Brief Report
Leveraging HIV Programming to Enhance Access to Noncommunicable Disease Care in Southern Botswana
Journal of the International Association of Providers of AIDS Care 1–4 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2325957415569310 jiapac.sagepub.com
M. J. A. Reid1,2,3, M. K. Haas1,2,4,5, P. Sedigeng1, D. Ramogola-Masire1,2,3, H. M. Friedman1,2, and A. R. Ho-Foster1,2
Abstract Objective: The objective of this study was to assess whether HIV programming in southern Botswana could be leveraged to provide care for patients with noncommunicable diseases (NCDs). Methods: A retrospective analysis was performed to determine the spectrum and complexity of NCDs seen by HIV-focused outreach programming delivered between July 2011 and December 2013, to 9 facilities in southern Botswana. The association of HIV status and specific International Classification of Disease codes was examined using bivariate analysis. Results: Outreach HIV physicians recorded 926 outpatient consults involving 835 patients during the studied period. While 25% (n ¼ 209) of patients seen were HIV infected, most patients were either HIV negative (49%, n ¼ 410) or had an unknown HIV status (26%, n ¼ 216). Noncommunicable disease referrals were as common at primary- and district-level facilities (90% [n ¼ 459] versus 93% [n ¼ 301]; P ¼ .22). Conclusion: This study demonstrates how HIV programming in Botswana can be leveraged to improve access to specialist medical services for patients with NCDs. Keywords HIV, noncommunicable diseases, PEPFAR, sub-Saharan Africa
Background Despite a huge burden of infectious diseases such as tuberculosis and HIV/AIDS across sub-Saharan Africa, increasing incidence of chronic diseases such as diabetes mellitus and hypertension is placing strains on limited health resources. Recognized as having the second highest HIV/AIDS prevalence in the world, Botswana has established one of Africa’s most progressive programs for dealing with HIV. By 2010, Botswana achieved near universal access to antiretroviral (ARV) treatment, with more than 95% of eligible persons able to access therapy.1 The speed and scope of Botswana’s ARV treatment scale-up have been attributed to a number of factors, not least the political will of the Botswana government. Key factors include significant donor investment, highquality HIV-specific training,2 and effective mentorship programs to facilities.3 Although there are several published studies demonstrating the impact of donor funding in Botswana to improve HIV care and treatment outcomes,2,4 data quantifying the impact of HIV donor funding on diseases other than HIV are sparse.5 Since 2006, the Botswana-UPenn Partnership (BUP) supported the Botswana national HIV treatment program with US government support through Presidents Emergency Plan For AIDS Relief (PEPFAR). One aspect of BUP’s support has
been its HIV outreach program, providing regular clinical and technical support at facilities in southern Botswana. This program was originally developed to support the management of patients with advanced HIV and complicated tuberculosis/HIV coinfection. However, at the request of local clinical staff, the support was extended to care for noncommunicable diseases (NCDs).
Objectives The objective of this study was to assess the extent to which BUP’s HIV programming in southern Botswana was used to 1
Botswana-UPenn Partnership, Gaborone, Botswana Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 3 School of Medicine, University of Botswana, Gaborone, Botswana 4 Denver Metro Tuberculosis Clinic, Denver Public Health, Denver, Colorado, CO, USA 5 Department of Medicine, Division of Infectious Diseases, University of Colorado-Denver, Denver, Colorado, CO, USA 2
Corresponding Author: Ari Ho-Foster, PO Box AC 157 ACH, Gaborone, Botswana. Email: [email protected]
Downloaded from jia.sagepub.com at Harvard Libraries on April 27, 2015
2
Journal of the International Association of Providers of AIDS Care
Table 1. Characteristics of Outpatients Seen on Outreach. HIV Infected
HIV Uninfected
HIV Unknown
Total
P Value by HIV Status
49% (410/835)
26% (216/835)
100% (835/835)
– .26
57% (235/410) 43% (175/410) 46.7 (- 0.99)
59% (127/216) 41% (89/216) 51.3 (- 1.54)
59% (496/835) 41% (339/835) 46.2 (- 0.7)
64% (261/410) 36% (149/410)
59% (127/216) 41% (89/216)
61% (509/835) 39% (326/835)
86% (352/410) 14% (58/410)
75% (161/216) 25% (55/216)
76% (633/835) 24% (202/835)
30% 12% 10% 8% 10%
43% (93) 13% (27) 9% (19) 13% (27) 8% (18)
30% 13% 10% 9% 9%
Patients encountered, % (n) 25% (209/835) Sex Female, % 64% (134/209) Male, % 36% (75/209) Mean age in years (SE) 41.2 (- 0.98) Facility level where patients were seen Primary level 58% (121/209) District level 42% (88/209) Number of medical diagnoses Presented with < 2 diagnoses 57% (120/209) Presented 2 diagnoses 43% (89/209) Most frequent diagnosesa Cardiovascular 17% (36) CNS 14% (30) Gastrointestinal 11% (23) Endocrine 7% (15) Musculoskeletal 7% (15)
Leveraging HIV Programming to Enhance Access to Noncommunicable Disease Care in Southern Botswana
Journal of the International Association of Providers of AIDS Care 1–4 ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2325957415569310 jiapac.sagepub.com
M. J. A. Reid1,2,3, M. K. Haas1,2,4,5, P. Sedigeng1, D. Ramogola-Masire1,2,3, H. M. Friedman1,2, and A. R. Ho-Foster1,2
Abstract Objective: The objective of this study was to assess whether HIV programming in southern Botswana could be leveraged to provide care for patients with noncommunicable diseases (NCDs). Methods: A retrospective analysis was performed to determine the spectrum and complexity of NCDs seen by HIV-focused outreach programming delivered between July 2011 and December 2013, to 9 facilities in southern Botswana. The association of HIV status and specific International Classification of Disease codes was examined using bivariate analysis. Results: Outreach HIV physicians recorded 926 outpatient consults involving 835 patients during the studied period. While 25% (n ¼ 209) of patients seen were HIV infected, most patients were either HIV negative (49%, n ¼ 410) or had an unknown HIV status (26%, n ¼ 216). Noncommunicable disease referrals were as common at primary- and district-level facilities (90% [n ¼ 459] versus 93% [n ¼ 301]; P ¼ .22). Conclusion: This study demonstrates how HIV programming in Botswana can be leveraged to improve access to specialist medical services for patients with NCDs. Keywords HIV, noncommunicable diseases, PEPFAR, sub-Saharan Africa
Background Despite a huge burden of infectious diseases such as tuberculosis and HIV/AIDS across sub-Saharan Africa, increasing incidence of chronic diseases such as diabetes mellitus and hypertension is placing strains on limited health resources. Recognized as having the second highest HIV/AIDS prevalence in the world, Botswana has established one of Africa’s most progressive programs for dealing with HIV. By 2010, Botswana achieved near universal access to antiretroviral (ARV) treatment, with more than 95% of eligible persons able to access therapy.1 The speed and scope of Botswana’s ARV treatment scale-up have been attributed to a number of factors, not least the political will of the Botswana government. Key factors include significant donor investment, highquality HIV-specific training,2 and effective mentorship programs to facilities.3 Although there are several published studies demonstrating the impact of donor funding in Botswana to improve HIV care and treatment outcomes,2,4 data quantifying the impact of HIV donor funding on diseases other than HIV are sparse.5 Since 2006, the Botswana-UPenn Partnership (BUP) supported the Botswana national HIV treatment program with US government support through Presidents Emergency Plan For AIDS Relief (PEPFAR). One aspect of BUP’s support has
been its HIV outreach program, providing regular clinical and technical support at facilities in southern Botswana. This program was originally developed to support the management of patients with advanced HIV and complicated tuberculosis/HIV coinfection. However, at the request of local clinical staff, the support was extended to care for noncommunicable diseases (NCDs).
Objectives The objective of this study was to assess the extent to which BUP’s HIV programming in southern Botswana was used to 1
Botswana-UPenn Partnership, Gaborone, Botswana Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA 3 School of Medicine, University of Botswana, Gaborone, Botswana 4 Denver Metro Tuberculosis Clinic, Denver Public Health, Denver, Colorado, CO, USA 5 Department of Medicine, Division of Infectious Diseases, University of Colorado-Denver, Denver, Colorado, CO, USA 2
Corresponding Author: Ari Ho-Foster, PO Box AC 157 ACH, Gaborone, Botswana. Email: [email protected]
Downloaded from jia.sagepub.com at Harvard Libraries on April 27, 2015
2
Journal of the International Association of Providers of AIDS Care
Table 1. Characteristics of Outpatients Seen on Outreach. HIV Infected
HIV Uninfected
HIV Unknown
Total
P Value by HIV Status
49% (410/835)
26% (216/835)
100% (835/835)
– .26
57% (235/410) 43% (175/410) 46.7 (- 0.99)
59% (127/216) 41% (89/216) 51.3 (- 1.54)
59% (496/835) 41% (339/835) 46.2 (- 0.7)
64% (261/410) 36% (149/410)
59% (127/216) 41% (89/216)
61% (509/835) 39% (326/835)
86% (352/410) 14% (58/410)
75% (161/216) 25% (55/216)
76% (633/835) 24% (202/835)
30% 12% 10% 8% 10%
43% (93) 13% (27) 9% (19) 13% (27) 8% (18)
30% 13% 10% 9% 9%
Patients encountered, % (n) 25% (209/835) Sex Female, % 64% (134/209) Male, % 36% (75/209) Mean age in years (SE) 41.2 (- 0.98) Facility level where patients were seen Primary level 58% (121/209) District level 42% (88/209) Number of medical diagnoses Presented with < 2 diagnoses 57% (120/209) Presented 2 diagnoses 43% (89/209) Most frequent diagnosesa Cardiovascular 17% (36) CNS 14% (30) Gastrointestinal 11% (23) Endocrine 7% (15) Musculoskeletal 7% (15)
