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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

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BOTSWANA/SOUTHERN AFRICA

Boarders: /South Africa /Namibia/Zambia/Zimbabwe.

Area; 582,000sq km

Population 1,6 million

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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

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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

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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

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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)

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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

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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

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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.

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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 .

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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

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Way forward in the care of patients on ARV therapy

Explore the role of NP’s in ARV therapy in Botswana and compare it to other countries

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International roles and responsibilities of NP’s

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.

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International roles and responsibilities of NP’s

Established in response to perceived shortage of primary care medical practitioners

Capable of providing care equivalent to the medical doctors.

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Benefits of having NP’s 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

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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

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Results of studies cont’d

Unlike physicians NP’s take a holistic approach to care (also focus on preventive and promotive care)

A decreased number of hospitalizations NP’s training is less time consuming and

less costly

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Conclusion

NP’s provide health care equal to that of physicians in primary care setting at a lower costs

NP’s have adequate skill required to care for patients on ARV therapy yet they are the list utilized in the country

Maximum utilization of NP’s in routine monitoring of clients reduces workload on doctors

Hence allowing doctors more time to concentrate on newly enrolled candidates

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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

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Conclusion

Utilizing NP’s in ARV clinics gives Drs. the opportunity to concentrate on initiating therapy and managing complex medical conditions

NP’s can provide routine monitoring of clients. For Now: Maximum utilization of NP’s is the

best health care strategy to lessen the acute shortage of doctors and health care deficiencies that exist in the most underserved communities.

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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

NP’s in Botswana are a viable option in HIV/AIDS treatment care

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THANK YOU!!!!!