July 2003
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HIV Clinical Centre of Excellence provides 'light of hope'
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| The upstairs waiting room of the Centre provides a comfortable family environment. (Photos by Smiley Pool Jr.) |
The afternoon African sun gilds the Botswana-Baylor Children’s Clinical Centre of Excellence, its reflected light setting the large windows afire.
For this country with arguably the highest adult rate of human immunodeficiency virus (HIV) disease in the world, the Center – a joint project of Baylor College of Medicine and the nation of Botswana -- represents the light of hope for children who have the disease. Located in the capital Gaborone, it is expected to draw youngsters and their families from all corners of Botswana.
On July 10, it drew U.S. First Lady, Laura Bush, who met many of the clinic’s staff and patients as part of her husband’s first visit to Africa, a continent whose future is threatened by AIDS. The United States has pledged $15 billion to fight AIDS globally and particularly in Africa where a dearth of available health care and a lack of access to drugs that fight the virus hamper the abilities of nations to care for their people.
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| First Lady, Laura Bush, visits the Botswana - Baylor Children's Clinical Centre of Excellence. |
“The focus of the Center is on providing the best possible HIV primary and specialty care both for the children and their families,” said Mark Kline, MD, director of the Baylor International Pediatric AIDS Initiative and a professor of pediatrics at Baylor. (More about Kline can be found in this month’s A Matter of Health column).
When Kline and his team arrived in Botswana, there was no place in the country dedicated to the outpatient care of HIV-infected children. It cost $25,000 to renovate a three-room area in the Princess Marina Hospital, and by mid-2001 the BANA (an acronym for Baylor-Botswana Anti-retroviral Assessment) clinic was ready for business.
It was no accident that BANA is also the Setswana word for children, said Kline.
The BANA clinic operated alongside the government-run national clinic to help treat approximately 400 children infected with HIV. At that time, few children in Botswana were tested for the virus, said Kline. The prevailing attitude was that since there was no treatment available, what was the point in knowing if they had the disease. He anticipates that testing will increase now that people in Botswana know their children can receive care.
Forty-five percent of all adults in the capital city of Gaborone are infected with the AIDS virus, according to statistics from the U.S. Agency for International Development. The average age of death for men and women is less than 40.
The government of Botswana has begun providing drugs to fight HIV. It was also one of the first to provide antiviral medication to pregnant women in order to lower the numbers of infants born with HIV. Government health officials were enthusiastic when approached about the prospect of building a children’s HIV treatment center, Kline said.
On June 20, The Botswana-Baylor Clinical Centre of Excellence opened officially, merging the activities of both the BANA clinic and the national clinic for children. Kline projects that within a year, they will be treating more than 1,000 children.
“We wanted to replicate what we’d done in Romania in Africa and Botswana was a logical place,” Kline said. “Botswana has an extraordinarily high prevalence rate and the government has been active in promoting HIV prevention, care and treatment.”
The two-story, 14,000-square-foot outpatient clinic has 10 examination rooms, two procedure rooms, a pharmacy, a laboratory and two conference rooms. Among those working at the new Center are seven physicians, several nurses, nutritionists and social workers.
The Center cost $2.6 million to build and it will take $500,000 a year, exclusive of drugs, to keep the center up and running. The drugs are provided by the Botswana government or through the studies of drugs that are undertaken at the center under medical supervision.
Gabriel Anabwani, MD, director of the Botswana-Baylor Clinical Centre of Excellence, is also a full-time professor of pediatrics at Baylor.
“He’s one the few African pediatricians who has experience in treating children with HIV in Africa,” Kline said. “He’s been our partner in the BANA clinic from the beginning. He’s the number one authority on pediatric HIV in Botswana.”
Family-based care is the heart of the Botswana-Baylor Clinical Centre of Excellence, said Kline. When a child is identified as having HIV infection, he or she is referred to the center. That child receives care and so do members of the family.
“We’ll evaluate the entire family,” Kline said. “Then we’ll screen everyone in that household who wants to be tested and provide care and treatment for everyone in that family. It is critical to maintain the family’s integrity and the economic nucleus of the family.”
Mothers and families are the key to child survival in Africa. For example, a recent report showed that a child born without HIV to a mother with HIV infection has no greater life expectancy than an HIV-infected child born to an HIV-infected mother.
On a continent where AIDS is as devastating as the warfare that bedevils many of the nations, the need for treatment is great. The future of Africa lies in its children, and Kline would like to see a coordinated treatment effort. He envisions a network of 10 African clinics in the nations where AIDS rates are highest. The clinics could share in expertise, purchasing and research in an attempt to bring the epidemic under control.
“It would be a true African experience,” he said.
| A Matter of Health | |
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A global view makes a difference |