|Capacity Building | MEPI | KITSO | PEPFAR | Fogarty
EDUCATION & TRAINING: KITSO
The name of this program was designed to incorporate the culture of Botswana and to capture the groundbreaking nature of this collaborative educational effort. While English is the official language of Botswana, the national language of Setswana is an important element of the country's proud heritage. "Kitso" is the Setswana word for "knowledge." KITSO AIDS also stands for "Knowledge, Innovation, and Training Shall Overcome AIDS."
Conceptualized through private seed funding, the KITSO AIDS Training Program was established in 2001. It is the Botswana Ministry of Health's national training program for HIV/AIDS treatment and care. KITSO was initially conceived, developed, and implemented through a collaboration between the MOH and the Botswana–Harvard Partnership (BHP).
In order to offer more training opportunities for healthcare professionals in Botswana, the KITSO AIDS Training Program was expanded in 2004 to include the expertise of additional partner organizations. Within this enlarged framework, BHP's KITSO Program (KITSO-BHP) continues to provide high quality, multi-disciplinary, sustainable, and standardized training to help healthcare workers understand and apply the Botswana national HIV/AIDS care and treatment guidelines.
KITSO-BHP's training efforts are made possible through the financial support of the African Comprehensive HIV/AIDS Partnerships (ACHAP), a collaboration between the Government of Botswana, the Bill & Melinda Gates Foundation, and The Merck Company Foundation/Merck & Co., Inc.
When ARV therapy was first introduced in Botswana in 2002, few physicians in the country had experience in AIDS treatment. Through KITSO training and front-line experience in the ARV clinics, healthcare professionals in Botswana have gained the expertise and confidence to both provide ARV therapy and train other healthcare workers at their treatment sites. KITSO-trained staff now provide ARV therapy at 33 hospital sites and 137 satellite clinics throughout the country, and currently serve over 130,000 patients enrolled in the national ARV program.
Curriculum and Implementation
Curriculum development and course implementation have been driven by the immediate need to train Botswana's healthcare workers in HIV/AIDS care in formats that provide a comprehensive grounding in good clinical practice without requiring long periods of staff release for training.
As mandated by the MOH, KITSO training modules are the national standard of training for HIV/AIDS care and treatment in both public and private sectors. The KITSO-BHP team oversees the standardized training implementation, curriculum development, updating, course examination and certification.
AIDS Clinical Care Fundamentals
Since 2006 KITSO-BHP has been implementing distance learning as an alternative training format utilizing an audio-enhanced CD ROM of AIDS Clinical Care Fundamentals. Distance learning participants receive a training package, including the CD Rom, course binder and support materials for their self studies. A one-day classroom training activity where clinical scenarios pertaining to the learning objectives of the course are discussed. A final assessment concludes the distance learning experience.
Topics covered in AIDS Clinical Care Fundamentals:
AIDS Clinical Care Fundamentals Refresher/Update
The module was first implemented in January 2008. All efforts will be made to re-train healthcare workers as quickly as possible in order to maintain the high standard of HIV/AIDS care and treatment in Botswana.
Medication Adherence Counseling
A combination of lectures, case discussions, role-playing, and interactive activities are employed to reinforce good counseling techniques and strengthen the participants' ability to devise and implement successful adherence interventions. Implemented in collaboration with the Botswana-Baylor Children's Center of Excellence, the course also includes teaching and case discussions about pediatric and adolescent adherence, as well as disclosure of HIV status for children, adolescents, and their families.
Advanced HIV/AIDS Care and Treatment
Advanced HIV/AIDS Care and Treatment combines lectures and interactive case discussions to provide advanced and comprehensive training in ARV therapy, emphasizing treatment principles and strategies practiced world-wide and applying them to the Botswana setting. This course familiarizes participants with the full complement of ARV drugs and provides strategies for the management of treatment failure, interpretation of drug resistance assays, designing of "salvage" regimens, and understanding short- and long-term ARV side effects and toxicities. Course content equips clinicians with the skills and knowledge necessary to manage complicated patients and provide guidance and support to their colleagues, thereby strengthening the growing HIV treatment expertise in Botswana's healthcare sector.
Advanced HIV/AIDS Care and Treatment covers adult, adolescent, and pediatric HIV care. Special emphasis is placed on primary care for HIV-infected children and on disclosure issues, especially in regards to children and adolescents.
Each advanced course also provides updates on relevant research and clinical trials conducted internationally and in Botswana as well as summaries of recent international HIV/AIDS meetings.
Introduction to AIDS Clinical Care
Course content includes an introduction to HIV pathophysiology and immunology and information about testing, eligibility and referral for ARV therapy, identification of common ARV side effects, the importance of medication adherence, counseling and referral for PMTCT, and post-exposure prophylaxis. This course is suitable for general health educators, family welfare educators, and lay counselors and social workers. Since 2006, Introduction to AIDS Clinical Care has been implemented at ARV sites by the BHP–PEPFAR Master Trainer Program.
Sexual and Reproductive Health in HIV Infection
Reference Corners and Resource Materials
KITSO-BHP has also provided each district hospital in Botswana with a laptop computer and an LCD projector for in-service staff education.
From its inception, KITSO-BHP has carefully incorporated monitoring and evaluation tools into its training formats to assess the quality and integrity of the program's structure, content, and implementation. This commitment to assessment and evaluation has allowed the KITSO-BHP program to quickly adapt to changing national healthcare guidelines, stakeholder advice, faculty and participant feedback, and the recommendations of external evaluators.
A Long-Term Evaluation was conducted in 2006 to assess the impact and reach of KITSO-BHP training. Site leaders from 17 ARV sites were interviewed and 494 former course participants completed survey questionnaires and knowledge assessments. The final evaluation report was released by the MOH in January 2008.
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