HIV Diagnosis and Treatment

2008 was the second year of support for TB interventions and assistance to the Botswana National TB Programme. The assistance was provided in recognition of the severe TB epidemic closely associated with, and fuelled by the HIV/AIDS epidemic. While there is evidence of a reduction in TB incidence, rates are still extremely high, with close to 500 cases per 100 000 population, and TB continues to be a major cause of morbidity and mortality amongst HIV positive persons.

In 2007 ACHAP provided support to the Ministry of Health to strengthen TB diagnostic services in laboratories at the central level (National TB Reference Laboratory) as well as in 6 district hospital TB laboratories. Dedicated TB laboratory space was provided for the Mmadinare, Tsabong,Thamaga, Kasane Palapye and Goodhope Primary hospitals and the national TB Reference Laboratory through the construction of 7 prefabricated/portacabin structures. This addressed needs identified in the comprehensive national TB programme review of 2006. Human resources support was also provided to strengthen district TB services, management of the TB programme at national level, and capacity improvement at the TB Reference Laboratory.

Laboratory Diagnostic Services

Concerted efforts have been made to improve TB diagnosis capacity particularly at the district hospital level. With ACHAP support in 2008, and in collaboration with other partners, an External Quality Assurance (EQA) Unit has been established at the National TB Reference laboratory with human resources provided through ACHAP support. A total of 6 staff members were hired for the national TB reference laboratory which has considerably improved quality assurance capacity for all laboratories performing sputum microscopy, improved capacity to diagnose resistant TB strains and assisted in the completion of the Drug Resistance Survey.

District laboratory diagnostic capacity and has been improved through training of district laboratory staff (41 laboratory personnel trained in the government and private sector). Building on the infrastructure developments of 2007, in 2008 laboratory equipment including 38 microscopes was provided to at least 20 hospital laboratories to improve diagnostic capacity and improve quality assurance. This has been further strengthened through the improved supervisory capacity of the national TB reference lab. It is expected that this improved performance of the lab diagnostic services will improve patient management through increased clinician confidence and the service and better use of sputum microscopy for TB diagnosis and management.Infrastructure development and Improvement of Infection Control.

One of the greatest challenges for TB control in an environment such as Botswana where a large proportion of hospital patients are HIV positive, and TB infection rates are amongst the highest in the world, is the risk of TB transmission in health care settings. ACHAP therefore provided support to the national TB programme to strengthen infection control capacity in the following ways:

• Financial support was provided to the Bamalete Lutheran Hospital, a mission hospital in South Eastern Botswana, to build a TB isolation facility complementing resources from the Global Fund to fight AIDS, TB and malaria. This building was officially opened in November 2008, and has improved infection control capacity for patients requiring admission in the southern part of the country. ACHAP funded this building to the value of BWP 1,3 million.
• It was recognized that to reduce TB transmission in health care settings some modification would be required to existing government facilities, and new ones constructed would need to have appropriate infection control facilities in place for TB control. To improve design input into such facilities from the infection control perspective ACHAP supported an architect from the Department of Building and Engineering Services working with the Ministry of Health on such designs to attend an infection control training course.

The Ministry of Health and the Botswana University of Pennsylvania Partnership were supported to implement a programme to reduce TB transmission among health care workers. This project was to start in two hospitals in Francistown and Gaborone. The lead physician for the project was hired and the groundwork was laid for implementation of the project. Consultations in the early phase of the project revealed the need to expand the facilities at which the project is being implemented and to align it with the newly developed national TB infection control strategy. This project will now be implemented in 7 hospitals through the country and is due to be completed in June 2010. The expectation is that lessons learnt through this project will be applied to more facilities in the country reducing the risk of TB transmission among health care workers as part of a comprehensive TB infection control strategy.

Improved Capacity for TB/HIV Management

The TB and HIV/AIDS epidemics in Botswana are very closely linked with between 65% and 85% of TB patients also co-infected with TB. The human resource support to the programme begun in 2007 was completed in 2008. This assistance has included programme officer positions at the national TB programme to support management of the programme at national level, provision of district personnel to support coordination of TB and HIV/AIDS services at the district level, as well as supporting TB information and education efforts in the community. Over the past two years, an additional 35 personnel in various categories have been added to support the delivery of TB services, which has improved case detection at health facility level, and has also improved services at the community level. This should help reduce the TB burden in the country in years to come.

To improve ACHAP’s own capacity to support TB interventions and provide technical support to national TB efforts a position of TB HIV/AIDS specialist was created. An area of focus in 2009 and beyond, will be providing support to strengthen integration of TB and HIV/AIDS services as many patients are affected by both diseases.