Mabedi Kgositau MSN( FNP), B Ed, RM, RN : Presenter Onalenna Seitio. MSN (C/S) .BED. RM. RN

1. The Nurse Practitioner: A viable option in HIV/AIDS treatment care in resource limited settings: Botswana • Mabedi Kgositau MSN(FNP), B Ed, RM, RN: Presenter • Onalenna Seitio. MSN(C/S).BED. RM. RN Np's and ARV therapy

2. BOTSWANA/SOUTHERN AFRICA • Boarders: /South Africa /Namibia/Zambia/Zimbabwe.Area; 582,000sq kmPopulation 1,6 million Np's and ARV therapy

3. HEALTH CARE SYSTEM • Based on PHC model • levels based on complexity • From lowest level • 712 Mobile stops • 324 Health posts • 232 Clinics • 17 Primary hospitals • 6 District hospitals • 3 referral hospitals Np's and ARV therapy

4. Introduction • Botswana is among the hardest hit countries by HIVAIDS world wide & sub-Sahara • Estimated prevalence rate: 37.3% • High mortality rate & drop in life expectancy from 72 to 39 years Np's and ARV therapy

5. Introduction • Estimated 270,000 living with HIV: 2005 • Close to 75,000 of this population in urgent need for ARV therapy • Around 43,000 enrolled in the program since 2002 • Program initiated 2002 initially in 4 sites • Now rolled over to 31 sites Np's and ARV therapy

6. Capacity Challenges of ARV program • Chronic shortage of staff • Pharmaceutical logistics • Lack of storage and security facilities • Poor infrastructures, inadequate resource and equipment • Inadequate laboratory testing facilities (Gaolatlhe, PMH) Np's and ARV therapy

7. Outcome of capacity challenges • Program limited to urban areas and big villages • Over-congestion in ARV clinics (Long waiting) • Patient travel long distances to seek HIV/Care and treatment • Enrollment capacity very low • 19,000 to enroll first year but only 3,500 managed • Around 60% enrolled today Np's and ARV therapy

8. Outcome of capacity challenges • Long waiting period before start of therapy • Clinics -overflowing with patients waiting to be started on ARV therapy. • Some have lost their lives even before they could be initiated on ARV therapy. • Number of people requiring ARV increasing as infection progress to AIDS and there is delay in initiating ARV therapy Np's and ARV therapy

9. Outcome of capacity challenges • Poor routine check up for continuity of care because patients have to travel long distances to treatment centers. • Poor adherence because of long distances to treatment centers. Np's and ARV therapy

10. Benefits of ARV therapy • Highly cost effective • Improves health and quality of life • Drop in Morbidity and mortality rate • Decreased HIV/AIDS related hospitalizations • Reduction of spread of infection to uninfected partners by 60% • Reduced the frequency of opportunistic infections • Hospital beds becoming decongested . Np's and ARV therapy

11. Challenges in Care of patient on ARV therapy • ARV have adverse side effects • Require routine check up and comprehensive assessment by a highly skilled practitioners • Most of skilled personnel found in big villages and urban areas • Poor of continuity of care because shortage of Doctors Np's and ARV therapy

12. Way forward in the care of patients on ARV therapy • Explore the role of NP’s in ARV therapy in Botswana and compare it to other countries Np's and ARV therapy

13. International roles and responsibilities of NP’s • NPs are equipped with advanced skills in areas of assessment and management of clients with various health care problems including HIV/AIDS. • Practice independently, have prescription authority and hospital admission privileges • Provide: comprehensive health assessment, arrive at a medical diagnosis and prescribe medications independently. Np's and ARV therapy

14. International roles and responsibilities of NP’s • Established in response to perceived shortage of primary care medical practitioners • Capable of providing care equivalent to the medical doctors. Np's and ARV therapy

15. Benefits of having NP’s in a health care facility(Results of studies) • provide health care equal to that of physicians in primary care setting at a lower costs • have patient care outcomes similar to that of physicians • NP services costs 40% less than that of physicians Np's and ARV therapy

16. Results of studies • high level of satisfaction reported by patient • significant reduction in waiting times for patients waiting to be seen by doctors for minor illnesses, • rational prescription of drugs in comparison with other prescribers • Provide opportunity for physicians to see clients who need them most Np's and ARV therapy

17. Results of studies cont’d • Unlike physicians NP’s take a holistic approach to care (also focus on preventive and promotive care) • A decreased number of hospitalizations • NP’s training is less time consuming and less costly Np's and ARV therapy

18. Conclusion • NP’s provide health care equal to that of physicians in primary care setting at a lower costs • NP’s have adequate skill required to care for patients on ARV therapy yet they are the list utilized in the country • Maximum utilization of NP’s in routine monitoring of clients reduces workload on doctors • Hence allowing doctors more time to concentrate on newly enrolled candidates Np's and ARV therapy

19. Conclusion • Routine monitoring at local clinics: • reduces congestion at ARV centers, • Reduces unnecessary traveling to centers • Allows NP to continuously provide counseling and education even outside ARV clinic hours • Promote adherence as more patients will be monitored in their villages Np's and ARV therapy

20. Conclusion • Utilizing NP’s in ARV clinics gives Drs. the opportunity to concentrate on initiating therapy and managing complex medical conditions • NP’s can provide routine monitoring of clients. • For Now: Maximum utilization of NP’s is the best health care strategy to lessen the acute shortage of doctors and health care deficiencies that exist in the most underserved communities. Np's and ARV therapy

21. Conclusion • The positive impact of Nurse Practitioners on quality of care has been registered internationally • WHO and ICN considers Botswana fortunate to have established NP program • NP’s in Botswana are a viable option in HIV/AIDS treatment care Np's and ARV therapy

22. THANK YOU!!!!! Np's and ARV therapy