ANTIRETROVIRAL TREATMENT CLINIC IN BOTSWANA SERVES AS MODEL FOR OTHER PROGRAMS
Lessons learned in establishing a public ARV treatment clinic

February 2005

GABORONE, Botswana, February XX, 2005 – A Botswana public clinic offering antiretroviral (ARV) treatment to people with HIV/AIDS offers valuable lessons for other developing countries trying to launch their own treatment programs. The various challenges that were encountered and how they were met are detailed in an article written by a team of care-givers and researchers who spent considerable time and effort making the Botswana clinic work. The article appears in the Mar. 15 issue of Clinical Infectious Diseases, now available online at http://www.journals.uchicago.edu/CID/home.html.

Botswana recognized the need to respond to the escalating AIDS epidemic and established aggressive prevention and treatment campaigns – opening Africa’s first public ARV clinic in Gaborone, Botswana’s capital city, in January of 2002. The clinic was immediately faced with the challenges of meeting the needs for space, staffing and training.

The facility’s 4,000-patient capacity for consultation and counseling was quickly reached. Additional buildings were erected to accommodate the more than 11,000 patients now being treated at the clinic.

Clinic staffing changes were also necessary. Initially, medical personnel were rotated in from inpatient hospital wards in order to gain outpatient care experience. However, to ensure consistent care for clinic patients, a core team of HIV specialists was eventually created to staff the clinic and train junior staff as HIV care providers. All ARV clinic staff members involved in patient care received ongoing training to utilize the most up-to-date information on HIV treatment.

There are various reason to explain the lack of medical personnel available to staff such a specialized clinic in an African nation, “In some places, this deficit is not because the experts’ don’t exist, but rather that the system can’t pay them or have positions for them, said Richard Marlink, M.D., lead author of the article and senior research and executive director of the Harvard School of Public Health AIDS Initiative in Boston. He added, “In other places, the experts just don’t exist in the numbers needed. Botswana has a peculiar combination of the two problems: there are lots of nursing schools, but no medical schools. Many nurses are often forced to look for work outside Botswana due to a lack of positions that pay well, but physicians have to be contracted from other countries.”

The Botswana government’s support of efforts to control the spread of HIV/AIDS has been a key to the ARV clinic’s success. “From President [Ketumile] Masire to President [Festus] Mogae, the leadership on approaching the epidemic as a national emergency has been remarkable,” said Dr. Marlink.

Most African medical centers can only deal solely with acute problems, such as medical emergencies, rather than chronic conditions. Therefore, the ARV clinic’s success is promising. “We’re hoping that this will create infrastructure that will help not only with HIV, but with other chronic diseases that would normally be easily treated in the West,” Dr. Marlink said.


For further information, please contact:

Yvonne Ng
Communications & Events Manager
Harvard School of Public Health AIDS Initiative
651 Huntington Avenue, FXB 643
Boston, MA 02115
tel: 617.432.6106
fax: 617.432.4545
email:yng@hsph.harvard.edu

About the Harvard School of Public Health AIDS Initiative (HAI):
For almost two decades, HAI has been dedicated to promoting research, education and leadership to end the AIDS epidemic. As the number of AIDS cases continues to escalate disproportionately in Africa and other resource scarce settings, HAI has directed its research efforts toward developing prevention and treatment strategies to stem the epidemic in these regions.