Reports

The Botswana Comprehensive Cancer Care and Prevention Needs Assessment evaluated the current health system and services available for cancer across four of the nation’s hospitals that are referred to as public oncology centers. These sites are Princess Marina Hospital in Botswana’s capital city of Gaborone, Letsholathebe II Memorial Hospital in Maun, Nyangabgwe Referral Hospital in Francistown, and Sekgoma Memorial Hospital in Serowe.

This evaluation encompassed not only health facilities but also perspectives from health care providers, cancer patients and survivors, caregivers, members of the public, and local nongovernmental organizations that support cancer care and prevention programs. The evaluation was completed in 2021 and included site visits, focus groups, and questionnaires. With support from the Bristol Myers Squibb Foundation, the national cancer needs assessment also included an evaluation of cancer awareness at a population level to inform approaches for broader health campaigns throughout the country.

In 2022, this report of the assessment’s findings and recommendations was presented to the Botswana Ministry of Health and Wellness and subsequently published by the Botswana-Rutgers Partnership for Health. The report provides key insights into awareness about cancer and its prevention, disparities in access to cancer-related services, and the difficulties of care based on different locations and types of facilities in Botswana.

Rutgers Global Health Institute is actively recruiting for three new faculty positions: Cancer Care and Prevention in Sub-Saharan Africa; Global Health; and Health Equity, Social Justice, and Population Health. In addition, the spring semester brought the institute’s first in-person member meeting in more than two years.

The year also brought expansions in the institute’s Equitable Recovery program in New Jersey and in the work of the Botswana-Rutgers Partnership for Health.

This is the final report of the University Partnerships Initiative (UPI): Creation of a COVID-19 Clinical Telehealth Program for Distance Learning, Telementoring, and Telemedicine in Botswana.

The project, which took place from November 2020 to November 2021, was launched through the University Partnerships Initiative (UPI) of the U.S. State Department. Through this effort, a technical advisory committee and implementation team was assembled, comprising members from the Government of Botswana (MoHW), the University of Botswana, Rutgers Cancer Institute of New Jersey, Botswana-Rutgers Partnership for Health, and Rutgers Global Health Institute. Together, the members present recommendations to the Botswana Ministry of Health and Wellness that support telementoring, tele-education, and future telemedicine efforts.

Disparities in health, which existed long before the COVID-19 pandemic, include imbalances not only in access to care but also in all the conditions that make good health possible. The pandemic only worsened these disparities.

Rutgers Global Health Institute launched Equitable Recovery for New Jersey’s Small Businesses, which provides crucial support to small businesses and nonprofits in underserved communities. The institute also expanded efforts in Botswana to respond to both the threat of COVID-19 and the need to continue improving cancer care and prevention in the country.

The COVID-19 pandemic uprooted our lives, changed the way we work, and created many new urgent challenges worldwide.

Rutgers Global Health Institute responded with new efforts to confront COVID-19 and related challenges, both in New Jersey and in Africa.

The “Improving Cancer Care and Prevention in Botswana” workshop, held at the University of Botswana Conference Centre in Gaborone in August 2019, brought together a multi-sectorial stakeholder group interested in advancing Botswana’s cancer care and prevention efforts.

The goals of the workshop were to discuss the current challenges facing cancer care in Botswana and to generate a list of recommendations for a comprehensive national cancer control program. Hosted by a partnership of the Botswana Ministry of Health and Wellness, Rutgers Global Health Institute, and the University of Botswana, the workshop welcomed 121 participants from the academic, civil society, corporate, and public sectors.

In 2018, Rutgers Global Health Institute unveiled its five-year strategic plan. This report summarizes year one’s impact, a time filled with firsts and new developments.

As part of its commitment to establish global health partnerships that focus on long-term impact, the institute entered into its first partnership in Botswana. Joining with the University of Botswana and the Ministry of Health and Wellness the partnership is focused on developing the present and future health care workforce and establishing a national, comprehensive cancer care and prevention program. And through a new partnership between Rutgers, The State University of New Jersey and the University of Puerto Rico, the institute is helping build resilience in Las Carolinas, a community still reeling from the effects of Hurricane Maria.

Our Year of Impact reflects upon the institute’s progress over the past year and sets the stage for all that lies ahead for its global health initiatives, both at home and abroad.

Rutgers Global Health Institute is committed to improving the health of vulnerable populations, both in New Jersey and around the world, by building on the university’s strengths; establishing partnerships for long-term impact; and preparing the next generation of global health change agents.

Amplifying Our Impact is the institute’s five-year strategic plan to coordinate and grow these efforts. This plan is the result of broad input from faculty and students across Rutgers, The State University of New Jersey, as well as from many advisors beyond Rutgers. The strategies within it are intended to be dynamic, and as we learn from implementation, we expect them to evolve.

ACHAP, a public-private community development partnership established in 2000, has provided technical assistance and health-focused capacity building in Africa for more than 20 years. Using a comprehensive approach, the partnership has successfully supported HIV/AIDS and tuberculosis prevention, care, and treatment with remarkable results.

As an ACHAP board member, Richard Marlink provides oversight, strategic guidance, and technical expertise to the partnership. He believes that blending modern medical practices with traditional approaches to care and prevention will make the most impact through community engagement, education, training, and capacity building.

Learn about the annual strides and impacts ACHAP has made over the years on its company website, www.achap.org. 

Project HEART (Help Expand AntiRetroviral Therapy) was an eight-year initiative that began in 2004 to extend life-saving treatment to millions of people living with HIV in Côte d’Ivoire, South Africa, Tanzania, and Zambia, and Mozambique.

Project HEART was part of the President’s Emergency Plan for AIDS Relief (PEPFAR) Track 1.0 treatment initiative to rapidly scale up antiretroviral therapy (ART) through existing organizations implementing prevention of mother-to-child transmission of HIV programs. Through the project, more than 1 million men, women, and children received HIV care and support, more than 2.5 million pregnant women received HIV counseling and testing, and more than half a million people started ART.

The rapid scale-up of life-saving HIV care and treatment services has been a public health success. To date, the U.S. Government-funded rapid HIV program scale-up efforts in resource-limited settings have been implemented mostly through funding international nongovernmental organizations (NGOs).

Over the past few years, funding priorities for the global health and development community have shifted from an emergency response to local ownership and longer-term health systems strengthening. The expectation is that host country governments and local NGOs fully own and manage the implementation of their HIV care and treatment services.

Over the past three decades, nearly 30 million people have lost their lives to AIDS and the epidemic has transformed communities around the world. Today, an estimated 34 million people are living with HIV. The number of people affected leaves no doubt: AIDS remains an urgent global health crisis.

Despite these sobering facts, recent advancements have provided unprecedented hope for an end to the epidemic. A rapid scale-up of antiretroviral therapy and prevention efforts has saved millions of lives. In many of the hardest-hit countries, in certain settings, the rate of new infections is decreasing. The number of AIDS-related deaths is also on a consistent downward slope. Most notably, new research has definitively shown that antiretroviral therapy can prevent new infections. These historic developments, along with many local and national achievements, have changed the global conversation about the epidemic. The end of AIDS is within our reach. The question that remains is how will we get there.

In Botswana, about 25% of adults have HIV. In 2001, the government showed extraordinary vision in deciding to provide antiretroviral (ARV) medication to all in need. The national HIV/AIDS treatment plan was created, scaled-up, and continues to provide life-saving ARVs today. Questions that always need to be asked about ambitious government programs are, how well is it working and what does it cost?

The Models of Care project was designed to provide answers. From 2007 to 2011, as executive director of the Harvard AIDS Initiative, I led researchers in the examination of the costs and effectiveness of the Botswana National Antiretroviral Treatment Program. Collaborating with the Botswana-Harvard AIDS Institute Partnership (BHP), the Botswana Ministry of Health, and the African Comprehensive HIV/AIDS Partnerships (ACHAP), the Models of Care program serves to inform the debate regarding the efficacy, financial sustainability, feasibility, and effectiveness of existing models of clinical health care delivery and laboratory monitoring in Botswana.

In 1998, Harvard University and the Merck Company Foundation established the Enhancing Care Initiative (ECI) to improve the clinical care of people living with HIV/AIDS in resource-scarce settings. ECI’s key strength was its multisectoral and multidisciplinary AIDS Care Teams that lead the analysis and improvement of HIV/AIDS care.

Teams of local care experts (based in São Paulo and Santos, Brazil; Dakar, Senegal; KwaZulu-Natal, South Africa; Northern Thailand; and Western Puerto Rico) worked to address the problems in HIV/AIDS care in their specific communities and regions by designing locally appropriate solutions in challenging contexts, and generating new evidence and best practices that were applicable in diverse settings.

This publication is an outgrowth of the work of the Enhancing Care Initiative. In the process of learning to work together, the members of the ECI AIDS Care Teams collectively accumulated important insights as to how to form and sustain effective care teams.

Focusing on the process of working together across organizations and sectors, the purpose of this publication is to share the lessons learned about what we believe it takes to make these sorts of collaborations most effective, and to help make more sustainable improvements in the global response to HIV and AIDS. It is also intended to signal what issues people may anticipate in collaboration across organizations and sectors and what some possible courses of action might be.

The Madison Project developed as a response by AIDS researchers and activists to the disappointing lack of progress reported in AIDS biomedical research at the IX International Conference on AIDS, held in Berlin in June 1993. One month later, an invitational meeting in Madison, Wisconsin, launched a nongovernmental think-tank process. The participants—leading AIDS researchers, government officials, AIDS activists, and pharmaceutical industry representatives—discussed specific priority research questions concerning HIV and host pathogenesis. At this meeting, they agreed unanimously that truly effective AIDS therapies would eventually be discovered. Once that common belief was recognized, the key question of the meeting became clear: How do we attain these therapies more quickly?

Marlink R, Delaney M, Pauza D. Future Directions in AIDS Research: The Madison Project Report. Harvard AIDS Institute Special Report 94-03, Cambridge, MA: Harvard AIDS Institute, 1994.