The Nurse Practitioner: A viable option in HIVAIDS treatment care in resource limited settings: Bots

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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 kmPopulation 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 NPs in ARV therapy in
  Botswana and compare it to other countries

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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.

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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.

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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

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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 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

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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

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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 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.

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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
• NPs in Botswana are a viable option in HIV/AIDS
  treatment care

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• THANK YOU!!!!!