Refilwe Sello transitioning adolescents at Botswana ... - Team PATA
Refilwe Sello transitioning adolescents at Botswana ... - Team PATA
Refilwe Sello transitioning adolescents at Botswana ... - Team PATA
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Transitioning Perin<strong>at</strong>ally<br />
infected <strong>adolescents</strong> to<br />
adulthood :The <strong>Botswana</strong>-<br />
Baylor Children’s Clinical Centre of<br />
Excellence Experience<br />
Dr <strong>Refilwe</strong> <strong>Sello</strong><br />
Program Manager, Adolescent Services<br />
<strong>PATA</strong> forum, Gaborone<br />
16 th November, 2011<br />
© 2011 Texas Children’s Hospital. All rights reserved.
© 2011 Texas Children’s Hospital All rights reserved.<br />
Adolescent Transition<br />
Page 1<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Present<strong>at</strong>ion Outline<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
•Background<br />
•Challenges & opportunities<br />
•Adolescent Transition Clinic<br />
•Adolescent Support<br />
services<br />
•Conclusion<br />
Page 2<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM<br />
Photo courtesy of Molly Waite
“Among the challenges th<strong>at</strong> lay ahead, the need to prepare<br />
for the care of the ever increasing popul<strong>at</strong>ion of<br />
<strong>adolescents</strong> and young adults who are living with HIV and<br />
AIDS stands out most. We must pool our resources and<br />
discover better methods to help these most vulnerable<br />
members of our community. This is the challenge of our<br />
time; it is also the opportunity of our age.”<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 3<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM<br />
Professor Gabriel Anabwani, Executive<br />
Director, <strong>Botswana</strong> Baylor Children’s<br />
Clinical Centre of Excellence (COE)<br />
2008 Annual Report
© 2011 Texas Children’s Hospital All rights reserved.<br />
205<br />
306<br />
412<br />
511<br />
1206<br />
1800<br />
Source: <strong>Botswana</strong> Ministry of Health, MASA ARV Programme, Monthly Report St<strong>at</strong>istics (December 2008)<br />
Page 4<br />
2400<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM<br />
3006
© 2011 Texas Children’s Hospital All rights reserved.<br />
Source: <strong>Botswana</strong>-Baylor Children’s Clinical Centre of Excellence, PIDC D<strong>at</strong>abase (December 2008)<br />
Page 5<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Source: <strong>Botswana</strong>-Baylor Children’s Clinical Centre of Excellence, PIDC D<strong>at</strong>abase (March 2010)<br />
Page 6<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
A total 783 <strong>adolescents</strong> for<br />
transition!<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Frequency<br />
Age-sex distribution<br />
300<br />
200<br />
100<br />
0<br />
10-12 13-15 16-21 22-24<br />
gender Female 214 198 192 4<br />
gender Male 269 236 157 3<br />
Page 7<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
• Psychological (“The Adolescent Mind”)<br />
‐ Concrete thinking<br />
‐ Limited future orient<strong>at</strong>ion<br />
• Disclosure<br />
• Adherence<br />
• Normalizing life experiences<br />
• High-risk behaviors<br />
‐ Sex<br />
‐ Alcohol Abuse and other Drugs<br />
• Transition to Adult Care<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Challenges<br />
Page 8<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
•Not children, not yet adults<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Opportunities<br />
•Benefits of preparing teens for adulthood and involving<br />
them in the planning of implement<strong>at</strong>ion is critical<br />
•Ongoing input from <strong>adolescents</strong>, teens ,caregivers and staff<br />
•Positive Health, Dignity & Prevention<br />
•…..Growing with our children <strong>at</strong> the COE!!!<br />
Page 9<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Adolescent Clinic<br />
• Adolescent-focused tre<strong>at</strong>ment clinic<br />
• Started with 23 teenagers in 2005<br />
• Currently, over 783 <strong>adolescents</strong> in PIDC aged 13-19 years<br />
• Adolescent-focused providers: continuity of care<br />
• Full-time Clinical psychologists, Social Workers and Peer educ<strong>at</strong>ors<br />
• Address adolescent-specific medical and psychosocial needs<br />
Page 10<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Age 13-15<br />
Remain in PIDCC<br />
GAPS #1 annually<br />
PHASE 1:<br />
· Multidisciplinary discussion re: pt<br />
reviewed <strong>at</strong> Adolescent Forum<br />
· Psychological evalu<strong>at</strong>ion & in-reach<br />
· Continue pursuing phase 1 goals<br />
To family clinic<br />
Work with<br />
multidisciplinary team<br />
to cre<strong>at</strong>e long-term<br />
care plan<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Adolescent Transition Algorithm Transition Algorithm<br />
· Transition templ<strong>at</strong>e #1<br />
· Maintain Adolescent visit interval (6 weekly)<br />
· Record periodic achievement of skills outlined<br />
on templ<strong>at</strong>e<br />
Option 2:<br />
- Prior to age 16 (~15.5)<br />
- Achieved Templ<strong>at</strong>e #1 skills<br />
Age 16-21 5.Continue pursuing phase 1 goals<br />
Enter Adolescent Transition Clinic<br />
PHASE 2:<br />
Begin GAPS #2 annually<br />
Attains Phase<br />
1 goals<br />
· Transition templ<strong>at</strong>e # 2<br />
· Begin independence around<br />
medic<strong>at</strong>ion adherence<br />
Age 18:<br />
Not <strong>at</strong>tained Phase 1<br />
goals ·<br />
· Initial psychology assessment<br />
· Meet w/peer educ<strong>at</strong>or<br />
·<br />
Undetectable VL x2 consecutive<br />
measures<br />
· Adherence >95% x 6 months<br />
· Meet templ<strong>at</strong>e #2 goals<br />
Pt reduces interval of visits to Q3 mo<br />
Option 1:<br />
Transfer to IDC<br />
Pt returns paper work to<br />
COE for confirm<strong>at</strong>ion<br />
Certific<strong>at</strong>e of gradu<strong>at</strong>ion<br />
No<br />
· Undetectable viral load x6 mo<br />
· Adherence >95%<br />
· Psychology has approved transfer<br />
P<strong>at</strong>ient chooses<br />
Transfer care to IDC w/<br />
interval visits to COE for<br />
physical / psychosocial check<br />
Meds from IDCC<br />
Offer inclusion in young<br />
adult support group<br />
yes<br />
PHASE 1 Goals:<br />
- Full disclosure<br />
- Understand disease process<br />
- Understand disease markers<br />
- Understand Positive Prevention<br />
measures<br />
Offer teen club –<br />
address issues<br />
relevant to life<br />
skills and<br />
transition<br />
PHASE 2 Goals:<br />
- Medic<strong>at</strong>ion independence<br />
-Maintain >95% adherence<br />
- Undetectable viral load<br />
- identify and enroll in IDCC<br />
Not achieved by age 20<br />
Pt declines transfer:<br />
Continue x 4 Q3 mo<br />
visits, transfer option 1<br />
or 2 when agrees<br />
Refuses after 4 visits<br />
Psychology re-evalu<strong>at</strong>ion<br />
Psychosocial support with<br />
Option 2 process<br />
Consider revision of long<br />
term care plan<br />
Page 11<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Adolescent Transition<br />
Consult questions<br />
Page 12<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Adolescent Care<br />
•Comprehensive integr<strong>at</strong>ed Multidisciplinary team approach<br />
‐ Adolescent continuity provider<br />
‐ Psychologist<br />
‐ Peer counselor<br />
‐ Social worker<br />
‐ In reach<br />
‐ Peer support<br />
‐ Voc<strong>at</strong>ional placement &Mentoring<br />
Page 13<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Adolescent Forum<br />
• Bi-monthly multi disciplin<strong>at</strong>ory team meetings<br />
• Led by psychologist and social workers<br />
• Attended by healthcare providers with interest in adolescent issues:<br />
‐ Physicians<br />
‐ Nurses<br />
‐ Psychologist<br />
‐ Social Workers<br />
‐ Auxiliary Staff- teen club<br />
• Case discussions: challenging adolescent cases with a psychosocial<br />
emphasis<br />
• Discuss upd<strong>at</strong>es in adolescent support activities<br />
Page 14<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Challenge clinic<br />
• Bi-monthly multi disciplin<strong>at</strong>ory team meetings<br />
• Led by HIV specialist<br />
• Case discussions: challenging adolescent<br />
‐ Adherence<br />
‐ Virologic Failure<br />
‐ Resistance<br />
‐ Complex medical cases<br />
‐ Complex social situ<strong>at</strong>ions<br />
‐ Intervention<br />
Page 15<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Psychosocial/Educ<strong>at</strong>ional Interventions<br />
<strong>at</strong> <strong>Botswana</strong> COE<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Age (Years)<br />
20<br />
15<br />
10<br />
5<br />
0<br />
Morning<br />
Play<br />
Group &<br />
Sunshine<br />
Club<br />
Interventions<br />
Page 16<br />
Camp<br />
Hope<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM<br />
Teen<br />
Club<br />
Older Teens<br />
Younger Teens
<strong>Botswana</strong> Teen Club Mission<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
•“To empower HIV-positive <strong>adolescents</strong> to build positive<br />
rel<strong>at</strong>ionships, improve their self-esteem and acquire life<br />
skills through peer mentorship, adult role-modeling and<br />
structured activities, ultim<strong>at</strong>ely leading to improved clinical<br />
and mental health outcomes as well as a healthy transition<br />
into adulthood.”<br />
•Enrollment Criteria: 13-19 years old, fully disclosed,<br />
guardian consent obtained<br />
Page 17<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Background<br />
•The <strong>Botswana</strong>-Baylor COE Teen Club, based in <strong>Botswana</strong>’s<br />
capital, Gaborone, has experienced phenomenal growth, from 4<br />
members in 2005 to over 887 members in 2010.<br />
•Partners <strong>at</strong> our outreach sites have requested assistance in<br />
developing similar programs outside the capital.<br />
•In response, the <strong>Botswana</strong>-Baylor COE has partnered with local<br />
hospitals and NGOs to establish 7 s<strong>at</strong>ellite Teen Clubs.<br />
Page 18<br />
© 2010 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Map of S<strong>at</strong>ellite Teen Clubs<br />
Key<br />
Oper<strong>at</strong>ional S<strong>at</strong>ellite<br />
S<strong>at</strong>ellite in Development<br />
Gaborone Teen Club<br />
Page 19<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Source: <strong>Botswana</strong>-Baylor Children’s Clinical Centre of Excellence, Teen Club Attendance D<strong>at</strong>abase (March 2010)<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 20<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Teen Club Highlights<br />
Best Practice in UNICEF St<strong>at</strong>e of the World Children’s Report 2010<br />
UNICEF’s 2010 Stocktaking Report as Best Practice for the provision on<br />
Psychosocial Support<br />
USAID’s AIDSTAR-One Promising Practices D<strong>at</strong>abase; http://www.aidstarone.com/promising_practices_d<strong>at</strong>abase/search<br />
N<strong>at</strong>ional recognition through NACA , VISION 2016 and Mama Africa Award<br />
Highlighted by UNICEF with UNAIDS, UNESCO, UNFPA, ILO, WHO and the<br />
World Bank “HIV Infections in Young People” in the section on “solutions”<br />
for its “broad range of medical, psychological and educ<strong>at</strong>ion services and<br />
support” for children and <strong>adolescents</strong> living with HIV<br />
Page 21<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
MCP Project – NACA/BNAPS<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 22<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Teen Talk Guide<br />
•Adapted and revised - with<br />
permission - from US-based<br />
public<strong>at</strong>ion.<br />
•Question & Answer model directed<br />
towards teens.<br />
•Includes modules on reproductive<br />
health, emotions, rel<strong>at</strong>ionships,<br />
stigma, ARV adherence, and other<br />
issues specific to HIV+<br />
<strong>adolescents</strong>.<br />
•Consult<strong>at</strong>ions ongoing with MoH<br />
IEC Dept. for n<strong>at</strong>ional rollout<br />
Page 23<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Stitch x Stitch Income-Gener<strong>at</strong>ing<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Sewing Project<br />
A Barclays’ Supported Initi<strong>at</strong>ive<br />
•Initially an idea to teach our teens a life skill they will be able to utilize throughout their whole<br />
lives, StitchxStitch m<strong>at</strong>erialized as a pilot project in September 2011<br />
•Selected teens <strong>at</strong>tend daily sessions with a local tailor to learn basic sewing techniques in a sewing<br />
lab set up <strong>at</strong> the <strong>Botswana</strong> Baylor Centre of Excellence<br />
•By November 2011, our teens will have cre<strong>at</strong>ed 200 bags for a Paedi<strong>at</strong>ric AIDS Tre<strong>at</strong>ment for<br />
Africa (<strong>PATA</strong>) conference<br />
•StitchxStitch is our Adolescent Programme’s first income-gener<strong>at</strong>ing project; it will be followed<br />
by courses including jewelry-making, graphic design and c<strong>at</strong>ering<br />
•The goal of Stitch x Stitch is to encourage <strong>adolescents</strong> to be resourceful, develop their full<br />
potentials and seek independence in their futures!<br />
Page 24<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Training Programmes<br />
•Pedi<strong>at</strong>ric/Adolescent HIV Care & Support Training for Non-<br />
Medical Professionals<br />
•Leadership and Communic<strong>at</strong>ion Str<strong>at</strong>egies Training for Teen<br />
Leaders and Peer Educ<strong>at</strong>ors<br />
•Fundraising & Marketing Training for Non-Governmental<br />
Organiz<strong>at</strong>ions<br />
•Adherence Training for Caregivers of Adolescents (In<br />
Development)<br />
Page 25<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Adolescent Centre<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
• Safe and welcoming environment for teens to visit during:<br />
‐ Monthly clinic appointments<br />
‐ Weekends<br />
‐ Holidays<br />
• Services provided will include:<br />
‐ Psychosocial counseling<br />
‐ Peer counseling<br />
‐ Life skills and health educ<strong>at</strong>ion<br />
‐ Recre<strong>at</strong>ional activities<br />
‐ Tutoring<br />
‐ Caregiver support<br />
‐ Organic gardening<br />
Page 26<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Proposed Adolescent Centre<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 27<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Michelle Obama’s Mural on our<br />
Adolescent Centre Wall<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 28<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Adolescent Centre: 3-D Rendering<br />
Plan for the Adolescent Centre from Logan and Johnson Architecture (Houston, Texas)<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 29<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
“I, as an HIV-positive adolescent would<br />
like to say: the st<strong>at</strong>e th<strong>at</strong> I am in might<br />
make me vulnerable in a way but it does<br />
not prevent me from trying to reach my<br />
goals, I have plans just like you, I see<br />
myself growing old just like you, with<br />
the support of Teen Club I believe I can<br />
overcome the challenges th<strong>at</strong> come my<br />
way because I’m not alone”<br />
- Quote from an older Teen Club member<br />
© 2011 Texas Children’s Hospital. All rights reserved.
Conclusions<br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
•Increasing numbers of HIV+ <strong>adolescents</strong> cre<strong>at</strong>e unique challenges<br />
for health care providers.<br />
•Comprehensive, adolescent-focused services can help to foster<br />
successful transitions to adulthood for HIV+ youth.<br />
•Our achievements so far are:<br />
‐ Not solely our own;<br />
‐ Not an end in themselves;<br />
‐ Not even the beginning of the end<br />
•Let’s work together to achieve more!<br />
Page 31<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
A brighter future for our <strong>adolescents</strong><br />
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 32<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
http://botswan<strong>at</strong>eenclub.wordpress.com<br />
Email : botswan<strong>at</strong>eenclub@gmail.com<br />
Page 33<br />
© 2007 Baylor College of Medicine<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Acknowledgements<br />
•Government of <strong>Botswana</strong><br />
•BIPAI leadership<br />
•Our Donors<br />
•<strong>Botswana</strong> Baylor Management, Staff and P<strong>at</strong>ients<br />
•<strong>PATA</strong> organizers and participants<br />
Page 34<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
© 2011 Texas Children’s Hospital All rights reserved.<br />
Page 35<br />
xxx00.#####.ppt 11/16/2011 7:33:23 PM
Change language