2017 Botswana

Clinical outcomes of HIV-positive individuals treated with dolutegravir-containing regimens in Botswana

Led by Paul Saleeb, MD, School of Medicine, Institute of Human Virology

Students (school affiliation): Rhiya Dave (medicine-public health) and Kimberly Graninger (nursing)

Project summary

Botswana has one of the highest prevalence rates of HIV in the world. In 2016, the Botswana Ministry of Health and Wellness updated its guidelines for the treatment of HIV-infected individuals in the country such that all newly-diagnosed persons would henceforth be treated with an antiretroviral regimen containing dolutegravir, a relatively new and potent drug. Since Botswana was the first sub-Saharan African country to introduce dolutegravir into the routine treatment regimen of persons living with HIV, there was little information available on the efficacy of this antiretroviral drug in resource-limited settings outside of controlled clinical trials. Thus, our project was a retrospective chart review whose purpose was to determine the rates of virologic suppression and adverse events in HIV-positive individuals initiated on dolutegravir at three clinics in Gaborone, the capital of Botswana. The team of UMB students worked closely with a team of physicians, nurses, pharmacists, and laboratory and quality improvement specialists at the Botswana-University of Maryland School of Medicine Health Initiative (BUMMHI) throughout this study. After determining which individuals met the inclusion criteria for this project, they visited the three clinical sites where they were introduced to local nurses, pharmacists, and social workers employed by the Botswana Ministry of Health and Wellness, who assisted them in collecting the data from patients’ clinical charts. The project was successfully completed over a three-week period, and the students presented their findings to BUMMHI senior staff prior to their return to the States. The study findings will be disseminated once approval is received from the Botswana Ministry of Health Ethics Committee.

Project outcomes

The interprofessional objective was to develop a collaborative, working relationship with various cadres of healthcare workers on site. Over the course of their three-week stay in Botswana, Rhiya and Kim were introduced to BUMMHI's multidisciplinary team of physicians, nurses, pharmacists, and laboratory and quality improvement specialists and worked with them effectively in implementing this study. In addition, the two students were successful in working collaboratively with local healthcare workers at the three clinics with minimal assistance of BUMMHI staff. By the time this project was completed, Kim and Rhiya had clearly gained an understanding of the important roles of each member of the healthcare team in ensuring optimal care for individuals infected with HIV.

Other study findings will be updated when approval for general dissemination is finalized.

Reflections

"The CGEI grant allowed me to have a unique multidisciplinary experience. This was a wonderful opportunity to introduce UMB students from other schools to the care and treatment of people living with HIV in resource-limited settings." - Paul Saleeb, faculty project leader, school of medicine

"Although I had not known exactly what to expect in Botswana, I did know that it would be a different kind of ‘medical education.’ From an interaction with a patient in Bontleng Clinic, I understand now that medical education is more than what happens in the classroom, or even in clinics and hospitals in the United States. To be an educated, prepared health care provider means being aware of inequality and cultural context. It means meeting people where they are, as they are, and empowering them to improve their health. It means working in partnership with health providers, patients, and communities. Working in Botswana emphasized all of these aspects of medical education to me, and I hope to expand on this experience in the future." - Rhiya Dave

"Working under Dr. Paul Saleeb with Rhiya Dave was a great opportunity and we worked very well together. I think that the things I learned during my trip could not have been taught to me in a book; only through experience. The lessons I learned, people I met, and things I experienced will stick with me far beyond my time in Gaborone, Botswana." - Kimberly Graninger

Back to the Global Experiences page