The Botswana-University of Pennsylvania (BUP) aims to build capacity throughout Botswana in response to the HIV/AIDS epidemic. BUP trains health care providers in prevention and treatment of HIV/AIDS and its complications and supports development of post-graduate training programs at the University of Botswana (UB).

BUP has developed educational programs and consultative services to compliment clinical care and build capacity of Botswana health care providers, focusing on complicated aspects of HIV management and related medical conditions including multi drug-resistant TB (MDR-TB), the See and Treat approach to cervical cancer prevention, and enhanced diagnosis of pediatric TB. Formal didactic training and direct clinical teaching and mentoring target physicians and nurses at 23 health facilities in 11 districts in both inpatient and outpatient settings.

Strong partnerships with the MOH and UB School of Medicine (SOM) to build capacity, share consultative expertise in HIV and co-infection management, and support informatics infrastructure and integration will encourage future sustainability and country ownership. BUPs engagement with UB SOM provides teaching and mentoring to pediatric, internal medicine, and family medicine residents as well as medical students. In coming years BUP will intensify support to MOH and UB SOM to develop and integrate telemedicine and informatics in programs and infrastructure, extending service coverage, knowledge access, and service provision.

Botswana-University of Pennsylvania (BUP) aims to increase the quality of care received by HIV-infected adults by providing outreach to the southern districts, collaborating with the University of Botswana School of Medicine (UBSOM), and developing adult inpatient care guidelines. BUP provides continuing medical education and specialist services to eight hospitals on a monthly basis. Our program provides training and support to the districts, improving care while decreasing the need for referrals. In future, outreach services will transition to the Department of Medicine at Princess Marina Hospital with provision by MOH specialists. BUP provides 40% of the staffing for the Department of Medicine (DOM) for training of residents and medical students. Through our collaborations with the DOM we continue to support training of future Batswana specialists, some of whom may join the faculty. In collaboration with our partners, we will draft six national guidelines and begin training and implementation for all. Pilot implementation will first occur in FY 2012 at three hospitals. The adult inpatient guideline steering committee is currently reviewing the first three drafts; another three drafts are in development. An outcomes evaluation will examine the impact of one guideline on improved practice and health outcomes.The pilot See and Treat (SAT) program aims to improve the health of HIV+ women. It provides cervical care to HIV+ women through screening for and treatment of pre-cervical cancer lesions in Gaborone. BUP established the program at a community clinic in Gaborone with colposcopy and loop electrosurgical excision procedure (LEEP) occurring at the nearby Princess Marina Hospital (PMH). Strong linkages exist between the SAT clinic and other service providers including the sexually transmitted infection clinic, infectious disease care centers, and PMH gynecology clinic. Our referral clinic also provides treatment to patients referred for management of abnormal Pap smears. The program will extend services to Francistown to cater for the northern part of the country by training an additional medical officer in colposcopy and LEEP. The program will continue providing expert advice to the National Cervical Cancer Prevention Committee, National HIV Specialist Committee, and others as requested. We will build capacity of health care workers to provide quality care and treatment services for cervical cancer prevention. We will strengthen womens health pre- and in-service training programs for health care workers and continue to deliver lectures on cervical cancer prevention to various organizations including the HIV society, UBSOM, and others. A weekly quality assurance meeting led by a specialist gynecologist reviews all pictures taken by nurses at the SAT clinic. After March 2012, a program evaluation will consider the numbers screened and treated in the programs first three years and estimate impact on disease prevention.

Botswana-University of Pennsylvania (BUP) TB/HIV Program improves the prevention, diagnosis, and treatment of adult and pediatric patients with TB/HIV and drug resistant (DR)-TB through clinical, teaching and technical support to the Ministry of Health (MOH), Botswana National TB Program (BNTP), and University of Botswana School of Medicine (UBSOM). The objectives for FY 2012 are to 1) strengthen clinical care of all TB/HIV and DR-TB patients; 2) optimize referral systems and provide consultative and outreach services to medical care providers of TB/HIV and DR-TB patients; 3) enhance pediatric TB diagnosis by training nurses nationwide to do gastric aspirates; 4) prevent new TB cases through isoniazid preventive therapy (IPT) in children and tracing of all case contacts; 5) provide TB/HIV and DR-TB clinical training and mentoring for clinicians and UBSOM students and residents; 6) enhance UBSOMs clinical education capacity through curriculum and guideline development and use of novel education tools; and 7) provide TB/HIV and DR-TB technical assistance to MOH.

Despite Botswanas HIV successes, several key challenges remain such as TB/HIV co-infection, increasing DR-TB, pediatric TB, and the health systems capacity to respond to an evolving HIV epidemic. Princess Marina and Nyangabgwe Referral Hospitals (PMH and NRH) TB/HIV clinics provide referral care for complicated TB/HIV, including a majority of DR-TB cases. The PMH clinic serves as a teaching site for DR-TB clinicians and UB trainees. MOH staffs five DR-TB centers in Botswana with regular outreach support from BUP specialists. Nationwide outreach visits include significant support to UB Department of Family Medicine (DFM) in Maun and Mahalapye. BUP teaches an advanced TB/HIV curriculum to doctors, nurses, and UB students. Two BUP specialists teach on the UB inpatient medical teaching service at PMH. BUP created a TB/HIV elective for UB students. In 2011, BUP specialists provided technical support to revision of the National TB Manual, National TB/HIV Policy Guideline, TB Infection Control Guidelines, DR-TB Management Guidelines, and Integrated Management of Childhood Illness. We continue to assist with development of the Global Fund Application, BNTP Strategic Plan, National HIV Guidelines revision, MOHs Pediatric Technical Working Group, and IPT Taskforce. BUP has supported TB contact tracing established in Gaborone and trained community volunteers.

Future plans are to continue direct TB/HIV clinical mentoring to doctors selected by MOH to staff DR-TB centers; assist MOH to develop a sixth DR-TB center; improve patient referral and consultation between outreach sites and PMH TB/HIV clinic; begin a weekly family TB/HIV clinic at PMH for adult and pediatric referrals and UB trainee teaching; continue UB adult inpatient medical teaching and begin for pediatrics; continue clinical mentoring for UB trainees at PMH TB/HIV clinic and transfer clinic leadership to UB; increase support to UB DFM through outreach visits and guideline development; assist UB to optimize general pediatric in- and out-patient curricula for trainees; expand enhanced pediatric TB diagnosis to three new districts and support existing sites using scaled withdrawal; expand TB contact tracing through community training; and continue TB/HIV and DR-TB technical support as requested by MOH.

The Health Informatics Program of the Botswana- University of Pennsylvania (BUP) focuses on supporting the Ministry of Healths (MOH) strategies related to optimizing health information systems (HIS); improving and integrating telemedicine and disease surveillance initiatives including those enhancing HIV/AIDS interventions to expand the reach of specialty care in Botswana; and collaborating with the University of Botswana (UB) and other local stakeholders to build awareness and capacity for health informatics nationwide.

The objectives for FY 2012 are to 1) expand and upgrade existing mobile telemedicine initiatives in collaboration with MOH in order to increase specialist access in underserved areas and provide training and technical assistance to local clinicians in order to effectively utilize these systems; 2) host, with local partners, a national health informatics conference in early 2012 and continue to foster collaboration and training of local partners from the conference through smaller working group meetings; 3) collaborate on development of an information systems blueprint for HIS within the MOH; and 4) work closely with UB School of Medicine (SOM) to integrate health informatics into their curriculum, as well as create opportunities for faculty development.

Mobile telemedicine has proven to be an inexpensive and effective method to expand specialist care and disease surveillance in underserved areas. The 2012 national informatics conference will highlight the importance of health informatics and create a forum for all local stakeholders in Botswana to meet and explore opportunities for collaboration. Health Programme Development, Monitoring, and Evaluation (HPDME) is a new department in the MOH which is tasked with formulating an information systems blueprint for HIS within the MOH.

Since 2008, BUP has conducted research and implemented several types of mobile phone health initiatives in numerous clinics throughout Botswana. BUP is part of the technical working group within the MoH and has worked with HPDME since October of 2010. HPDME has expressed interest in advisory support from health informatics specialists at BUP. BUP completed and delivered an introductory health informatics workshop curriculum to 76 medical students at UB SOM, in collaboration with a UB SOM faculty member and a few guest speakers from the MOH.

The long-term plan is for BUP to integrate the mobile telemedicine system, including key staff, into the MOH in the coming years. BUP will also support a public-private partnership between two key partners in Orange Botswana (a mobile phone provider) and the MOH. BUP will continue to facilitate local collaboration and capacity building. Since HPDME is a new department and contains skill gaps related to health informatics, BUP will share its health informatics specialties and train members of the group upon request. BUP will work to integrate informatics into curriculum and empower the faculty to manage those components on their own in coming years through programs in faculty development.