EDUCATION & TRAINING: PEPFAR

In alignment with the needs of Masa, Botswana's National ART Program, the BHP PEPFAR (President's Emergency Plan for AIDS Relief) program addresses three critical areas—training, monitoring and evaluation.

Begun in 2004, the BHP-PEPFAR Master Trainer and Site Support Program is aimed at developing sustainable training capacity in clinical care and treatment of HIV/AIDS patients, expanding CD4, viral load, and other laboratory testing to decentralized laboratories, and strengthening the Botswana Ministry of Health's monitoring and evaluation capacity to evaluate the efficacy of Masa.

Funded by the United States Government Department of Health and Human Services, the project consists of three program components:

Clinical Master Trainer/ARV Site Support Program (CMT)
This program provides ongoing, site-specific training, mentoring, and on-site and telephone support to ARV therapy sites designated by the Ministry of Health (MoH). These activities ensure that health care professionals are up-to-date in all aspects of HIV/AIDS treatment and care, that they strengthen and reinforce their skills on a continual basis, and that they receive technical mentoring and support at ARV sites.

CMT activities include training and support of 32 hospital and 72 clinic ARV sites (more than 3,800 healthcare workers have been trained by CMTs to date); assistance with establishing new ARV rollout sites at the request of the MoH; development and implementation of the four-day Nurse Dispenser and 30-day Nurse Prescriber and Dispenser training; implementation of the Newborn Care and Neonatal Resuscitation (Perinatal Education) curriculum; spearheading the establishment of Failure Management Registries at ARV sites (20 of the 32 sites now have a functioning failure management reporting system.); and expanding efforts in TB/HIV Integration; Universal HAART through the PMTCT program; Paediatric scale up; Site-level Drug Supply Management; and QAI support to teams at ARV sites.

Laboratory Master Trainer/ARV Site Support Program (LMT)
The LMT program was developed to support the government's goal of establishing decentralized laboratories capable of performing CD4, viral load, and other laboratory testing to relieve the burden and time delays at the country's two National HIV Reference Laboratories in Gaborone and Francistown.

LMT activities include establishing and supporting decentralized laboratories. Currently there are 21 decentralized labs performing 59% of CD4s and eight decentralized labs performing 30% of viral loads countrywide. The LMTs have trained more than 125 laboratory staff and are conducting five-day theoretical and practical trainings of the new laboratory training manual for which they spearheaded development. Topics of the Laboratory Training Manual include the following:

• Overview of HIV and AIDS, Botswana National HIV/AIDS Treatment Guidelines
• Specimen Management and Tracking in the Laboratory
• Diagnosis of HIV Infection
• Viral Load Testing
• CD4 Cell Count Testing
• Clinical Biochemistry
• Hematology
• Laboratory Quality Management System
• Continuous Quality Improvement
• Safety in the Laboratory

Supporting the Establishment of the Monitoring and Evaluation (M&E) Unit within the Department of HIV/AIDS Prevention and Care (DHAPC), MoH
BHP-PEPFAR has been instrumental in supporting the Government of Botswana in establishing a Monitoring and Evaluation (M&E) Unit within the National ARV Program, Masa, in the DHAPC. The M&E Unit developed standardized indicators, reporting instruments, and a uniform reporting schedule. This is supported by electronic medical records and reporting tools which are currently being upgraded as part of the PIMS II project. The team, with additional resources through SCMS, managed to complete development of all the nine modules within schedule and conducted preliminary testing to ready the system for demonstration to users and stakeholders. Four workshops were conducted during which PIMS II was successfully demonstrated to, and was exceedingly well received by the participants. Two sites (Mochudi and Ramotswa), comprised of 11 separate health facilities, were prepared for the PIMS II pilot and each received a five-day training workshop. The M&E Unit is productively collaborating with the Clinical Master Trainers for resource assistance in providing user support.

Data quality is emphasized and data audits are conducted on a regular basis at ARV sites. The M&E Unit, at the request of the MoH, is also involved in many operational research activities at present and provides data management support for these projects. The M&E Unit staff field calls regarding reporting uniformity and deadlines, PIMS II and IPMS support, and new pharmacy data collection.