Dr. Kline prepares to go into the field with the Tororo- Based Home-Based Care team

The Baylor International Pediatric AIDS Initiative at Baylor College of Medicine has recently been awarded a five-year grant from the Centers for Disease Control and Prevention for their Global AIDS Program (GAP). Under the auspices of the GAP, BIPAI will commit its experience in international HIV/AIDS curriculum and educational resource development, training, and care and treatment, to further the goals and objectives of CDC-Uganda. Specifically, beginning immediately, Baylor will collaborate with CDC-Uganda to (1) assist the pediatric staff of the Makerere University and Mulago Hospital in establishment of a pediatric HIV/AIDS outpatient center, and (2) assist in the implementation of a pediatric antiretroviral treatment program as part of the Tororo-based Home-Based AIDS Care (HBAC) project.

In addition to these two immediate and specific projects, Baylor will assist CDC-Uganda by conducting reviews and evaluations of HIV/AIDS care and treatment programs, as needed. Baylor's special expertise in pediatric care and treatment gives it a niche not occupied by many other participating Ugandan partners. Baylor also will collaborate with CDC-Uganda in designing educational materials and conducting training activities relevant to HIV/AIDS care and treatment. Existing educational materials, such as the HIV Curriculum for the Health Professional will be pilot tested, and then adapted collaboratively to ensure relevance to the settings in which they will be used. In general, we favor a train-the-trainer approach to dissemination of educational materials. Ultimately, local trainers assume responsibility for dissemination of content to site personnel on an ongoing basis. Individualized approaches to training and site assessment will be used to accommodate sites and settings with varying existing levels of infrastructure, capacity, and experience. BIPAI also is prepared to assist CDC-Uganda in designing and implementing pediatric HIV/AIDS care and treatment-related research projects. Such projects are an important element of documenting objectively the outcomes of various care and treatment strategies.

The head of the Nile

Establishment of a Pediatric HIV/AIDS Outpatient Center at Makerere University/Mulago Hospital

CDC-Uganda recently funded extensive renovation of a large building on the grounds of the Mulago Hospital in Kampala to serve as a new pediatric HIV/AIDS outpatient center. A single-story structure adjacent to pediatric inpatient units, the building has ample space for an outpatient clinic, procedure rooms, a waiting and play area, laboratory, and offices. When opened and fully operational, this center could serve as a focal point in Uganda for the training of health professionals in pediatric HIV/AIDS care, treatment, and clinical research, as well as in community education on HIV prevention and treatment.

Under the auspices of its University Technical Assistance Project, Baylor proposes to collaborate with CDC-Uganda to assist the Department of Pediatrics at Makerere University and Mulago Hospital in equipping and opening this outpatient center. Baylor will work with Dr. Phillipa Musoke, Chief of pediatric infectious diseases at Makerere/Mulago, to develop a training curriculum on pediatric HIV/AIDS for staff (physicians, nurses, social workers, and others). Other stakeholders will be identified by Dr. Musoke and CDC-Uganda and invited to participate in the collaborative development of this curriculum. A training program faculty will be developed consisting of Ugandan and U.S. professionals. We anticipate that most training of health professionals will occur on site, but short-term training also may be conducted in Houston or at the Baylor-Botswana Children's Clinical Center of Excellence in Gaborone, Botswana.

A Ugandan woman standing beside a typical rural home

Implementation of a Pediatric Antiretroviral Treatment Program for the Tororo-Based Home-Based AIDS Care (HBAC) Project

CDC-Uganda has developed a novel home-based AIDS care (HBAC) project in the rural Tororo district of eastern Uganda. A cadre of counselors and medical professionals is being trained to deliver HIV/AIDS care, support, and antiretroviral therapy to a large cohort of HIV-infected adults and children. Adults will be enrolled in a three-arm trial comparing several intensity levels of laboratory monitoring for antiretroviral efficacy. All HIV-infected children (currently about 50-60) will be monitored routinely with careful clinical follow-up, as well as CD4 lymphocyte counts and virus load determinations. Baylor proposes to collaborate with CDC-Uganda in the training and ongoing support of HBAC physicians, counselors, and other staff in aspects of HIV/AIDS care, support, and treatment unique to pediatrics. Baylor staff will serve on a continuous basis as consultants in pediatric medicine to the HBAC team, helping to build capacity for pediatric HIV/AIDS management. This will make possible future expansion of the pediatric cohort, if resources permit. Baylor will assist CDC-Uganda in the design and implementation of studies of this population, as well as in the creation of a patient database. Baylor also will collaborate with CDC-Uganda in the development of an elective rotation in Tororo for outstanding U.S. pediatric residents and postdoctoral fellows interested in tropical medicine and international HIV/AIDS.