BHP-KITSO Curriculum Structure
KITSO has developed distinct curricula to address the varying levels of medical and technical knowledge and clinical responsibility expected from physicians, pharmacists, nurses, pharmacy technicians, laboratory technicians, other health professionals, non-medical professionals, and non-technical staff.

Curriculum Activities
Through the KITSO AIDS Training Program the Ministry of Health is committed to developing and implementing a curriculum that provides comprehensive, setting-specific theoretical and practical training in HIV and AIDS care and ARV therapy for Botswana’s health professionals. The collaboratively developed curriculum modules already in use, and those still in development will prepare health workers in their fight against HIV and AIDS.

Curriculum for Physicians and Pharmacists
Physicians and Pharmacists are trained through Module 1: AIDS Clinical Care Fundamentals and Module 2: Integrated Practical Attachment. Those physicians who complete ACCF plus treatment experience through a practical attachment or on-site preceptorship may choose to receive more training through the advanced elective module Advanced Module in HIV/AIDS Care and Treatment, which will be introduced in March 2005.

Curriculum for Nurses and Other Health Professionals

Nurses and other health professionals receive training through Module 1: AIDS Clinical Care Fundamentals and Module 2: Integrated Practical Attachment. Nurses and other health professionals involved in counseling may then enroll in the advanced elective module, Medication Adherence Counseling.

Curriculum for Laboratory Personnel
Core Module 1: Laboratory Fundamentals provides standardized, interactive training that includes practical information on laboratory procedures for HIV and AIDS care and treatment in Botswana. Laboratory Fundamentals is a one-day, facility-based course offered to professional health staff working in prospective ARV sites. Topics include: background to the testing done for the ARV program, sample collection and handling, completion of lab forms, interpretation of test results, and biosafety.

Satellite Trainings
In response to facility requests and the recommendation of the Health Development Africa evaluation, KITSO has created Satellite Training Modules that can be easily conducted by a wide range of KITSO faculty as in-service trainings at health facilities throughout Botswana.

Introduction to HIV & Biosafety
This half-day training has been developed for non-professional staff (cleaners, drivers, orderlies, etc.) in sites selected to provide ARV therapy. This facility-based course is implemented in tandem with the Laboratory Fundamentals course. Conducted in the local language, Setswana, this training provides general information on HIV, biosafety, sample handling, and the Botswana National ARV Program.

Introduction to AIDS Clinical Care
This one-day course has been developed to provide non-technical professional staff with detailed information on HIV disease and management of HIV and AIDS within Botswana’s health care system. Introduction to AIDS Clinical Care is also suitable for lay counselors and family welfare educators, and can be used as a sensitization course for nurses and social workers.

Practical Attachment
KITSO provides on-going support to the Botswana National ARV Program at the Infectious Disease Care Clinics at Princess Marina Hospital in Gaborone and Francistown, the largest HIV/AIDS treatment sites in the country. The IDCCs operate under the leadership of Ministry of Health physicians and benefit from the full-time service of a cadre of local HIV specialists. Two KITSO team members and an ACHAP clinical preceptor are available to support clinic leadership and assist in the training of new physicians. These physicians also dedicate a portion of their time to seeing patients in the national ARV program at the IDCC.

The Health and Development Africa (HDA) external evaluation recommended the standardization of practical training throughout Botswana. This recommendation echoed that of the September 2002 BHP-KITSO Stakeholders meeting, which recognized that a number of practical training models were in use and that the Ministry of Health and its partners should determine the national standard. BHP-KITSO worked with practical training preceptors from all the ARV implementation sites as part of a Working Group to develop and recommend standardized practices to the Ministry of Health for practical in-country training and criteria for health care workers trained outside Botswana. Practical training requirements include physicians observing preceptors, followed by physicians under the direct supervision of a preceptor, and conclude with physicians independently working with patients while reporting to and discussing cases with a preceptor as well as the use of standardized logbooks. The standardization of practical training effectively unites the efforts of all parties providing practical training to reinforce their commitment to serve the nation’s needs.

Throughout 2004 core teams consisting of one doctor, one nurse, and one pharmacy staff from new designated ARV treatment sites received practical attachment training in adult and pediatric ARV therapy at Nyangabgwe and Princes Marina hospitals.

Practical training described in the KITSO Expansion Plan 2004 is divided into four categories:
• Preceptorship Program: A six month, facility-based, cadre-specific training for personnel at each of
the national ARV sites. Personnel include doctors, nurses, pharmacy staff, and other relevant staff at each site.
• Integrated Attachment Program: A one month, regionally-based, practical training in adult and
pediatric HIV care and treatment for one doctor, one nurse, and a member of the pharmacy staff from each ARV site. Trainings are/will be held in Gaborone, Maun, Serowe, and Francistown.
• Advanced Practical Training in Pediatric HIV/AIDS (in development): Advanced Practical
Training in Pediatric HIV/AIDS will be a two week training for doctors, nurses, and pharmacy staff intended to complement didactic training in pediatric HIV care issues. Trainees will rotate through the Pediatric Infectious Disease Clinic, Pediatric Screening Clinic, and the Family Model Care Clinic. There are also plans to start an adolescent clinic in Gaborone, and once opened, trainees will have the opportunity to train there as well. Initially, training will take place at Nyangabgwe Hospital in Francistown and at the Baylor Botswana Children’s Clinical Center of Excellence in Gaborone.
• Practical HIV Counselor Training: Practical training will be required for all participants enrolled
in the Foundations of HIV Counseling course as recommended by the HIV Counseling Consortium.

Curriculum Standardization
To ensure uniformity in HIV and AIDS training throughout Botswana the Ministry of Health has designated the KITSO curriculum as the official standard for HIV and AIDS training of health professionals nation-wide.

The KITSO module, AIDS Clinical Care Fundamentals is the basis for all baseline theoretical HIV and AIDS training in Botswana and is followed by the administration of an examination to ascertain participant knowledge. Trainers teaching within Botswana are directed by the MOH to teach AIDS Clinical Care Fundamentals as a baseline, but are certainly encouraged to provide specialized instruction beyond the scope of the course. The implementation of a standardized curriculum across Botswana will enable the Ministry of Health to better coordinate training, monitor and measure results, and track trainees.