ipt botswana experience
Skip this Video
Download Presentation

Loading in 2 Seconds...

play fullscreen
1 / 40


  • Uploaded on

IPT BOTSWANA EXPERIENCE. Oaitse I Motsamai RN, MW, B Ed, MPH Ministry of Health Botswana 11 th November 2008 Addis Ababa, Ethiopia. OUTLINE. Botswana context Rationale for IPT in Botswana Pilot Current Programme Administration IPT Programme Evaluation. Background of Botswana.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'IPT BOTSWANA EXPERIENCE' - masato

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
ipt botswana experience


Oaitse I Motsamai RN, MW, B Ed, MPH

Ministry of Health


11th November 2008

Addis Ababa, Ethiopia

  • Botswana context
  • Rationale for IPT in Botswana
  • Pilot
  • Current Programme
  • Administration
  • IPT Programme Evaluation
background of botswana
Background of Botswana
  • Population 1.7 million
  • HIV prevalence in general population 17% (2004)
  • HIV prevalence in antenatal women 33.4% (2005)
  • TB notification rate 514/100,000 (2006)
  • HIV seroprevalence among TB patients 60-86%
tb services in botswana
TB Services in Botswana
  • National TB Program (Disease Control Unit, MOH)
  • Tuberculosis treatment free and universally available
  • >600 health facilities provide TB and IPT services
  • 24 Districts each with TB Coordinator
  • TB surveillance through electronic TB register
hiv tb program context
HIV/TB Program Context
  • Anti-retroviral therapy (ART) has been available since 2001 and is free to all Batswana citizens
  • Policy on Routine HIV Testing (RHT) introduced 2004
  • Under national ART guidelines, TB patients eligible for ART; initiation based on CD4 count
  • There are 35 ART centers in Botswana
ipt timeline
IPT Timeline

1998: Joint WHO/UN Guidelines on HIV/AIDS

recommending 6 months of IPT

1999: Formation of an IPT Working Group

2000: Pilot conducted in three districts in

to assess feasibility of national scale-up

2001: Pilot completed in April; evaluated in

October 2001

2001: National roll out commenced

2003: IPT office established (3 officers)

2004: Complete roll out

progress of enrolment 2001 2007
Progress of enrolment: 2001-2007


rolled out

Roll out


Programme Review

Coag signed

National office

Pilot study

pilot study goals
Pilot Study Goals
  • Assess motivation to undergo testing and accept IPT;
  • Determine if IPT would increase HCW workload; and
  • Determine whether HCWs could successfully exclude clients with active disease
pilot findings
Pilot Findings
  • IPT well-integrated into general clinic services
  • Acceptable to clients; clients motivated to test by knowledge that HIV interventions (IPT/ART) available
  • CXR should not be used for ASX patients
  • Reporting and recoding methods too cumbersome for HCWs


Overall, IPT is feasible and should be implemented.

current programme
Current Programme
  • Screen and enroll medically eligible patients referred from VCT/RHT/PMTCT
  • 6 months self-administered in 6-9 mos.
  • Monthly follow-up visits
    • Side effects counseling
    • TB screening
    • Compliance
    • Prescription refill
eligibility criteria
Eligibility Criteria
  • Confirmed HIV-infected
  • 16 years and above
  • Not currently pregnant
  • No active TB
  • No terminal illness
  • No hepatitis
  • No history of INH intolerance
  • No History of TB in the past 3 years
  • History and physical examination
    • Exclusion of persons with cough and fever
  • Client counseling
  • Monthly review
    • Side effects assessment
    • TB screen
    • Drug re-supply
enrollment 2001 2007
Enrollment 2001-2007*




n= 73,263

Eligible and started IPT

n= 71,541




Other exclusions








major challenges
Major Challenges
  • Referral to IPT
    • Difficult to estimate % eligible captured
  • Medical Screening
    • Eligibility
    • Active TB (prior to and during treatment)
  • Treatment adherence* (preliminary data, n= 71,541)
    • Median- 4 follow-up visits
    • Duration of therapy 98 days
  • Monitoring and evaluation
    • High levels of incomplete data
    • Recording and data entry barriers
  • Staff turn over: IT no data manager (national)
ipt staffing
IPT Staffing
  • National Level: MOH
    • National Coordinator
    • Regional Coordinators (2)
    • Data officers (3)
    • IEC officer
  • Implementation at the district level
    • Doctors and nurses (MOLG, MOH)
    • Complementary staff
support supervision
Support & Supervision
  • District-level TB Coordinators (DTBCs) placed at District Health Teams
  • TBCs are supervised by the District Health Teams
  • District-level activities supervised by TBCs
  • The national level monitors a sample of facilities on quarterly basis
  • DHTs are given feedback on their performance
  • TBCs hold workshops (twice a year)
  • Training for IPT, TB/HIV surveillance and TB case management, Community TB care for HCWs
reporting and recording
Reporting and Recording
  • Patient out-patient card (pink/blue)
  • Register and Compliance record
  • Dispensary Tally Sheet
  • Patient Transfer form
  • Monthly Report Form
other documents database
Other Documents & Database

Other IPT Documents:

  • Training guides: Facilitators’ & Health workers’
  • IEC materials: Brochures, video cassettes

Electronic Database:

  • Developed and Funded with the assistance of CDC (BOTUSA)
  • Rolled out to all 24 districts in November 2005
  • Built-in reporting and error functions
programme funding
Programme Funding
  • Second-Five year cooperative agreement between CDC and MOH; (2002-2005, 2005-2010)
  • Ministry of Health provides: infrastructure, drugs & technical support
  • Clinical staff supported thru Ministry of Local Government O Ministry of Health
  • CDC provides funds for salaries, training, purchase of equipments; 2001-2007: Over $2 million + technical support
ipt programme evaluation
IPT Programme Evaluation
  • Conducted in May 2008 (external)
  • Await final report
  • Reviewed key functions
    • Referral systems
    • Medical screening
    • Adherence
    • Reporting/recording for M&E
    • HCW training
    • Patient counseling
  • Assessed programmatic implications
  • Botswana National TB Program Staff
  • CDC Division of TB Elimination
  • CDC Global AIDS Program/BOTUSA
caliber trained
Caliber Trained
  • Health professionals:
    • Doctors
    • Nurses
    • Pharmacy Technicians
    • Health Educators
    • Social Workers
  • Non-professionals

- Family Welfare Educators

- Lay Counselors

- Health auxiliary

challenges encountered
Challenges Encountered
  • Overstretched national staff
  • Inadequate counseling of some clients
  • Loss of clients who are still on treatment
    • Lack of clients’ follow up (defaulters)
    • Transport problems particularly in the districts
    • High mobility of clients
    • Wrong addresses given by clients
challenges cont d
Challenges Cont’d
  • Recording and Reporting problems
    • Incomplete clients’ records
    • Lack of timely reporting
  • Personnel
    • High turnover in districts including TBCs
    • Weak supervision especially at district level
  • Training: Continuous re-training of HCW necessary
botswana drug resistance surveys
Botswana Drug Resistance Surveys
  • Since 1995, 3 resistance surveys done
  • Fourth resistance survey in progress
  • Results expected by 4th quarter 2008.
plans to prevent drug resistance
Plans To Prevent Drug Resistance
  • Emphasis on constant & proper use of the algorithm on screening of clients
  • Screening of clients at each visit
  • Thorough investigation of TB suspects
  • Extensive adherence counseling of clients
ipt as part of hiv care and treatment
IPT as Part of HIV Care and Treatment
  • Implementation of routine HIV testing from January 2004.
  • HIV testing of TB patients is routine but so far at 68%
  • IPT is prescribed in all health facilities by

doctors and nurses.

  • IPT is given as (often first) package of HIV care
  • Other sources of referral to IPT
    • PMTCT
    • VCTs
    • NGOs
    • ARV programmes
integration of tb hiv services
Integration of TB/HIV services
  • IPT provides a systematic way to screen PLWH for TB
  • Policy to provide HAART to HIV-infected TB patients
  • TB/HIV integrated surveillance rolled out 2005
  • TB/HIV advisory body established
  • TB/HIV care issues in the new TB manual
  • TOTs in all 24 districts (average; 5 per district)
  • Trained (65%) of all health workers
  • IPT programme officers at national level
  • IPT available in all 24 districts and all 636 facilities
  • Public awareness & uptake has increased
  • Improved paper based reporting from districts
  • Computers purchased for all districts
achievements continued
Achievements Continued
  • Database available in all districts
  • Designated TB coordinators in almost all districts
  • Enabled linkage of IPT to TB and ARV databases through the use of national ID
  • Improved frequency & quality of support visits