Program Description
Written by Dr. Harvey Friedman, Director, Botswana UPenn Partnership

The University of Pennsylvania (UPenn) has been in Botswana since 2001. The program began at the invitation of ACHAP (African Comprehensive HIV/AIDS Partnership), which is a joint operation of the Bill and Melinda Gates Foundation, the Merck Foundation and the Government of Botswana. UPenn physicians were invited to assist in training local providers on the management of HIV infected patients. Over the years our partnership with Botswana has grown to involve the following additional components.

1. Clinical Care and Education: In 2004 UPenn signed a Memorandum of Agreement with the Ministry of Health in Botswana to participate in medical care and educational programs at the Princess Marina Hospital (PMH). This was later amended to include the Nyangabgwe Referral Hospital (NRH) and district hospitals in Botswana. In 2004 UPenn received funding from the US Public Health Service through PEPFAR (President’s Emergency Program for AIDS Relief) to support clinical care and education in Botswana. Our PEPFAR program currently supports six full time UPenn physicians in Botswana (five in Gaborone and one in Francistown). These physicians provide inpatient care on the medical wards at PMH and NRH, HIV care in the outpatient clinics and outreach care to nine surrounding district hospitals. In addition, UPenn physicians run a referral clinic for complicated HIV/TB co-infected patients. The UPenn physicians are directly involved in training the local providers with daily “bedside” teaching and in supervising four weekly educational conferences at PMH and NRH.

2. Collaborations with the University of Botswana (UB): In September 2006, the UB and the UPenn signed a Memorandum of Agreement to establish collaborations in medicine, nursing and other disciplines at the two institutions. UB will enroll its first medical school class in August 2008. UPenn has agreed to help with teaching at the medical school with an emphasis on post-graduate education. In January 2007, approximately 23 Batswana medical students returned to Botswana for internship training at the main referral hospitals. UPenn has taken a leadership role in developing the curriculum for a rotating internship at the teaching hospitals, and is helping to develop the post-graduate residency training programs in Internal Medicine.

Other Schools at UPenn have developed collaborations with the UB, including the School of Nursing, the Wharton Business School, and the School of Arts and Science. In January 2007, UPenn undergraduates participated in “Semester abroad” experiences in Botswana for the first time, and during the summer of 2007, 9 UPenn undergraduates and 6 UPenn nursing students did internships in Botswana.

3. Global Health Experience for UPenn Medical Students and Residents: In academic year 2006-07, approximately 35 fourth year UPenn medical students spent 6-week electives working as sub-interns on the medical wards in Botswana at PMH. In addition, approximately 12-16 third year Internal Medicine residents, and several infectious disease fellows, neurology residents, obstetrics, and gynecology residents, dermatology residents, and emergency medicine residents did 4-6 week electives in Botswana, which has become the most exciting and popular location for experience in International Medicine for UPenn trainees. UPenn rents 4 3-bedroom apartments and one house in Botswana for the medical students, residents and visiting faculty. Many of these UPenn trainees have described this opportunity as the most important experience of their medical career.

4. Research Programs: UPenn is one of 19 NIH-funded Centers for AIDS Research (CFAR) in the USA. The goal of the CFAR is to establish Core facilities to promote HIV research. UPenn has established a CFAR Core in Botswana to support clinical and translational research studies. The Core supports study nurses and a microbiology technician to help carry out research studies. Through the activities of the CFAR Core in Botswana a growing number of UPenn and Botswana researchers are participating in HIV research. Projects include a study of TB and HIV co-infection, an analysis of predictors of treatment success and treatment failure in subjects on antiretroviral medications, an evaluation of the causes of an unusual ocular tumor seen in HIV infected subjects, and an assessment of the causes of meningitis in patients admitted to PMH. A large collaborative NIH grant involving UB and UPenn faculty was recently funded to study HIV prevention in Botswana. In addition, funds were awarded by UPenn to fund exploratory meetings between UB and UPenn faculty to promote research on HIV and others areas of mutual interest.

Three in-country staff, including an In-Country Program Director, a Head of Operations and a Program Coordinator provide critical support for the UPenn Botswana program. Their roles are to seek new initiatives for UPenn in collaboration with governmental departments and to ensure the successful operation of the existing programs. Our progress has been exciting, rewarding and stimulating and has contributed to the reduced prevalence of HIV in Botswana and to enhancing the hopes of its citizens.

Revised September 30, 2007