-TECH will continue to support the NSTRC to scale up clinical mentoring to the remaining districts
through training of clinical mentors and providing support to trainers during the initiation of clinical
mentoring. PEPFAR funds will be used to develop and reproduce a clinical mentoring guide (training
materials) for all district trainers (27 trainers including master trainers), as well as support partial time and
travel of the I-TECH Quality Improvement (QI) Specialist who is developing this training and supporting the
NSTRC with the scale out.
I-TECH will assist the NSTRC to strengthen the Supportive Supervision Visits conducted. In 2007, there
were 3-4 supervisory visits in 14 districts conducted by the district trainers who were trained by Master
Trainers. The plan is to conduct supervisory visits into the remaining districts (10) and maintain the quality
of mentoring and training in the initial 14 districts.
2008 funds will support four staff at the NSTRC until such time as the MOH is able to absorb these positions
and hire them directly. These include:
- STI Master Trainer at D4 level
- STI Training Coordinator at D3 level
- STI Master Trainer/M&E Officer, all continuing from prior years and
- STI Data Clerk, part time to be supported with 2008 funds.
Activity Narrative: 2008 funds are also requested for MOH/NSTRC staff development, specifically funding the study tour costs
for the MOH/STI Training Coordinator and two other STI Master Trainers from implementing districts to
attend the University of Washington's Principles of HIV & STD Research Course in July 2008.
The I-TECH funded STI Master Trainers are responsible for supporting the district trainers with their
supportive supervision visits, responding to efforts to improve the quality of care, and reporting on the visits.
One of these Master Trainers will also be responsible for scaling up use of acyclovir to the remaining
districts (ten additional districts in Phase 3), providing support to the trainers and pharmacy technicians in
the scale up, and monitoring the correct prescription and stock levels at district clinics and hospitals.
I-TECH will provide technical assistance to the NSTRC on integrating their monitoring activities into the
MOH's overall M&E and surveillance activities. The I-TECH funded Master Trainers will work with the
NSTRC coordinator and clinic staff, administration, Central Medical Stores (CMS), and other stakeholders
to improve the quality of STI care.
2008 funds are requested to support half the salary and relocation costs of a M&E Technical Lead to be
based in the Gaborone office, as well as partial time and one trip for I-TECH (Seattle-based) QI Specialist to
work with the I-TECH M&E Lead to build the capacity of the MOH/STI program with in-service training, how
to enter, analyze and interpret data to result in evidence-based planning activities. I-TECH will conduct
individual training assessments of the STI unit staff in order to tailor training based on individual need and
conduct this training accordingly.
Additional printing of the STI syndromic management training materials (1,000 Participant Handbooks) will
be needed to provide for two additional years' worth of training.
Continuing Activity: 17283
17283 10288.08 HHS/Health University of 7713 1331.08 I-TECH $360,000
10288 10288.07 HHS/Health University of 5285 1331.07 ITECH GHAI $210,621
09.T.AT05: University of Pennsylvania
The scope for this activity is to assist the Ministry of Health (MOH) of the Government of Botswana (GOB) in
providing high quality HIV-related palliative care and treatment training to clinicians at the two referral
hospitals, Princess Marina and Nyangabgwe, and further training in outreach services in palliative care to
selected district and primary hospitals. The goal is to increase the clinicians' knowledge of palliative care
and to improve the standard of patient care to those suffering with HIV/AIDS, TB/HIV and other
opportunistic infections (OI). This should have a direct influence on the treatment of inpatients at the two
referral hospitals and have an indirect influence on the care and treatment at the level of the district and
primary hospitals.
It is expected that the University of Pennsylvania (UPenn) will assist the MOH in developing its clinical
curriculum for palliative care for the University of Botswana's new medical school and, by the end of
FY2009, will have a comprehensive package compiled for the training and services to be extended to some
peripheral primary hospitals. UPenn will train health care workers and other partners according to the
national TB/HIV curricula for nurses and medical officers to ensure adherence to the Botswana National TB
Control Program (BNTP) guidelines and will provide in-service training of health care workers in the care of
children with TB and TB/HIV co-infections and, in collaboration with the BNTP, will implement strategies to
enhance the diagnosis of TB in children and improve contact tracing.
With respect to in-patient services, UPenn will provide inpatient care support to the medical departments
within the two referral hospitals and will deliver direct care to inpatients suffering with HIV/AIDS and its co -
infections, including patients with dual TB/HIV disease and multidrug-resistant TB (MDR-TB). UPenn, in
addition to the direct in-patient care services, will undertake a structured educational training program aimed
directly at enhancing the care practices of various internal medicine clinicians' performance. A similar
program in the practice of medicine related to HIV/AIDS will be arranged for all clinical staff, both doctors
and relevant nursing staff. UPenn will also provide pediatric TB/HIV clinical services at the two referral
hospitals for advanced treatment, consultative, outreach and educational services for TB/HIV co-infected
children and will work with all partners to strengthen linkages between the TB and Anti-retroviral Treatment
(ART) programs at the national, district and facility levels.
In terms of outpatient services, UPenn will run ART clinic and specialized HIV clinics at both referral
hospitals and will provide the standard of care treatment for patients with TB/HIV and MDR-TB. These
clinics will create a "one stop shop" idea for patients with HIV and other complications, such as metabolic
problems, co-morbidity issues and co-infections, which can be managed on an outpatient basis.
Botswana's two referral hospitals have patients referred to them from district hospitals and primary
hospitals. With the current HIV/AIDS pandemic, the increasing rate of opportunistic infections (OI) in
patients suffering from HIV/AIDS and the lack of clinical skills in the primary and district hospitals to manage
these OIs, lead to patients being referred to the two referral hospitals, which is a major cause of their
overcrowding. UPenn will provide an outreach program, using both lectures and direct bedside teaching,
aimed at training clinicians from primary and district hospitals in the management of patients with HIV/AIDS,
TB/HIV and other OIs.
Continuing Activity: 17287
17287 10232.08 HHS/Health University of 7713 1331.08 I-TECH $50,000
10232 10232.07 HHS/Health University of 5285 1331.07 ITECH GHAI $50,000
Health-related Wraparound Programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $50,000
Table 3.3.09:
09.T.AT02: ITECH - Continuing Medical Education Courses
CONTINUING ACTIVITY UNDER PERFORMANCE PASS
From COP08
This activity continues to complement the Botswana national HIV/AIDS training program by providing
workshops on advanced topics of HIV/AIDS care and treatment. Two successful CME trainings on ARV
resistance and salvage ARV regimens, and neurological complications of HIV have been conducted. Each
session trained 75 public and private physicians.
In FY2008, I-TECH will provide another series of didactic and skill-building workshops to physicians on four
advanced HIV/AIDS topics selected by in-country clinicians. For each topic, an experienced clinician trainer
will conduct two workshops, one in Gaborone and one in Francistown. The 2008 scope of work includes
four, one-week trips to Botswana for the I-TECH expert clinical trainer. During each week of trainings, the
clinician/trainer will work with an in-country co-facilitator to conduct lectures, facilitate workshops, and
provide technical assistance to the in-country team as identified. The trainer will develop specific training
objectives prior to each training session, as the topic and audience are identified. PEPFAR funds will cover
time and travel, lodging and per diem of the I-TECH clinical trainer, training materials, training site logistical
costs, as well as a portion of overall I-TECH country management and administrative costs.
Continuing Activity: 17286
17286 10223.08 HHS/Health University of 7713 1331.08 I-TECH $75,000
10223 10223.07 HHS/Health University of 5285 1331.07 ITECH GHAI $312,248
09.T.PT07: I-TECH - ART Outcomes among Children
CONTINUING ACTIVITY UNDER A PERFORMANCE PASS: ONGOING ACTIVITY FOR WHICH NO
ADDITIONAL FY2009 FUNDS ARE REQUESTED - DELAYED IMPLEMENTATION
Expected cost and implementation period: This is a 1-year project to conduct analysis of routinely collected
pediatric data, with an estimated cost of $100,000
Local co-investigator: Drs. Jibril (MOH); Negussie Taffa; Stephane Bodika and Disasi Kisanga (BOTUSA)
Project description: Children age below 15 years made up 9.4% of the total 85,000 people on ART in
Botswana by May 2007. The ARV program (MASA) in Botswana is far advanced in terms of patient-based
information tracking system once an individual is put on ART. The system has limited some systematic
data on pediatric care and treatment that has not been sufficiently utilized to date. This project will conduct
initial data analysis on clinical and immunological profiles of children at HIV diagnosis, disease history, and
treatment outcomes including (if available from the routine record) treatment adherence, drug side effects,
toxicities and occurrence of opportunistic infections.
Evaluation questions
1)What are the clinical profiles HIV infected children who are initiated on ARV treatment?
2)How do these profiles differ by point of entry or referring program (PMTCT, out patient clinic and routine
HIV testing)?
3)What is the level of early mortality (at 3 and 6 months) and what are the common causes?
4)What types of drug toxicities are commonly observed early and late in the course treatment for children
put on ARV therapy?
5)What are the commonly observed opportunistic infections for children on ARV therapy and what factors
are associated with OIs?
6)What are chances of survival after 2-3 years on ARV therapy?
7)What is the level of loss to follow up and treatment adherence as defined by the country's treatment
guideline?
Programmatic importance/anticipated outcomes:
Adequate knowledge of HIV manifestations, treatment outcomes and adherence issues among HIV infected
children in Botswana will inform quality care and treatment design and management. The analysis will be
used to describe the profiles of children in treatment, particularly with respect to adherence and retention,
and to develop a concept sheet for a prospective PHE to evaluate strategies to improve treatment
adherence among children who are suspected as ART failures due to adherence problems. Also part of
this initial project we will consult with other PEFPAR countries in the region who are implementing PHEs on
pediatric adherence in order to learn experiences. A third part of this initial project may be a sample record
review and abstraction from the paper-based medical records of the children receiving treatment at the 24
sites that are not linked to the electronic patient management system (IPMS). For this portion of the
evaluation, we will consult with those countries planning to conduct national pediatric outcomes evaluations
who have already developed protocols and data collection instruments that we might adapt for Botswana.
Method:
This is a retrospective record review of all children (below 12 years of age) initiated on ARV treatment
between 2003 and 2004 in six major ARV treatment hospitals in Botswana (Baylor, Nyangagbwe, Maun,
Molepolole, Selebe-Phikwe, Serowe/Palapye). These sites were among the few initial sites where pediatric
ARV treatment was started alongside the one for adults. It is believed that a complete treatment data worth
3-4 years (i.e. January 2003 to December 2007) is obtainable from the national HIV/AIDS data warehouse.
This data will be counter-checked with electronic patient records at each treatment site for completeness,
accuracy and consistency. Unique identifiers will be developed to merge data from the six sites since
children in Botswana do not have national identity numbers. Frequencies and cross-tabulations will
conducted on selected variables of interest to the study. As indicated above, the study does not involve
field data collection. Data extraction forms will be developed to address study objectives and variables.
Database managers at national HIV/AIDS data warehouse will move the information into data analysis
software of choice.
Population of interest:
Study population: All HIV infected children below 12 years of age who are on ART in public health facilities.
Information dissemination plan:
Study findings will be disseminated to health workers involved in care and treatment of children infected
with HIV in Botswana, and elsewhere as needed. Abstracts will be presented to the national and
international audiences for experience sharing.
Budget justification ($)
Salary 50,000
Equipment5,000
Supplies5,000
Travel15,000
other (contractual services): 25,000
Activity Narrative: Total 100,000
Continuing Activity: 17812
17812 17812.08 HHS/Health University of 7713 1331.08 I-TECH $100,000
Table 3.3.11:
09.C.TB15: I-TECH - Co-morbidity of HIV
In FY2009, I-TECH is requesting funding to support the following activities related to the TB Curriculum and
Training:
Training roll-out:
I-TECH requests FY2009 funds to support lodging and per diem of the nurse master trainer and physician
master trainer to travel to the 25 districts throughout the year in support of ongoing "cascade level" trainings.
Funds will also support the professional development of the master trainers. FY2009 funds will support
partial time of the I-TECH Training Coordinator to abridge and repackage the current 4-day training
curriculum for medical officers to form a two-day, weekend course for private sector health care providers.
Refresher training:
The master trainers will provide four two-day regional refresher trainings, targeting the nurses, medical
officers and TB coordinators trained as district trainers in FY2008.
TB Clinical Mentoring:
I-TECH will support a TB clinical mentoring program for health care workers, building upon the first three
levels of training, namely, didactic, skills-building, and practicum, with the addition of three training levels
through clinical mentoring, which will be on-site mentoring, distance consultation, and systems
strengthening. I-TECH requests funds to hire and second one nurse and one doctor to the Ministry of
Health/Botswana National TB Program (MOH/BNTP) as clinical mentors to build the capacity within the
districts and to support 0.3 FTE of an I-TECH Clinical Advisor who will build the capacity of BNTP-seconded
Clinical Mentors. I-TECH will support MOH/BNTP in its TB clinical mentoring program in four districts,
specifically Mabutsane, Boteti, Tsabong and Ghanzi, and will support clinical mentors' per diem and lodging
expense in the districts.
Pre-service assessment and updating of TB curricula:
In its continued effort to build sustainable capacity, I-TECH requests FY2009 funds to conduct an
assessment among key stakeholders regarding pre-service TB curricula needs and pre-service training in
Botswana's tertiary institutions.
Health Informatics Support:
Both BNTP and MASA have expressed the need to integrate the BNTP and Botswana HIV/AIDS Response
Management System (BHRIMS) databases for effective implementation and national reporting. I-TECH
requests FY2009 funds to second a Senior Informatics Specialist to MOH/BNTP to support the unit in
integrating TB data into eBHRIMS. The Health Informatics Specialist will work closely with the Senior
Epidemiologist who will be supporting the BRHIMS database at National AIDS Coordinating Agency
(NACA).
Based on the Botswana National TB guidelines and program manual, I-TECH Botswana developed a
training package for Medical and Nursing Officers. The curricula include content on TB diagnosis, TB
prevention and infection control, contact tracing, complexities of clinical management, Anti Tuberculosis
Treatment (ATT); Treatment of the dually infected patient; drug-drug interactions/toxicities and sequencing,
and multi-drug resistant TB. Each curriculum consists of a set of presentation slides, a Facilitator Guide,
and a Participant Handbook. Utilizing the I-TECH 5-Level Training Framework, didactic training, skill
building workshops, clinical training, clinical consultation, and technical assistance, I-TECH Botswana will
support building a training structure for BNTP training program to purposefully and incrementally develop
capacity among Botswana health care providers to manage the clinical complexity of TB-HIV co-infection.
This structure will provide steps to lead health care providers from increased knowledge, to building skills, to
receiving support to change practice that would fit newly learned skills and knowledge, to having access to
more advanced consultation in support of new practice, and, finally, technical assistance in system level
changes that may be needed.
As part of this effort, I-TECH will recruit, hire, train, and second to the BNTP MOH two dedicated Master
Trainers to train and mentor Botswana clinicians using the training package developed and piloted by I-
TECH in close collaboration with BNTP and BOTUSA. BNTP in collaboration with I-TECH Botswana
developed a TB Case management training plan for Botswana; Starting April 2008, BNTP with I-TECH
Botswana support plans to train 170 Nurses Officers, 80 Medical Officers and 40 Private doctors. The target
area includes all the districts in Botswana. Funds are requested to support the two positions (one nurse and
one doctor) to be seconded at MOH, to roll out the TB trainings in the districts of Botswana and to support
0.20 FTE I-TECH Botswana Training Coordinator who will oversee this process and the two Master
Trainers. A portion of these funds will cover technical assistance and management costs for I-TECH
management in-country.
Continuing Activity: 19625
19625 19625.08 HHS/Health University of 7713 1331.08 I-TECH $400,000
Estimated amount of funding that is planned for Human Capacity Development $380,000
Table 3.3.12:
09.C.TB03: University of Pennsylvania
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS: Funds are requested to provide monthly
two-day visits to Maun, Kasane, Bobirwa and Serowe District Hospitals by two pediatric clinical specialists
from Francistown to advance the care of TB/HIV infected children and to increase local capacity of on-site
medical officers to deliver state-of-the-art pediatric care.Funds are requested to recruit two nurses and two
social workers to augment TB contact tracing teams in Francistown and Serowe, to strengthen the existing
contract tracing teams and to establish new teams where they are not in place. The focus will be on children
admitted to hospital with TB and HIV-TB co-infected adults at the Infectious Disease Care Clinic (IDCC)
who have children. The nurse/nurse assistant cough team that worked at Ramotswa District Hospital in
FY2008 will teach these skills to colleagues at all district hospitals in Southern Botswana in FY2009. Funds
are requested to disseminate TB meningitis educational material developed in FY2008 to clinics and to
develop the first phase of a national database for pediatric TB cases.
The Penn HIV/TB program was initiated in April 2006 at PMH with PEPFAR funding, with the goals of
strengthening the care of HIV/TB co-infected persons in Botswana through training and education, clinical
consultation and collaboration with the BNTP. More than one third of all TB patients in Gaborone are
diagnosed at PMH.
It is estimated that a quarter of the 2,000 children admitted each year to NRH in Francistown are co-infected
with HIV/TB. NRH has a critical shortage of pediatric specialists: only 6 of the 10 pediatric specialist posts at
NRH are currently filled. This number includes 2 rotating pediatricians from the Baylor Center of Excellence
and an expatriate pediatrician who will be leaving Botswana in late 2007. Each year NRH pediatricians
attend to 2,000 in-patients, 2,000 HIV-infected children in the outpatient HIV clinic and provide limited
outreach work to 4 district hospitals and 12 primary care hospitals.
PMH admits more than 2,000 children per year, 10-20% of whom are co-infected with HIV/TB. There are
only 4 pediatric specialists, including 2 Baylor pediatricians. PMH is the pediatric referral center for 5 district
hospitals and pediatric specialist outreach by the Baylor Pediatric Team reaches 4 of these hospitals. This
proposal will provide pediatric specialist outreach to the fifth, Ramotswa Hospital.
2007 Achievements
In FY2007, the Penn TB/HIV program implemented changes within the reporting systems at PMH to ensure
collection of relevant information, improved TB-HIV surveillance within the facility, improved transition to
district directly observed treatment strategy (DOTS) and eventual referral for ART. During this period, the
PMH IDCC provided care to 266 HIV-TB patients, including 20 with multidrug-resistant TB (MDR-TB).
During the same period, 27 HIV-TB patients were initiated on ART, while 67 TB patients were diagnosed in
other wards and departments at PMH and referred for ART at the IDCC.
The Penn TB/HIV program conducts clinical didactic teaching and clinical mentoring at four district hospital
sites in the greater Gaborone area. The program trained 190 health care workers in TB-HIV palliative care
issues, and participated at BNTP training workshops held in Gaborone for 60 medical officers working in all
hospital facilities in Botswana (three 2-day workshops held in Gaborone, including one exclusively for
private practitioners).
Penn is collaborating with I-TECH to develop new national TB/HIV training curricula for medical officers and
nurses. Penn is actively collaborating with the BNTP to develop and implement a national strategy for MDR-
TB management, and contributed to the finalization of the national TB management manual which was
finalized with FY2007 support.
2008 Plans
PMH, Gaborone
It is proposed to continue with the 2007 activities of providing treatment, consultative and educational
services for HIV/TB co-infected patients, training of 180 health care workers in collaboration with the BNTP
and I-TECH according to the new TB/HIV curricula for nurses and medical officers to ensure adherence to
BNTP guidelines, and strengthening linkages between the hospital and the national TB and ART programs.
It is proposed to continue with the subspecialty HIV/TB clinic at PMH and to provide TB treatment to 180
HIV-infected clients with TB disease (particularly those patients with drug-resistant TB), HIV counseling and
testing to 600 registered TB patients, and clinical prophylaxis for TB to 200 HIV-infected individuals. The
Penn TB/HIV program intends to refer 600 patients for DOTS in the Gaborone City Health Clinics, and to
refer 90 TB patients for HIV care at local IDCCs.
The baseline proportion of HIV-infected IDCC clients screened for TB infection in 2007 will be evaluated
and it is intended to improve the proportion by 5%-10% in 2008. It was determined that approximately 90%
of TB patients are offered screening for HIV. The targeted rate for 2008 will increase this by 5%. In 2007,
only 50% of HIV/TB co-infected patients at PMH had baseline CD4 testing. It is intended to improve the rate
by 10%-20% in 2008.
It is proposed to increase the TB/HIV program by adding one full-time specialist and one nurse to do TB/HIV
co-infection work at PMH at a cost of $110,000. Specific areas that require more staffing include: clinical
work; infection control at PMH; outreach to the City Council Clinics and Primary Hospitals; greater
involvement in developing and implementing a nationwide TB training program; expanded participation on
ministry related committees, task forces and workshops.
It is proposed to form 2 TB Support Teams (TB teams) of lay persons trained to carry out basic diagnostic
Activity Narrative: and reporting functions for the enhanced management and diagnosis of TB and TB-HIV. Health care
workers (HCWs) are overburdened, in short supply and are currently responsible for most activities related
to TB control in the health facility. Therefore, trained local technical staff could help TB diagnosis and follow-
up. The hospital-based TB team would be comprised of two individuals (with nurse and physician backup)
who will 1) conduct simple symptom screens on all admitted medical patients to identify TB suspects; 2)
collect sputum specimens from all identified TB suspects (expectorated or induced samples); 3) transport,
retrieve and report on all specimen results to the appropriate health care teams caring for the individual
patients; 4) perform rapid bed-side HIV testing on all TB-suspects with no known HIV result; 5) submit
serum for CD4 T-cell testing on HIV infected patients; 6) initiate access to HIV and TB services for identified
patients.
A second TB support team will be based in the City Clinics and will have a similar composition with the
primary responsibility of ensuring specimen collection and reporting of all TB patients during TB treatment
(at 2 months to initiate consolidation of TB therapy in those responding to treatment and at 6 months to test
for cure). All Gaborone City Clinics will be monitored with the goal of scheduling follow up visits at the
various clinics on different days of the month such that the TB team can see all the patients. The cost for
the TB support teams will be $80,000.
Nyangabgwe Referral Hospital, Francistown
PEPFAR funds will be used to recruit two pediatric clinical specialists to advance treatment, consultative,
outreach and educational services for HIV/TB co-infected children in Francistown. Activities include
increasing the capacity to deliver care to HIV/TB infected children in both the in- and out-patient settings at
Francistown with outreach services to all the city clinics. PEPFAR will train 15 medical officers in the
Francistown area in the care of children with TB and HIV/TB co-infection through case-based discussions
and didactic lectures. Two nurses and two social workers will be recruited to initiate a pilot contact tracing
program at PMH, focusing on 2 key areas: (1) children admitted to PMH with TB, and (2) HIV-TB co-
infected adults at the Penn-Botswana IDCC clinic who have children. USG funds will support the training of
30 medical officers and pediatricians at PMH, Ramotswa Hospital, NRH, Maun and Kasane Hospitals on
contact tracing of patients with TB and HIV/TB co-infection.
At PMH, a cough team composed of one nurse and one nursing assistant will be formed to collect samples
from children (gastric washing or induced sputa), take samples to the laboratory, and follow up on all results
via a detailed log book. This pilot project to enhance the diagnosis of TB in children has the potential for
expansion to other district hospitals. To coordinate data entry, it is proposed to recruit one data manager.
The Botswana-Penn Adult HIV/TB program began at PMH in April 2006 with FY06 support. The program
has subsequently expanded and continues to build local infrastructure to improve the care of HIV/TB
infected adults. USG funds will support the Penn-Botswana Program and their pediatric partner, The
Children's Hospital of Philadelphia (CHOP) in strengthening the pediatric partnership between PMH, NRH
and Penn-CHOP.
Continuing Activity: 17285
17285 5158.08 HHS/Health University of 7713 1331.08 I-TECH $805,000
9858 5158.07 HHS/Health University of 5285 1331.07 ITECH GHAI $183,509
5158 5158.06 HHS/Health University of 3602 2412.06 ITECH $163,826
Resources Pennsylvania
09.T.LS03: I-TECH - Laboratory Positions Support
ACTIVITY HAS BEEN CHANGED IN THE FOLLOWING WAYS:
In FY2009, I-TECH is requesting funding to support the following activities:
Activity 1 - Human Resources
Funds are needed for the continuation of salary support for a laboratory scientist at the Botswana Harvard
HIV Reference Laboratory (BHHRL), two laboratory technicians at the National Quality Assurance
Laboratory (NQAL).
Additionally, funds are needed to continue the support of the Program Coordinator, Lecturer and two
laboratory technician positions seconded to the Bachelor of Science Medical Laboratory Sciences to
upgrade program at the University of Botswana.
Activity 2 - National Phlebotomy Curriculum
In FY2008, I-TECH developed a national phlebotomy curriculum. In COP09, funding is requested to pilot the
training program and roll-out training of phlebotomists.
Activity 3 - Curriculum: 4-Year B.Sc. Medical Laboratory Sciences degree (New)
The proposed 1-year training program at the University of Botswana that will commence in January 2009 is
a transitional arrangement in response to an urgent national need for medical laboratory scientists with
requisite knowledge and skills to perform complex diagnostic procedures in clinical laboratories. The long-
term goal is to develop a 4-year degree program with two exit points: diploma level after two years and
degree level after four years of study. This will be accomplished in phases.
The first phase entails curriculum development. In FY2009, I-TECH is requesting funding to support the
Ministry of Health (MOH), Institute of Health Sciences (IHS) and University of Botswana (UB) to develop a
curriculum for a four-year degree program in medical laboratory sciences.
Activity 4 - Pre-service assessment and updating of TB curriculum (New)
The pre-service curriculum should be guided by current knowledge and the requirements of service
providers. In FY2009, funds are requested to conduct an assessment of the IHS medical laboratory
technology pre-service TB curriculum needs. A Technical Working Group (TWG) made up of IHS, the TB
Reference Laboratory, the National Health Laboratory and the MOH will convene to discuss and document
needs related to the pre-service curriculum. The level and current relevance of the TB content in the training
curriculum for medical laboratory technicians will be determined through the TWG. Funds will support the
updating of the curriculum based on recommendations of the TWG.
Activity 1: Continuation of salary support for 1) Lab Scientist performing EID at Gaborone and 2) Lab
Scientist performing national quality assurance program
The International Training and Education Center on HIV (I-TECH) will be continuing with the salary support
for these 2 laboratory scientists. Costs include salary, benefits and local administration.
Laboratory Scientist placed at the Botswana-Harvard HIV Reference Laboratory
The laboratory scientist is responsible for testing infant DBS samples for early HIV diagnosis and the QA
system in the laboratory for infant DBS. The laboratory scientist also carries out CD4, viral load, and
resistance testing. The activities of this position are essential for the success of ARV treatment program in
pediatric patients.
Laboratory Scientist placed at the National Quality Assurance Laboratory
I-TECH will continue salary support for the position of one laboratory scientist at the National Quality
Assurance Laboratory (NQAL). This position characterizes proficiency testing specimens for different HIV
laboratory testing to support the NQAS; coordinates and organizes training in collaboration with the QA Unit
at MOH for lab techs; and assists laboratories in the annual proficiency testing. Shortage of staff at the
NQAL is an obstacle for quality assurance/quality control (QA/QC) implementation and rolling out of the QA
program in the country.
Activity 2: Continuation of Pre-Service Training Activities
Building upon the pre-service curriculum and training activities with the Institutes of Health Sciences (IHS) in
2007, and the technical assistance provided to explore development of the three-year program into a four-
year Laboratory Technician Bachelor's degree at the University of Botswana, I-TECH is requesting funds to
continue providing the TA to IHS and UB regarding the potential for a four-year degree program.
Activity 3: IHS capacity strengthening
In 2007 a pre-service training program was developed and PEPFAR supported the salary of five lecturers in
three district laboratories. Turnover is high and a steady cadre of trainers is not consistently available.
FY2008 funds will support three part-time trainers for these laboratories. It is anticipated that the part-time
employment may be more attractive to those with the qualifications and retention may be easier as a result.
Continuing Activity: 17288
17288 10259.08 HHS/Health University of 7713 1331.08 I-TECH $400,000
10259 10259.07 HHS/Health University of 5285 1331.07 ITECH GHAI $558,981
Estimated amount of funding that is planned for Human Capacity Development $800,000
Table 3.3.16:
09.X.SI10: I-TECH: M&E Support
The International Training and Education Center on HIV (I-TECH) requests funding to continue to support
two senior technical positions in the Ministry of Health (MOH). This includes providing continued support for
a Senior Epidemiologist at Department of HIV/AIDS Prevention and Care (DHAPC) who is providing
systems strengthening and capacity development in relation to the national surveillance systems in
Botswana. Additionally, I-TECH will continue to provide support for a Senior Health Informatics Officer for
the Department of Policy, Planning, and Monitoring and Evaluation (DPPME). FY2009 funds are also
requested to continue providing training and mentoring to the Monitoring and Evaluation (M&E) Officers
through support of two M&E Mentor positions and professional development of M&E supervisors.
Individualized Training and Mentoring of M&E Officers
The focus of the training and mentoring activities will be to move each M&E Officer from a functional skill
level to a level of excellence. I-TECH will develop and administer a knowledge and skills assessment to
identify individual gaps in knowledge and skills, as well as site-specific challenges and will tailor the training
and mentoring plan accordingly. In relation to the training activities, I-TECH will provide the Ministry of
Local Government (MLG) with technical assistance and curriculum development support for trainings to be
funded and organized by MLG. This will include providing the M&E Officers with skills they will need to
conduct sensitization workshops within their respective districts. Specifically, I-TECH will provide MLG with
support in the planning and implementation of one national workshop and two sets of regional workshops to
each be conducted in two regions, namely Gaborone and Francistown.
Mentoring visits will continue with each experienced M&E Officer receiving three sets of day-long mentoring
visits. It is anticipated that attrition rates will increase as the M&E Officers become more experienced. To
provide training to newly hired M&E Officers, I-TECH will conduct mentoring visits that are longer in duration
for newly hired M&E Officers. New M&E Officers will also receive three visits per fiscal year. Mentoring
activities will be developed around the two senior M&E Officers at MLG. I-TECH, in conjunction with the
Senior M&E Officers will develop a list key knowledge, skill, and ability areas critical to helping ensure that
the Senior M&E Officers are effective at carrying out their job duties. These competencies will be prioritized
and I-TECH staff will then work one-on-one with the Senior M&E Officers to help ensure they have the
necessary technical skills. In addition, I-TECH will provide technical assistance to the Senior M&E Officers
in the development and implementation of the President's Emergency Plan for AIDS Relief (PEPFAR)-
funded Data Quality Assurance Pilot Project being lead by MLG. I-TECH will provide human resource
support to MOH to conduct HIV drug resistance surveys during FY2009.
In order to share this cutting edge mentoring and training program with national and international
organizations, FY2009 funds will be used to begin collecting video footage of the challenges and successes
experienced by the M&E Officers. I-TECH has extensive expertise in media production and has produced
several video and media products in various countries, including Botswana, to address HIV-related training
and mentoring. The video footage collected will provide material that can later be used to showcase the
successes and challenges of this unique program. The collection of video footage and future processing
and packaging of this footage will be done in collaboration with the BOTUSA Communication Officers.
National Assessment of Data Transfer Systems
FY2009 funds are also requested to conduct a situational analysis of data transfer systems. This
assessment will focus on HIV-related programs with the intent of collecting the necessary information to
develop more effective strategies for data transfer. Specifically, this will involve investigating the transfer of
data from patient-level data at the facility-level to its ultimate integration into nationally reported health
statistics. The assessment will involve mapping the process and documenting the strengths and challenges
at each stage. The situational analysis will look at issues around data drop-off and will be utilized to
formulate realistic suggestions for improvement at each step of the data transfer process—facility, district,
and national levels. Methods will include key informant interviews and data audits. The situation analysis
will be performed in three districts with a mix of urban, rural, large, and small districts.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.17:
This PHE has been approved BW.08.0204.
A Publc Health Evaluationo of Male Circumcision Service Delivery and Impact on Population Risk Behaviors
and HIV Incidence.
Estimated amount of funding that is planned for Public Health Evaluation $515,000
09.X.SS16: I-TECH - In Service Training Technical Assistance
This is a continuing activity that aims to build the capacity of the training unit in the Department of HIV/AIDS
Prevention and Care in the Ministry of Health ((MOH). Funding and support for three training unit staff
seconded to MOH and the operation of the Resource Center developed in FY2008 will continue. ITECH will
develop a three-day in-service training for trainers and update 150 trainers with advanced training skills,
which will be one of the activity's major outputs in FY2009.
(Change of funding mechanism from HHS/CDC New Coag (7853.08) to HHS/HRSA I-TECH (1331.08);
Change Prime Partner from TBD to Uni of Washington; Increase funding amount from 200,000 to 450,000)
08-X1418: In-service Training Technical Assistance
Since the beginning of the epidemic, the Government of Botswana has responded proactively and rapidly to
the HIV/AIDS epidemic by training health care professionals to provide HIV/AIDS prevention, treatment and
care services. In 2000, a training need assessment was conducted to inform the development of a
coordinated approach to in-service training. This laid the groundwork for the establishment of the KITSO
AIDS Training program, the national training program for HIV/AIDS care and treatment, in 2001. By
September 2006, 7,240 health care workers received theoretical and practical training in HIV/AIDS.
Despite the above-mentioned achievements, the following constraints were experienced: Roles for different
partners were not clearly stipulated; existence of many training materials and tools developed locally and
internationally targeting the same health care providers, and; absence of long-term training plan and
structure to ensure sustainability, comprehensiveness and responsiveness of the training programs.
To address these constraints, the Ministry, with USG funding, developed the KITSO Expansion Plan 2004
to guide the MOH and its training partners in the coordination of HIV/AIDS health professionals training in
Botswana. As recommended, the Department of HIV/AIDS Prevention and Care (DHAPC) established the
KITSO HIV/AIDS Training Coordinating Unit to ensure comprehensive, standardized, coordinated HIV/
AIDS training and bring all existing and future trainings under the leadership and direction of the MOH. To
further this objective, there is need to strengthen the current training system by developing training
structures and guidelines, evaluating and revising current training materials and developing new training
materials where necessary.
2008:
Conduct an assessment of existing HIV/AIDS training, training mechanisms, including the training models
(TOT, master trainers), coordination, monitoring and evaluation and the certification process; develop
appropriate structures and guidelines for the coordination, and effective implementation of in-service
HIV/AIDS-focused training
Continuing Activity: 17924
17924 17924.08 HHS/Health University of 7713 1331.08 I-TECH $450,000
Estimated amount of funding that is planned for Human Capacity Development $500,000
Table 3.3.18:
09.X.SS18: TBD - Strengthening Lay Counselor
This activity is a follow on activity that will implement recommendations made during an evaluation
conducted in FY2008.
An important challenge faced by the health care system in Botswana is the shortage of skilled health
professionals. Since 2002, the President's Emergency Plan for AIDS Relief (PEPFAR) and other
development partners have supported the utilization of non-professional health workers in the provision of
HIV prevention, treatment and care services in Botswana's health facilities. The World Health Organization
(WHO) supports the increased use of auxiliary health workers and the newly developed Human Resources
for Health (HRH) Plan for Botswana recommends greater use of mid-level workers, lay counselors in
particular, in the health care system. In 2008, PEPFAR commissioned an evaluation of the lay counselor
cadre to identify implementation challenges and make recommendations for strengthening this cadre.
Based on the recommendations from the evaluation, a technical assistance partner will be chosen to: (1)
develop/revise and disseminate standards related to lay counselor recruitment, selection, training, job
duties, and supervisory structure; (2) provide technical assistance for the review and revision of the training
curriculum; and (3) undertake any other evaluation recommendation as identified
PEPFAR will continue to collaborate with the Ministry of Health (MOH), the Ministry of Local Government
(MLG), the National AIDS Coordinating Committee (NACA), African Comprehensive HIV/AIDS Partnership
(ACHAP), and the Global Fund. The outputs for this activity include the development of standards and
guidelines for lay counselors and the revision of the training curriculum.
(See page 463 in COP08)
Estimated amount of funding that is planned for Human Capacity Development $200,000
