1. Np's and ARV therapy1 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

2. Np's and ARV therapy2 BOTSWANA/SOUTHERN AFRICA Boarders: /South Africa /Namibia/Zambia/Zimbabwe. Area; 582,000sq km Population 1,6 million

3. Np's and ARV therapy3 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

4. Np's and ARV therapy4 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

5. Np's and ARV therapy5 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

6. Np's and ARV therapy6 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)

7. Np's and ARV therapy7 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

8. Np's and ARV therapy8 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

9. Np's and ARV therapy9 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.

10. Np's and ARV therapy10 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.

11. Np's and ARV therapy11 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

12. Np's and ARV therapy12 Way forward in the care of patients on ARV therapy Explore the role of NPs in ARV therapy in Botswana and compare it to other countries

13. Np's and ARV therapy13 International roles and responsibilities of NPs 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.

14. Np's and ARV therapy14 International roles and responsibilities of NPs Established in response to perceived shortage of primary care medical practitioners Capable of providing care equivalent to the medical doctors.

15. Np's and ARV therapy15 Benefits of having NPs 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

16. Np's and ARV therapy16 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

17. Np's and ARV therapy17 Results of studies contd Unlike physicians NPs take a holistic approach to care (also focus on preventive and promotive care) A decreased number of hospitalizations NPs training is less time consuming and less costly

18. Np's and ARV therapy18 Conclusion NPs provide health care equal to that of physicians in primary care setting at a lower costs NPs have adequate skill required to care for patients on ARV therapy yet they are the list utilized in the country Maximum utilization of NPs in routine monitoring of clients reduces workload on doctors Hence allowing doctors more time to concentrate on newly enrolled candidates

19. Np's and ARV therapy19 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

20. Np's and ARV therapy20 Conclusion Utilizing NPs in ARV clinics gives Drs. the opportunity to concentrate on initiating therapy and managing complex medical conditions NPs can provide routine monitoring of clients. For Now: Maximum utilization of NPs is the best health care strategy to lessen the acute shortage of doctors and health care deficiencies that exist in the most underserved communities.

21. Np's and ARV therapy21 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 NPs in Botswana are a viable option in HIV/AIDS treatment care

22. Np's and ARV therapy22 THANK YOU!!!!!