Clinic staff at the 10 room BIPAI-BMS Pediatric Day Hospital at Centre Hospitalier Universitaire - Sanou Sourou

Program Update (October 2008):

The BIPAI - Burkina Faso team, currently based at Centre Hospitalier Universitaire Sanou-Sourou (CHU-SS) - BIPAI Pediatric HIV Clinic, is working diligently to scale up pediatric HIV care while awaiting the completion of the first Baylor - Bristol-Myers Squibb (BMS) Children's Center of Excellence in West Africa.

In June 2008, UNICEF contributed a sport utility vehicle to BIPAI - Burkina Faso. This is our first project vehicle and has been extremely useful in supporting various elements of our program including: home visits, medical outreach, community outreach, and clinic operations support.

Baylor - Bristol-Myers Squibb (BMS) Children's Center of Excellence construction progress as of September 2008.

CLINIC OPERATIONS: The BIPAI team moved from a one room clinic to a 10 room refurbished wing of the Centre Hospitalier Universitaire Sanou-Sourou (CHU-SS) in October 2007. This facility was renovated and equipped with the generous support of the BMS Foundation and CHU-SS. It is a full service pediatric HIV clinic staffed in partnership by three different institutions: BIPAI, CHU-SS, and a community based organization (CBO) called Revs +. The clinic treats HIV-infected and exposed children, provides voluntary HIV counseling and testing to people of all ages, and accommodates various training and psychosocial support activities. Our staff also provides inpatient hospital care for enrolled patients in the adjacent pediatrics ward.

BIPAI-Burkina Faso administrator, Mr. Julien Ouedraogo, accepting sport utility vehicle from Dr. Ngone Toure, UNICEF - HIV/AIDS program coordinator.

Exciting developments:

• In 2008 the team has welcomed three new Burkinabe doctors, a data manager, and a Princeton Fellow.
• A supply of Plumpy'nut was donated to the clinic by UNICEF in June 2008 to enhance the nutritional support component of patient care. Outcomes have been remarkable as we have employed this product particularly to complement the early phase of ARV therapy for malnourished HIV-infected children. We are formalizing Plumpy'nut distribution, lobbying to establish a reliable supply chain for this product, and crafting an education program to guide families transitioning their children off Plumpy'nut into nutritious eating at home.
• Fixed-dose combination ARVs were introduced in August 2008 thanks to support provided to the Burkina Faso Ministry of Health by the UNITAID - Clinton Foundation HIV/AIDS Initiative. This convenient one-pill formulation of antiretroviral triple therapy greatly enhances medication adherence.
• A French version of the Electronic Medical Record, used throughout the BIPAI network, was introduced in October 2008. This streamlines medical documentation and data entry which in turn, greatly facilitates monitoring and evaluation and quality assurance.

Dr. Kopara Da, local physician employed by BIPAI-Burkina Faso, preparing a supply of Plumpy'nut for a malnourished patient.

MEDICAL OUTREACH AND TRAINING: Since our arrival in August 2006, we have been working with the Burkina Faso Ministry of Health and other local partners to scale up pediatric HIV care throughout the country.

• Our physicians are serving as consultants for the development of the first national pediatric HIV/AIDS training module as well as the first national pediatric HIV/AIDS norms and protocols.
• At the Pediatric HIV Clinic we offer clinical attachment training to assist health care workers preparing to provide pediatric HIV care at their own facilities.
• Our physicians travel to district hospitals in the region to provide on site technical assistance and mentorship to health care workers newly offering pediatric HIV care at their facilities.
• We conduct a weekly journal club for members of the local medical community who provide or who are interested in providing HIV care. Through interpretation of English documents, we serve as a bridge to the English medical literature for our francophone Burkinabe colleagues.
• We periodically perform training seminars for nurses, medical students, and members of local CBO's.

COMMUNITY OUTREACH/IN-REACH: Our team continues to strengthen its ties to the CBO's in Bobo-Dioulasso, aiming toward a well coordinated system which ensures that each patient and family is securely positioned in a continuum of care. With this support network in place, much of BIPAI's community outreach focuses on the concept of "in-reach" developed at the COE in Botswana.

• In-reach is built around identified obstacles to ARV adherence. For families struggling to maintain acceptable ARV adherence and for families with psychosocial problems that are likely to interfere with adherence in the future, home visits are conducted by a team of CBO counselors and BIPAI physicians. These visits aim to identify barriers to adherence and to assist families in developing and executing strategies to overcome these barriers.
• Weekly support and learning groups have been established for each of our caregiver categories: mothers, fathers, aunts/uncles, and grandparents. Each group meets monthly and is facilitated by two CBO counselors, the Princeton Fellow, and one physician.
• The counselors, physicians, and Princeton Fellow also lead a teen club for adolescents living with HIV/AIDS. The group engages in various activities aimed at decreasing stigmatization, increasing knowledge and coping skills, and enhancing comradery among participants.
• In response to a request for assistance made by the CHU-SS - BIPAI Pediatric HIV Clinic, a partner CBO called Association Espoir Pour Demain, has secured funding from BMS - Secure the Future to establish a transitional home for HIV-infected children and their mothers. This home will serve mother-child couples who are at increased risk of treatment failure due to very difficult psychosocial or geographic situations. Mother - child couples marginalized or abandoned by their families due to extreme stigmatization, in addition to families traveling from remote sites to obtain treatment, are eligible to lodge in the home until their problematic circumstances have been alleviated with the help of a psychosocial support team. Nutrition and health seminars and access to a psychologist will be available for occupants.