Overview of HIV/AIDS in Swaziland
Objectives of the Baylor College of Medicine Children's Foundation-Swaziland
Adolescent Psychosocial Support
Health Care Worker and Early Infant Diagnosis Trainings
Baylor Swaziland Outreach Activities
Mbabane Government Hospital Pediatric Ward Support
The Baylor-Bristol-Myers Squibb Children's Clinical Center of Excellence - Swaziland opened on February 24, 2006
The Swaziland Children's Centre of Excellence (COE) was established through collaboration between Baylor College of Medicine, Bristol-Myers Squibb Foundation, and the government of Swaziland and was officially opened by His Majesty King Mswati III on 24th February 2006. The COE serves as the largest pediatric antiretroviral (ARV) provider for children in Swaziland, dispensing ARV's for 42% of all the pediatric patients on anti-retroviral medication within the country. We currently have 3430 active patients (approximately 50% of these are children), with 2000 of these on ARV's. Since our clinic opened in 2006, we have served over 13,500 patients in total. We pride ourselves in offering the following to our patients:
We provide quality comprehensive pediatric care to our patients, meeting their primary care needs as well as their HIV care needs. During our consultations, we monitor growth and development, provide immunizations, and address common infections and other issues that arise as children grow. We assess their HIV clinical and immunologic staging and provide appropriate anti-retroviral medication if indicated, offering a model for pediatric HIV care and treatment for the many health-care workers across the country that spend time training with us.
Busi Bhembe (Director of the new Center), Dr. Mark Kline, and King Mswati III of Swaziland stand together at the Center opening.
At our centre, the child is the entry point for HIV care and treatment, but parents and other caregivers are also able to access their care there as well. We feel that when parents have easy access to quality HIV care and treatment at the same location as their children, they are more likely to stay healthy and be able to provide as well as they can for their families.
While patients wait for their health care needs to be attended to, we believe this time should be well-used. We start each morning with a health talk to all patients by either nurses or expert clients (patients stable on HAART that are trained with special health-related skills) covering such topics as medication adherence, identifying TB, family planning, and water hygiene. Any patient who comes in with a complaint of diarrhea or vomiting will be instructed on the proper use of oral rehydration, and that process will begin while they await consultation. We have a number of new volunteers who lead a daily group called the "Sunshine Club" for children aged 4-11 years old who are awaiting care. Leaders from our Teen Club assist with various activities, songs, and games for the children centered around the themes of positive living and holistic health issues. A volunteer group from the United States recently built a lovely playground for our children to access on the garden outside the clinic which rivals all playgrounds in the whole of Swaziland for beauty, safety, and fun. Every day one can look outside and see many children playing happily on the new playground equipment, a good reminder of how healthy and vibrant our patients can be when their health care needs are addressed.
Many of the caregivers who accompany their children for care to our centre are women, and we have made it a primary goal to ensure that these mothers can access services for all of their health care needs with us. We provide pap smears with referral to the local government gynecologic clinic for abnormalities, and offer full family planning services for our female patients of child-bearing age. Family planning options at our center include condom distribution, oral contraceptives, injectible progesterone, and, recently added, intrauterine devices. We also offer full HIV prevention of mother-to-child transmission (PMTCT) services. Our PMTCT clients include current patients who become pregnant as well as newly pregnant women coming into our clinic seeking services. At any given time, we are currently following approximately 90 HIV-positive pregnant women, taking care of their prenatal and comprehensive health care needs. This serves as a great entry point to care, as we then can provide full services for this HIV-exposed child by keeping them as our client from birth through the infant-feeding period.
Baylor Swaziland has been the lead partner with the Swaziland Ministry of Health in the roll-out of the country-wide HIV early infant diagnosis program, involving dried-blood spot (DBS) testing for all HIV-exposed infants. Many Swazi health care workers have been trained in DBS preparation, and this training has always involved time at our centre, watching and working alongside our own nurses as they expertly prepare the samples. We trace mothers of babies with positive results to ensure they return to us for appropriate care and ARV initiation.
Our pharmacy is well-equipped with several window dispensing areas for private consultation and instruction on the ARV's and other medications provided. Our pharmacists are well-qualified SiSwati speakers who reinforce adherence and answer any remaining questions that patients might have about their medications before being sent home.
Laboratory services are essential to the running of any HIV/AIDS clinic, and we are proud to be able to offer on-site analysis of specimens for full-blood counts, CD4s, and full chemistries. We analyze an average of 50-60 samples per day from our own clients, and also process specimens obtained while our staff members are out visiting other Baylor-supported sites within our outreach program.
Similar to many other clinics offering HIV care and treatment, we have instituted an expert client program that has become essential to our daily clinical operations. Patients who are stable on HAART, motivated, leaders among their peers, and interested in working in the health care setting are invited by our nurse manager to join our staff in our "expert client program". Initially, these patients assist with translation needs within the clinic, but they are gradually trained to assist with all aspects of clinic flow, and assume positions throughout the clinic at areas such as reception, HIV screening, triage, pill counting, adherence counseling, TB screening, and dispensing medication. Some of our expert clients have gone on to obtain diplomas through national training programs in HIV testing and counseling, phlebotomy, data management, and laboratory technical assistance. We also make it a priority for staff nurses to work alongside doctors so that they are able to feel more comfortable managing various clinical conditions. We hope that this experience, along with the various continuing medical education opportunities they have access to through our centre, provides them with the tools to be excellent clinicians and trainers of other health care workers that they encounter in the field.
With the highest incidence of tuberculosis (TB) in the world, any HIV clinic in Swaziland must have a system in place for the identification and treatment of TB. We have a system for screening every patient for TB clinical symptoms at each patient encounter, and refer them for assessment if appropriate. We have sound protocols for case identification of TB, including sputum collection and chest x-ray analysis. Due to our family-care model, we frequently have the benefit of seeing the family as a whole in our consultation rooms, so we can make sure that other family members exposed to TB are appropriately cared for. We dispense both anti-tuberculosis treatment to those who require it and isoniazid prophylaxis to many of our other clients in order to prevent them from developing TB in the future. We are increasingly challenged by the rising prevalence of multi drug resistant tuberculosis (MDR).
With all patients who are screened as positive for HIV at the point of entry, we begin on the first visit to discuss the importance of excellent adherence to ARV medication. On the day of initiation the client attends a group educational session or, as it is known at our centre, "Utofundza ngema ARV's." Also prior to initiation of ARV's, we have clients bring a treatment supporter and caregivers to bring a second adult as "back-up" for training should the primary caregiver need to delegate the ARV administration to someone else. At every visit, we calculate adherence to ARV's with pill counts, and we encourage and instruct as needed.
Nutrition assessment and counseling is critical to pediatric HIV care and treatment, and is integral to the care we offer daily. If our clients are identified as having moderate or severe malnutrition, they are either treated as an out-patient with our "Plumpy Nut" program, where they are monitored with frequent follow-up visits, or they are admitted to the local government hospital for in-patient treatment with therapeutic milk.
We have a fully-equipped emergency room within our centre to care for our critically ill clients. We are able to offer resuscitation services, intravenous (IV) fluid, necessary IV antibiotics and medications, nebulizing treatments, stabilization, and ambulance service to the local government hospital if the need arises.
Recognizing that many of our clients face not only the challenge of living with a chronic illness but also other issues such as economic disadvantage, loss of loved ones, and family strife, our psychosocial department serves to offer counseling and referral services for clients in need. We perform home visits when families need extra support and guidance in an effort to more closely identify ways we can partner with these caregivers to provide for their children. We also offer a monthly weekend support group for caregivers of our clients to discuss parenting skills, health-related topics, and share ideas for income-generating activities.
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Baylor International Pediatric AIDS Initiative
Last Updated: August 20, 2010
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