Conference on Retroviruses and Opportunistic Infections 2016

CROI, the annual Conference on Retroviruses and Opportunistic Infections (CROI), brings together top scientists, clinicians, and policy makers from around the world to discuss the latest studies and developments in the ongoing battle against HIV/AIDS and related infectious diseases. This year’s meeting is being held in February at the Hynes Convention Center in Boston, Massachusetts. Webcasts, abstracts, electronic posters, and other electronic resources are available online.



Below is a list of talks and posters by researchers associated with the Harvard AIDS Initiative and the Botswana Harvard AIDS Institute Partnership, being presented at this year’s CROI.

Tuesday, February 23
, 2016

SESSION 0-3 Oral Abstracts
11:00am Room 304/306
Prevention and Treatment of Pediatric HIV Infections

Similar Mortality With Cotrimoxazole vs Placebo in HIV-Exposed Uninfected Children

Roger L. Shapiro; Michael Hughes; Kathleen Powis; Gbolahan Ajibola; Kara Bennett; Sikhulile Moyo; Joseph Makhema; Sheryl Zwerski; M. Essex; Shahin Lockman

SESSION TD-2 Themed Discussion
1:45am –2:45pm Room 312
Global Burden and Mortality of Cancer in HIV
Themed Discussion Leader William A. Blattner, Institute of Human Virology, Baltimore, MD, USA

Cancer Versus Tuberculosis Mortality Among HIV-Infected Individuals in Botswana

Scott Dryden-Peterson; Gita Suneja; Heluf Medhin; Memory Bvochora-Nsingo; Mukendi K. Kayembe; Neo Tapela; Shahin Lockman

SESSION P-E1 Poster Abstracts
2:45pm-4:00pm Hall A/B
Antibody Responses to HIV Infection: What Drives Them and How They Affect the Virus

Humoral Immune Pressure Selects for HIV-1 CXCR4- Using Variants

Nina Lin; Oscar Gonzalez; Carlos Becerril; Behzad Etemad; Hong Lu; Xueling Wu; Shahin Lockman; M. Essex; Daniel Kuritzkes; Manish Sagar

SESSION P-S4 Poster Abstracts
2:45pm-4:00pm Hall D
MTCT: Regimens, Rates, and Early Infant Diagnosis

Infant Cotrimoxazole Prophylaxis Associated With Commensal Bacterial Resistance

Kathleen Powis; Sajini Souda; Shahin Lockman; Gbolahan Ajibola; Kara Bennett; Florence Chilisa; Michael Hughes; Sikhulile Moyo; Joseph Makhema; Roger L. Shapiro

HIV-Exposed Children Account for More Than Half of 24-Month Mortality in Botswana

Rebecca Zash; Jean Leidner; Sajini Souda; Kelebogile Binda; Heather J. Ribaudo; Sikhulile Moyo; Kathleen Powis; Joseph Makhema; Shahin Lockman; Roger L. Shapiro

Maternal ART and Hospitalization or Death Among HIV-Exposed Uninfected Infants

Scott Dryden-Peterson; Tatiana Ramos; Roger L. Shapiro; Shahin Lockman

SESSION P-T1 Poster Abstracts
2:45pm-4:00pm Hall D
Pharmacokinetics: Efficacy and Safety of New ARVs in Children

Nevirapine (NVP) Concentrations in HIV-Infected Newborns Receiving Therapeutic Dosing

Edmund Capparelli; Kenneth Maswabi; Steven Rossi; Muchaneta Bhondai; Sikhulile Moyo; Patrick Jean-Philippe; Michael Hughes; Mathias Lichterfeld; Daniel Kuritzkes; Roger L. Shapiro

SESSION P-W1 Poster Abstracts
2:45pm-4:00pm Hall D
Populations at Risk for HIV

Young HIV+ Adults in Botswana Less Likely to Seek Treatment or Be Virally Suppressed

Vladimir Novitsky; Tendani Gaolathe; Mompati Mmalane; Sikhulile Moyo; Molly Pretorius Holme; Kathleen Powis; Kathleen Wirth; Eric Tchetgen Tchetgen; Shahin Lockman; M. Essex

Wednesday, February 24, 2016

SESSION O-10 Oral Abstracts
10:00am Ballroom A
Getting to 90-90-90

Botswana Is Close to Meeting UNAIDS 2020 Goals of 90-90-90 Coverage

Tendani Gaolathe; Kathleen Wirth; Molly Pretorius Holme; Joseph Makhema; Sikhulile Moyo; Eric Tchetgen Tchetgen; Refeletswe Lebelonyane; Lisa A. Mills; M. Essex; Shahin Lockman

SESSION TD-10 Themed Discussion
1:45am –2:45pm Room 311
New Drugs for Kids: What’s Taking so Long?
Themed Discussion Leader Martina Penazzato, World Health Organization, Geneva, Switzerland

Nevirapine (NVP) Concentrations in HIV-Infected Newborns Receiving Therapeutic Dosing

Edmund Capparelli; Kenneth Maswabi; Steven Rossi; Muchaneta Bhondai; Sikhulile Moyo; Patrick Jean-Philippe; Michael Hughes; Mathias Lichterfeld; Daniel Kuritzkes; Roger L. Shapiro

SESSION P-O1 Poster Abstracts

2:45pm-4:00pm Hall A/B
Global Burden and Mortality of Cancer in HIV

Cancer Versus Tuberculosis Mortality Among HIV-Infected Individuals in Botswana

Scott Dryden-Peterson; Gita Suneja; Heluf Medhin; Memory Bvochora-Nsingo; Mukendi K. Kayembe; Neo Tapela ; Shahin Lockman

SESSION P-O2 Poster Abstracts
2:45pm-4:00pm Hall A/B
Anal and Cervical Cancer: Treatment and Prevention

HPV Type Distribution in HIV-Infected Persons With Anal HSIL and Impact on Recurrence

Michael Gaisa; Keith M. Sigel; Stephen Goldstone; Matthew Silverstein; Iain MacLeod

SESSION P-S5 Poster Abstracts
2:45pm-4:00pm Hall D
Mind the Gaps: Optimizing the PMTCT Cascade

Optimizing PMTCT Outcomes in Rural North-Central Nigeria: A Cluster-Randomized Study

Muktar H. Aliyu; Meridith Blevins; Carolyn M. Audet; Marcia Kalish; Mary Lou Lindegren; Usman I. Gebi; Obinna Onwujekwe; Bryan E. Shepherd; C. William Wester; Sten H. Vermund

SESSION P-S7 Poster Abstracts
2:45pm-4:00pm Hall D
Birth Outcomes and Mortality in HIV- and ARV-Exposed Infants

Higher Mortality in HIV-Exposed/Uninfected vs HIV-Unexposed Infants, Botswana

Gbolahan Ajibola; Gloria Mayondi; Jean Leidner; Haruna Jibril; Joseph Makhema; Mompati Mmalane; Modiegi Diseko; Roger L. Shapiro; Betsy Kammerer; Shahin Lockman

SESSION P-X3 Poster Abstracts
2:45pm-4:00pm Hall D
HIV Testing and Prevention

Cross-Sectional HIV Incidence at Scale-up of ART in 24 Rural Communities in Botswana

Sikhulile Moyo; Coretah Boleo; Terence Mohammed; Lucy Mupfumi; Simani Gaseitsiwe; Rosemary Musonda; Erik van Widenfelt; Joseph Makhema; M. Essex; Vladimir Novitsky

Thursday, February 25, 2016

SESSION TD-14 Themed Discussion
1:45am –2:45pm Room 302
Mind the Gaps: Optimizing the PMTCT Cascade
Themed Discussion Leader Marcel Yotebieng, Ohio State University, Columbus, OH, US

Optimizing PMTCT Outcomes in Rural North-Central Nigeria: A Cluster-Randomized Study

Muktar H. Aliyu; Meridith Blevins; Carolyn M. Audet; Marcia Kalish; Mary Lou Lindegren; Usman I. Gebi; Obinna Onwujekwe; Bryan E. Shepherd; C. William Wester; Sten H. Vermund

SESSION P-G5 Poster Abstracts
2:45pm-4:00pm Hall A/B
Clinical Distinctions and Therapeutic Response

Statin or ACE/ARB Effects on Neurocognitive Function of HIV-Infected Adults

Kristine M. Erlandson; Douglas Kitch; C. William Wester; Robert Kalayjian; Edgar T. Overton; Jose R. Castillo-Mancilla; Susan L. Koletar; Constance A. Benson; Kevin R. Robertson; Judith Lok

SESSION P-S9 Poster Abstracts
2:45pm-4:00pm Hall D
Outcomes of HIV and ARV-Exposed Infants, Children, and Youth

Similar HIV Protection From ZDV vs NVP Prophylaxis in Formula-Fed Infants in Botswana

Kathleen Powis; Shahin Lockman; Gbolahan Ajibola; Kara Bennett; Jean Leidner; Michael Hughes; Sikhulile Moyo; Erik van Widenfelt; Joseph Makhema; Roger L. Shapiro

SESSION P-X7 Poster Abstracts
2:45pm-4:00pm Hall D
Access, ART Initiation, Retention, and Outcomes in the Global South

Imputing Clinical Records From Routine Laboratory Data: Date of ART Initiation

Mhairi Maskew; Jacob Bor; Cheryl J. Hendrickson; William B. MacLeod; Till Bärnighausen; Deenan Pillay; Ian M. Sanne; Sergio Carmona; Wendy Stevens; Matthew P. Fox

SESSION P-X8 Poster Abstracts
2:45pm-4:00pm Hall D
Viral Suppression

Measuring Viral Load Suppression in South Africa Using a Novel, National Database

William B. MacLeod; Jacob Bor; Nicole Fraser; Zara Shubber; Ian M. Sanne; Wendy Stevens; Tshepo Molapo; Mokgadi Phokojoe; Yogan Pillay; Sergio Carmona

2015 – A Year of Highs and Lows, but a New Global Health Leader Emerges

Credit Jonathan Ernst/Reuters
Credit Jonathan Ernst/Reuters


With the close of 2015, we are wrapping up a year of impressive highs and tragic lows in global health. Here are some of the highlights …

The recent climate change accord signed last month in Paris by most of the nations of the world acknowledged a foundation for further global commitments to work on climate change. The importance of recognizing global warming as a major global health threat was a landmark for 2015. Global accords at the UN also brought nations to agree to a new round of “sustainable” development goals with the UN Sustainable Development Goals. (See:

The 2015 efforts to contain the Ebola virus’s most recent epidemic, which started in West Africa in February of 2014, finally saw success. In addition, via an impressive, international public-private enterprise, a new and an efficacious Ebola vaccine was fast-tracked and successfully tested.

Many have noted that the size and duration of the recent Ebola epidemic was a global catastrophe, which did not need to occur. The lack of functional health systems in the region and the dearth of physicians and nurses, mixed with the ostrich-like and anemic 2014 response of the WHO and some key local and international agencies, made the epidemic itself become the large global health tragedy of this past year.

The continued humanitarian crises of displaced families and communities created by violence and by lack of social structures has plagued 2015. Vast numbers from the Middle East and northern Africa have made or have tried to make their way to better lives in other countries. The outgoing UNHCR chief, Antonio Guterres, has noted that with the size of the refugee migration, “For the first time political leaders took it seriously.” Many communities worldwide are helping, while some are turning their backs or making it very difficult for the refugees. We can see this lack of compassion, at times, in a country of immigrants such as the United States.

New outbreaks of rare infections and the continued morbidities and mortality of the existing pandemics of HIV, TB and malaria occurred in 2015. Global funding for known effective measures to treat and prevent HIV and TB unfortunately continued its relative decline this last year. Malaria continues to be a global problem, but a partially effective vaccine was released this past year and large inroads into cubing this parasitic infection have occurred. (See Harvard’s site:

The improved appreciation of the global epidemics of both obesity and poor nutrition, along with attacking food insecurity have not translated into improvements in these problems overall. Anti-smoking efforts march on with some continued benefits in developed countries, but smoking and continued facilitation of the export of tobacco to developing countries expands this most preventable cause of death. Worldwide, tobacco use causes nearly 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030.  (See CDC fact sheets:

With the adverse effects of conflicts, the known pandemics and the diseases of poverty continuing their march in 2015, the year should still celebrate the recognition that people of all walks of life are making a difference – one step at a time. New environmentalists, new global health specialists and a new generation of leaders with an appreciation for global health have expanded in 2015.

But, who was the Global Health Leader of 2015?

Although in 2015 and before, UN Secretary General Ban Ki-Moon certainly should on the list of great global health leaders trying to stem global warming, and other calamities, perhaps the one 2015 leader who may have the greatest future global health impact is Pope Francis.

Pope Francis - Credit Damon Winter/The New York Times
Credit Damon Winter/The New York Times

If one considers that two of our greatest threats to health are poverty and global warming, both of which affect or will affect so many determinants of health, then perhaps our greatest global health advocate this last year was the Pontiff himself. Pope Francis issued a papal statement, called an encyclical, on environmental degradation. More than just extensively outlining the science and the political and financial agreements that might make a difference, the encyclical creates the moral statement that fighting global warming is an individual choice that all of us must make. Fighting global warming is an individual’s moral choice to care for our children’s future, to care for our planet and to care for all organisms that share the planet with us. This one charismatic leader has helped rally most of the world to have interest in the urgent global health issue of global warming, as he also has for our moral obligation to address poverty and its serious impact on health.

The above list of global health highs and lows for 2015 is certainly not exhaustive, to be sure. The list of leaders who have made extreme differences this year also is not included. The one global health leader dramatically emerging on the scene this last year, though, is very clear. I, for one, am praying for the Pontiff’s continued work and for my increased awareness of how I can help this work each day.

Here’s to a healthier 2016!

Legacy of a Gentle Warrior

Al Poussaint (L) and Mario Cooper (R), 1996
Mario Cooper speaking at the Leading for Life Campaign in 1996, with Dr. Alvin Poussaint of Harvard Medical School

Last weekend I attended a memorial for an old friend, Mario Cooper. Mario was on our International Advisory Council at the Harvard AIDS Initiative for many years. The gathering was held in the two-story, Washington, D.C. apartment of Peggy Cooper Cafritz, one of Mario’s sisters. On that bright, sunny September Sunday, her place filled up with family, old friends, and lots of funny and loving stories about Mario from all parts of his past. Peggy’s art-filled flat was also filled by so many who loved Mario that it felt like he was there with us.

Mario died a couple months ago, but he was very much alive in the stories, laughter, and tears of those of us blessed to be there to honor this gentle warrior. In her remarks about Mario, Pam Horowitz, Julian Bond’s widow, noted that her husband had been planning to attend this memorial until his own sudden death in August. To Mario, Julian Bond had been a true hero.

One of the things that upset Mario about the HIV/AIDS epidemic was the disproportionate impact it was having on U.S. minorities and within minority communities. When the first five cases of what would later be called AIDS were reported from doctors in Los Angeles in 1981, Mario later noted, two of the five men were minorities. That would be 20% of the first five cases. Today, the proportion of African Americans that make up the AIDS cases in our country is at 41% and among Latino Americans it is 20%.

What to we do about this situation? What Mario did was to do what he was good at. He organized political meetings and a campaign to address the crisis for African Americans. The meeting was a unique one.

Mario’s Leading for Life summit took place in 1996. The campaign, which we hosted at Harvard, involved one hundred influential African American leaders. Mario got Marion Wright Edelman, founder of the Children’s Defense Fund, and Alexis Herman, the highest-ranking African American in the U.S. government at the time to come. Also attending were David Satcher, Director of the CDC and soon to be Surgeon General, along with intellectuals and activists such as Julian Bond, Henry Louis (Skip) Gates, Alvin Poussiant and Cornell West. With my help, and the outreach of others in the “AIDS world” such as Helene Gayle, Eric Goosby, Phil Wilson and Cornelius Baker, and the help from leaders in the non-AIDS world, such as Reverend Edwin Sanders, singer Billy Porter and others from Leading for Life, intense lobbying of the Congressional Black Caucus in Congress was undertaken. Eventually $156 million was appropriated by the Clinton administration at the Caucus’ urging to specifically help with AIDS crisis in the African American community.

Mario made this happen. He was a skillful politician, and he knew he was most effective behind the scenes and not in the limelight. When he finally agreed to an interview with The Washington Post about the campaign and the Congressional Black Caucus’s success in getting the $156 million, he called the amount “chump change compared to what is really going to be needed” to turn the epidemic around in America’s minority communities. Mario did not mince words.

Unfortunately, Mario was right. Fast forward two decades since the Leading for Life campaign and our efforts to combat AIDS in minority communities has not altered the disproportionate impact the epidemic is having. Black men account for an estimated 44% of new infections in our country. Once living with HIV infection, African Americans have an age-adjusted death rate that is more than twice that of white Americans with HIV. The U.S. Hispanic populations also continue to be disproportionately affected and infected. We are still failing when it comes to affecting true change.

Kaiser Graph of New HIV Infections in US, 2010

As a black man from Mobile Alabama, Mario Cooper certainly knew the deck was stacked against minorities. The culprits that need to be addressed in our society are inequity, poverty, and marginalization. Mount a campaign against these evils that disproportionately affect minorities and we mount a truly successful campaign against AIDS in minority communities. Access to HIV testing and equal access to care and treatment are needed. Now.


  • Expand the use of clean needle exchange that has been proven to work and does not promote drug use.
  • Expand targeted Pre-exposure prophylaxis (PrEP) programs that use anti-HIV drugs prior to exposure to HIV to prevent infection.
  • Expand testing so that all people living with HIV will know they are infected.
  • Provide immediate access to treatment for the infected to help their own health and to prevent the spread of the virus to others.
  • And last, but certainly not least, make basic health services a right for all. Build a real and functional safety net for those in need of basic and preventative health care in our America.

Mario would have wanted the National Urban League, the Congressional Black Caucus and other minority leadership organizations to actually lead and demand these actions. I would say that national “leadership organizations” who really want to lead are trying, and our two national political parties need to do the same. This is a path we can all agree upon. In fact, leaders, leadership organizations and the governments of the cities of Atlanta, Denver and San Francisco, and the State of New York, have recently signed on to end AIDS in their populations in the next 15 years by the needed actions listed above. The campaign and path Mario envisioned is spelled out for us. LET’S EACH JOIN, LEAD AND GET IT DONE.

Footnote: The Report from the Leading for Life Summit and Campaign can be found at The Body’s website: The Body / Leading for Life Report, 1996 A similar AIDS summit of national Latino leaders was organized by the Harvard AIDS Initiative in 1998, called Unidos Para La Vida.

Stopping a Good Investment in the Health of Africa

Medical School Classroom in Mozambique
Medical School Classroom in Mozambique

August is of course Winter in the southern hemisphere, but we are just finishing the “dog days of summer” here in Boston. As we do so at the Harvard T.H. Chan School of Public Health, our first class of Doctoral students in the newly refurbished Doctor of Public Health degree have been plugging away for the past two months. These superstars are working towards a doctoral degree in the actual “practice” of public health. They will learn how to be the next leaders in creating, implementing, and evaluating the impact of large public health programs, which will save literally hundreds of thousands, if not millions of lives. As in its name, our Doctor of Pubic Health course showcases What Works and Why: Building Successful Programs in Global Health.

Doctor of Public Health Class, 2015,
Doctor of Public Health Class, 2015, “What Works and Why: Building Successful Programs in Global Health”

Half of these exceptional students are from countries outside of the U.S. All are successful already in some area of health or public health. Their creative energy and intelligence have many of us old-timers at Harvard Chan feeling optimistic that the world can be changed for the better. But another recent development, the reduction of U.S. government funding of healthcare in Africa, is a cause for deep concern.

Training the next generation of health practitioners is vital to addressing the world’s pubic health needs. We are investing in many top medical and public health programs in countries with resources, such as ours. These are worthy investments. Unfortunately, much of the developing world has difficulty making such investments. In Africa especially, there is an extreme shortage of healthcare professionals available to provide basic treatment and prevention services. Africa has been estimated to have 25% of the world’s burden of diseases, but only 3% of the world’s healthcare workforce. The World Health Organization estimates that there is a minimum threshold of 23 doctors, nurses and midwives per 10,000 people in a country necessary to deliver just the most essential maternal and child health services. The majority of the countries in sub Saharan Africa do not even come close to meeting this minimum requirement.

mepi-uganda-Dr. Nelson Sewankambo
MEPI Principal Investigator in Uganda, Dr. Nelson Sewankambo, leads a discussion with a group of medical students at Makerere University.

Six years ago, our country’s President’s Emergency Plan for AIDS Relief (PEPFAR) created a small, but uniquely effective program to expand the number of doctors and nurses trained in developing countries, especially in those being devastated by the AIDS epidemic. Dr. Eric Goosby slipped the program into the PEPFAR plans as he took over leading the program when he became the PEPFAR AIDS Ambassador in 2009. Goosby quietly but quickly got the funding for the $60 million, five-year program called the Medical Education Partnership Initiatives (MEPI for short). The funding, granted directly to 14 African medical schools, went to improve medical training in Africa. These African medical schools then partnered with U.S. medical schools or in our case, the School of Public Health. In designing the MEPI program, Goosby understood that those in control should be the local leaders and organizations that would be leading, implementing, and sustaining the effort in the long run.

The MEPI program has advanced medical training for both doctors and nurses in dramatic ways these past five years. (see )

Last year, Goosby moved back to his home in San Francisco and UCSF, having successfully guided our government’s PEPFAR effort. As of this month, August, the U.S. government has decided to end most of the MEPI program, one of its most impactful programs in terms of expanding and improving the future healthcare workforce in Africa. (There is a smaller program continuing to network the few heads of the African schools and foster training in research, but the main effort across 32 African medical schools and other African institutions and their U.S. partners has not been continued.)

Funding which would have been used to continue the MEPI program will now go towards other important, but short-term efforts, in the PEPFAR program. I can’t imagine, though, a more valuable investment for the long-term health of Africa than to invest in correcting the severe shortage of healthcare workers in Africa. Many of the young leaders trained here at Harvard and across the developed world want to work in Africa to improve healthcare there. Yet without more skilled African doctors and nurses, there will be scant opportunity to improve and expand health systems in Africa. We can best invest in the health of Africa by investing in African health professionals and community health workers. We need to expand programs like MEPI, not eliminate them.

What is the Harvard T.H. Chan School of Public Health AIDS Initiative?

The Harvard T.H. Chan School of Public Health AIDS Initiative (HAI) is dedicated to research and education to end the AIDS epidemic in Africa and developing countries. Since 1988, HAI has been at the forefront of HIV/AIDS laboratory research, clinical trials, education, and leadership.

Since 1988, HAI has promoted research, education, and leadership to end the AIDS epidemic. As the number of AIDS cases rose disproportionately to affect Africa and other resource scarce settings, HAI has directed its efforts towards developing prevention and treatment strategies to stem the epidemic in these regions.

Training students, researchers, and health professionals is vital to HAI’s mission. Education and training opportunities at Harvard and in Africa help create a network of experts to direct the next generation of public health leaders. HAI  also partners with government agencies, NGOs, research centers, and private corporations to develop initiatives that advance the understanding and treatment of HIV/AIDS.HAI logo

Botswana Leaders Meet at UN to Showcase Their Progress Against AIDS

Millennium Development Goal 6 calls for progress combating AIDS and other diseases. Botswana had one of the highest rates of HIV infection in the world. Choosing to address the problem head-on, the country is now held up as an example to the rest of the world, demonstrating that a country can get its HIV infection rates down while also helping those living with the disease to live healthy and productive lives. At the UN Leaders’ Summit, Global Health TV’s Mike Sheehan meets Dr. Richard Marlink of the Elizabeth Glaser Pediatric AIDS Foundation and Harvard, who tells us what Botswana has achieved and how.

Interview with Dr. Richard Marlink outside the UN

Interview with Dr. Richard Marlink outside the UN

Harvard President, Drew Faust, Visits Botswana

President Faust visiting BHP
(Gaborone, Botswana – November 25, 2009) Harvard University President Drew Faust visited the Botswana – Harvard AIDS Initiative for HIV Research and Education (BHP). BHP is a collaborative research and training initiative between the Government of the Republic of Botswana and the Harvard AIDS Initiative. Among those in attendance were Professor Max Essex and Professor Ric Marlink. This occasion was the first time a standing Harvard President had made an official visit to the continent.
Staff Photo Justin Ide/Harvard University News Office



















President Faust at BHP
(Gaborone, Botswana – November 25, 2009) Harvard University President Drew Faust visited the Botswana – Harvard AIDS Initiative for HIV Research and Education (BHP). BHP is a collaborative research and training initiative between the Government of the Republic of Botswana and the Harvard AIDS Initative. Among those in attendance were Dr. Joe Makhema and Professor Ric Marlink.
Staff Photo Justin Ide/Harvard University News Office




















Drew Faust at Training Center at BHP. 2009
Dr. Joe Makhema, President Drew Faust, Dr. Tendani Gaolathe, Ms. Christine Bussmann and Prof Ric Marlink at Training Center at BHP. 2009

KITSO AIDS Training Program reaches 8000+ milestone

KITSO AIDS Training Program reaches its 8000th person trained
KITSO AIDS Training Program reaches its 8000th person trained – 2008

The KITSO AIDS Training Program in Botswana reached the milestone of having trained over 8000 nurses, doctors and pharmacists in the fundamentals of HIV/AIDS care for the expanding Masa Programme. KITSO is the Setswana word for “knowledge“. Recently a detailed summary of the results of the training program and its support to the national ART treatment program in Botswana was published in the Open AIDS Journal, 2008, 2, 10 – 16.

Since its inception in the year 2000 by Dr. Richard Marlink and colleagues at the Botswana-Harvard Partnership, the KITSO AIDS Training Program has worked under the coordination of the MOH to increase local staff capacity within the healthcare sector and ensure the sustainability of HIV/AIDS care and treatment.

When ARV therapy was first introduced in Botswana in 2002, few physicians and nurses in the country had experience in AIDS treatment. Through KITSO training and front-line experience in the ARV clinics, healthcare professionals in Botswana have gained the expertise and confidence to both provide ARV therapy and train other healthcare workers at their treatment sites. KITSO-trained staff now provide ARV therapy at 33 hospital sites and 137 satellite clinics throughout the country, and currently serve over 130,000 patients enrolled in the national ARV program.

Curriculum and Implementation

KITSO has developed a module-based training curriculum which is tailored to the Botswana National HIV/ AIDS Treatment Guidelines. The curriculum has been collaboratively developed and is regularly updated by national and international experts to ensure that healthcare professionals gain competency and confidence in the latest national standards of HIV/AIDS care and treatment.

Curriculum development and course implementation have been driven by the immediate need to train Botswana’s healthcare workers in HIV/AIDS care in formats that provide a comprehensive grounding in good clinical practice without requiring long periods of staff release for training.

As mandated by the MOH, KITSO training modules are the national standard of training for HIV/AIDS care and treatment in both public and private sectors. The KITSO-BHP team oversees the standardized training implementation, curriculum development, updating, course examination and certification.

AIDS Clinical Care Fundamentals
Since its first offering in July 2001, AIDS Clinical Care Fundamentals (ACCF) has served as a gateway course to prepare Botswana’s healthcare professionals to provide basic ARV therapy and other HIV/AIDS care. Training is carried out using either a facility-based or centralized format, depending upon the staffing needs of individual healthcare facilities. Between July 2001 and December 2009, 7078 healthcare workers completed this module. Following four days of lectures and case study discussions, the course concludes with a final examination. Participants who meet course requirements as determined by the MOH receive a certificate of successful completion.


The ACCF module has been packaged onto a CD-Rom for distance learning.

Since 2006 KITSO AIDS Training Program has been implementing distance learning as an alternative training format utilizing an audio-enhanced CD ROM of AIDS Clinical Care Fundamentals. Distance learning participants receive a training package, including the CD Rom, course binder and support materials for their self studies. A one-day classroom training activity where clinical scenarios pertaining to the learning objectives of the course are discussed. A final assessment concludes the distance learning experience.

Topics covered in AIDS Clinical Care Fundamentals:
1. Introduction to the Botswana National ARV Program
2. HIV Epidemiology and Pathophysiology
3. Laboratory Diagnostics in HIV/AIDS Care
4. Principles of ARV Therapy in the Botswana National Programme
5. Pediatric-and Adolescent-Specific Issues in HIV/AIDS Care
6. Pediatric-and Adolescent-Specific Issues in HIV/AIDS Psychosocial Care
7. ARV Drug Side Effects and Toxicities
8. Drug-Drug Interactions in ARV Therapy
9. Treatment Failure and Its Management
10. Adherence in ARV Therapy
11. Adult and Pediatric Opportunistic Infections and Other Complications in HIV Disease
12. Mother-to-Child Transmission and Its Prevention
13. Post-Exposure Prophylaxis (PEP)
14. TB and HIV Co-Infection
15. Summary of the Major Changes in the 2008 Guidelines.

AIDS Clinical Care Fundamentals Refresher/Update
This two-day Refresher/Update training module was developed in response to a high demand for refresher training, as well as the need to update already trained healthcare staff on the most recent changes to the national treatment guidelines. Incorporating information from the new guidelines along with care and treatment fundamentals, the training covers HIV testing, ARV therapy eligibility, principles of ARV therapy, management of toxicities, management of treatment failure, PMTCT, and treatment of TB and other opportunistic infections.

The module was first implemented in January 2008. All efforts will be made to re-train healthcare workers as quickly as possible in order to maintain the high standard of HIV/AIDS care and treatment in Botswana.

Medication Adherence Counseling
This three-day course is designed to enhance the adherence counseling skills of healthcare workers. Offered as a centralized training for nurses, pharmacy staff, and social workers from ARV treatment centers, Medication Adherence Counseling focuses on strategies to overcome potential barriers to adherence.

A combination of lectures, case discussions, role-playing, and interactive activities are employed to reinforce good counseling techniques and strengthen the participants’ ability to devise and implement successful adherence interventions. Implemented in collaboration with the Botswana-Baylor Children’s Center of Excellence, the course also includes teaching and case discussions about pediatric and adolescent adherence, as well as disclosure of HIV status for children, adolescents, and their families.

Advanced HIV/AIDS Care and Treatment Training
This advanced training is designed for physicians and pharmacists providing ARV therapy in Botswana. Course participants must have previously completed AIDS Clinical Care Fundamentals and be actively involved in an ARV clinic.


Training participants involved in clinical case discussions with on-looking KITSO faculty

Advanced HIV/AIDS Care and Treatment combines lectures and interactive case discussions to provide advanced and comprehensive training in ARV therapy, emphasizing treatment principles and strategies practiced world-wide and applying them to the Botswana setting. This course familiarizes participants with the full complement of ARV drugs and provides strategies for the management of treatment failure, interpretation of drug resistance assays, designing of “salvage” regimens, and understanding short- and long-term ARV side effects and toxicities. Course content equips clinicians with the skills and knowledge necessary to manage complicated patients and provide guidance and support to their colleagues, thereby strengthening the growing HIV treatment expertise in Botswana’s healthcare sector.

Advanced HIV/AIDS Care and Treatment covers adult, adolescent, and pediatric HIV care. Special emphasis is placed on primary care for HIV-infected children and on disclosure issues, especially in regards to children and adolescents.

Each advanced course also provides updates on relevant research and clinical trials conducted internationally and in Botswana as well as summaries of recent international HIV/AIDS meetings.

Introduction to AIDS Clinical Care
In 2009 this satellite training module was upgraded from a one-day to a two-day training. The training provides nonmedical professionals with a basic understanding of identification and management of HIV/AIDS in Botswana.

Course content includes an introduction to HIV pathophysiology and immunology and information about testing, eligibility and referral for ARV therapy, identification of common ARV side effects, the importance of medication adherence, counseling and referral for PMTCT, and post-exposure prophylaxis. This course is suitable for general health educators, family welfare educators, and lay counselors and social workers. Since 2006, Introduction to AIDS Clinical Care has been implemented at ARV sites by the BHP–PEPFAR Master Trainer Program.

Sexual and Reproductive Health in HIV Infection
This new module provides training for health professionals providing counseling and care in sexual and reproductive health issues for persons living with HIV. The course will empower health care workers to identify and manage sexual and reproductive health issues pertaining to HIV infection, such as STIs, family planning including conception and contraception, sexual dysfunctions, menopause, pregnancy and PMTCT, and HIV prevention. Implementation of this module started 2010.

Reference Corners and Resource Materials
KITSO AIDS Training Program has established “reference corners” in the medical libraries of Botswana’s two referral hospitals, Princess Marina Hospital and Nyangabgwe Hospital. Resources in these reference corners include textbooks, medical reference guides, specialized journal subscriptions, and relevant handbooks and guidelines.

KITSO AIDS Training Program has also provided each district hospital in Botswana with a laptop computer and an LCD projector for in-service staff education.

KITSO AIDS Training Program owes its success both to ACHAP for its financial support and to the dedicated faculty members from the Botswana MOH and Ministry of Local Government, the ACHAP Clinical Preceptorship Program, Botswana-Baylor Children’s Clinical Center of Excellence, Botswana-Harvard Partnership, University of Pennsylvania, the PEPFAR Master Trainer Program, the Private Practitioner Association of Botswana, and the World Health Organization.