Botswana In-Reach Programme

Category 2

The In-Reach program provides access to care to children by creating linkages between families and staff. Staff members make home visits to get to know family members, get to know caregivers, offer testing, check hygiene, drug storage capacity, water resources, etc. In-Reach visits are provided to every child, however, it has demonstrated that it can be a strong channel to reach into the families, and resolve the most complicated issues, of the most vulnerable children, particularly those family members and caregivers who would otherwise not seek services on their own. By taking the tests services to the home environment, the atmosphere is none-threatening and reduces the stigma associated with COE, and reduces the financial burden born by families in traveling to the center. The In-Reach team visits clients' homes four days per week.

Goal of the Practice
  • To increase access to HIV testing, health and nutritional assessments for orphans and vulnerable children
  • To maximize the number of orphans and vulnerable children and their families receiving HIV treatment, care and support
  • To support HIV/AIDS care and treatment and reduce treatment failure rates and subsequent morbidity/mortality rates among children attending COE and other ARV clinics
  • To contribute towards the reduction of vertical and horizontal HIV transmission
  • To improve the quality of life of HIV-infected children and families in Botswana
Core Components
  • Emergency and routine home visits to all COE clients and their families. Routine visits are those that are done to every child regardless of any situation while emergency are those that are followed for serious or difficult situations, such as poor adherence or loss to follow up. Home visits are done four days every week, Monday to Thursday
  • Subjective and objective adherence evaluations with subsequent adherence counseling
  • Pre-post test counseling and testing for family members living in the household
  • Clinical, socioeconomic, and nutritional assessments, with relevant referrals
  • Psycho-social assessment and support, with referral to relevant stakeholders as indicated
Noteworthy Results
  • Since September 2008, 115 people have been tested for HIV (60% adults, 40% children). Testing results: Adults -- 85.8% negative, 14.2% positive; Children -- 98% negative, 2% positive
  • In July 2009 we began to work with community-based Health Education Assistants (HEAs), who have been invaluable in assisting us in finding homes more rapidly and developing rapport with families, thus making home visits more efficient and effective
  • Between 4-6 home visits per day are carried out four days per week -- approximately 60 home visits per month
Lessons Learned
  • The picture the child or family displays at the COE does not always reflect reality about their home situation. Very often treatment failure and or other problems are rooted in the home environment.
  • Many partners are not disclosed to mother's and child's HIV status; home visits must be conducted with this in mind.
  • Families are more willing to offer information and to test for HIV when they are relaxed in their home environment.
  • In collaboration with the Ministry of Local Government's Departments of Primary Health Care Services and Social Services, we have been able to involve their Health Education Assistants (HEA) as well as CBOs to help locate households. This has been key, as locating households continues to be a challenge since houses and plot numbering are not in any particular order. Without the assistance of the HEAs, the exercise can be time-consuming, affecting other planned home visits for the day.
  • The big challenge we continue to have is the transfer of retrospective data into the EMR, which has been ongoing. A balancing act is on-going between clinical research priorities on the one hand with those of operational constraints that include time, financial implication as well as human resource. Electronic importation of data calls for a renewed collaboration with our principal partners to reinforce buy-in on the EMR.
Focus Areas
Care and Support
Implemented By
Botswana-Baylor Children's Clinical Center of Excellence
Participating Organization
  • Botswana Ministry of Health
  • Ministry of Local Government
  • Department of Social Services
  • NGOs
  • CBOs
Region
Africa
Country
Botswana
Environment
Community/Household
Setting
Urban
Target Population
People Living with HIV (PLWH)
Scope
100 - 500
Implementation Years
09/2008 - ongoing