Baylor-Tanzania provides pregnant and breastfeeding mothers and their infants with medications to prevent infants from acquiring HIV from their mothers. Baylor-Tanzania also offers post-exposure prophylaxis medications to protect HIV negative children and adolescents who are exposed to HIV through sexual assault or needle stick injuries.
Baylor-Tanzania utilizes a multidisciplinary patient-first approach that simplifies and adapts treatment services to our patients’ needs so that every person receives the care and support needed to thrive. Baylor- Tanzania’s experts ensure that each child and adolescent is given the correct antiretroviral regimen and dosage. After starting antiretroviral therapy, the Baylor-Tanzania team focuses on achieving viral suppression and immune system restoration for each patient. However, for those who don’t achieve viral suppression, Baylor-Tanzania works diligently to identify the reasons why, and then works to develop a strategy to resolve the issues. Baylor-Tanzania is a national leader in innovative programs that offer peer support, family assistance, and personal empowerment to create effective practices that are essential to achieving sustained treatment success.
Every child and adolescent undergoes TB screening upon arrival to Baylor- Tanzania clinics, and all HIV + children and adolescents are offered six months of TB prophylaxis medicine. TB is also prevented through strong infection control efforts in schools and communities, such as the tracing and testing of contacts of those with a smear-positive TB case. Clinicians working at Baylor-Tanzania treat children and adolescents infected with TB, including those with drug resistant TB.
We offer reproductive health counseling and services to reduce the spread of sexually transmitted infections (STI) and to decrease unwanted pregnancies. Services include weekly “Teen Talks” to teach adolescents about living positively with HIV, screening and treatment for STIs, and access to reproductive and child healthcare in a safe, confidential environment.
All children and adolescents attending Baylor-Tanzania COEs undergo regular monitoring of their growth, nutrition and development and receive routine vaccines against serious illnesses. Fourteen-year-old girls are eligible to receive the human papillomavirus vaccine. Children and adolescents are screened for violence and the Baylor-Tanzania team advocates for child protection. Mental illnesses such as depression and anxiety are prevented through robust peer support groups, empowerment and stigma reduction efforts, and adolescent-friendly services.
The children and adolescents who attend Baylor-Tanzania COEs have complex illnesses and needs. To provide our patients with comprehensive care, Baylor-Tanzania has developed programs to address many common conditions. Baylor-Tanzania has an array of nutrition services including treatment of those with moderate and severe acute malnutrition using therapeutic foods, weekly nutrition classes including cooking demonstrations and food support for those with economic insecurity.
Patients with life-limiting conditions are eligible to participate in Baylor-Tanzania’s multidisciplinary palliative care program which includes evidence based medical care and symptom management, comprehensive patient focused psychosocial care that includes multidisciplinary home visits as well as medications and equipment to ease pain and provides social support to minimize financial burdens. Patients receiving palliative care are also eligible to participate in a wish-making program in which they select a small, desired toy or item.
Children and adolescents living with HIV face many social challenges that can make them vulnerable to poor clinical outcomes. Baylor- Tanzania’s social work department assesses children and adolecent’s needs during clinic visits, home visits and family meetings to provide targeted support and linkages with community- based organizations. Caregivers can join support groups where they receive coaching on how to disclose a child’s HIV status and how to hlp them with adherence. For families with severe food insecurity, Baylor-Tanzania offers “Shamba Darasa,” a backyard vegetable-growing program, as well as a three month intensive food security alleviation program. Families who participate in the programs learn gardening and cooking skills, allowing them to meet their nutritional needs while improving their economic situation.
Adolescent girls have the opportunity to join a program called “Tanzanite Girls.” These interactive sessions cover a variety of topics, including life skills, self-awareness, gender-based violence and violence against children, puberty, hygiene, children’s rights and the consequences of early pregnancy. For adolescents who are out of school, we offer income-generating activities at our clinic via low-cost programs such as “Stitch by Stitch” and “Bead by Bead,” which impart practical skills such as sewing and beading. After graduating from the program, participants receive a certificate and are ready to support themselves or find employment at shops in town. “Benki Yetu” (Our Bank) is a peer- led program in which adolescents learn financial management skills, such as how to receive and use micro-financing. Baylor-Tanzania’s array of best- practice adolescent support programs such as Teen Club, overnight camps, and peer-to-peer linkages, empower adolescents to live positively with HIV.
Older adolescents attending the COEs can join Baylor-Tanzania’s vibrant peer educator program. To participate in the program, adolescents must demonstrate that they are living positively with HIV. They should have good adherence to their medications, have achieved viral suppression, and have good communication skills. Peer educators work alongside adolescents attending the COEs and provide them with one-on-one counseling sessions, health talks and accurate HIV education. Between July 1, 2019 to June 30, 2020 peer educators were able to reach more than 400 adolescents during educational sessions and provided one-on-one counseling to over 200 adolescents. Peer educators were also able to work together with the COE nurses to reach more than 150 adolescents with accurate reproductive health information during reproductive health educational sessions.
Health System Strengthening
Baylor-Tanzania’s health systems strengthening work leverages one of our greatest strengths to improve health systems across Tanzania – our multidisciplinary team of pediatric experts. Baylor-Tanzania collaborates with the Pediatric HIV and TB working groups of Tanzania to develop and review national treatment guidelines. Baylor-Tanzania welcomes classes of healthcare providers from around the country to participate in an intensive, hands-on, pediatric HIV, TB and malnutrition training course. They attend lectures from our pediatric experts and get hands-on experience taking care of children with real-time feedback. They leave with improved competency in pediatric care, a specialized pediatric HIV handbook and a 24-hour hotline to call for clinical questions. Baylor-Tanzania also teaches medical and nursing students, pharmacy staff, counselors, and residents from both the Tanzanian and international education systems, bringing them to our clinic to learn best practices in HIV, TB, and malnutrition care. Baylor-Tanzania physicians, nurses, counselors, and support staff visit each of our outreach sites quarterly. Baylor-Tanzania reinforces best practices in pediatric HIV and TB care, identifies areas for improvement, and helps providers in the Lake and Southern Highlands Zones provide excellent, evidence-based HIV, TB, and general pediatric care.
Baylor-Tanzania has active research in the following areas:
Retrospective studies of clinical activities and outcomes
Tuberculosis clinical outcomes
Tuberculosis stool-based diagnostic assay
Tuberculosis blood-based DNA methylation diagnostic assay
NIH-funded study of the evaluation of novel stool and blood-based TB diagnostic tests in children and adolescents in Mbeya, Tanzania
Partnership with Henry M. Jackson Foundation Medical Research International (HFJMRI) for Mbeya COE to be a study site in their “Prevalence of, and factors associated with, virologic suppression and drug resistance in HIV positive children and adolescents on antiretrovial therapy in Tanzania (RV 517)”
Partnership with HJFMRI for Mbeya COE to be a study site in their “African Cohort Study (AFRICOS) Youth Cohort Study - Protocol RV 329”
COVID-19 Pandemic and Response
The COVID–19 pandemic has impacted healthcare facilities across the globe and Baylor- Tanzania is no exception. To ensure the safety of Baylor-Tanzania’s vulnerable patients and families, and to keep Baylor- Tanzania staff safe, several changes were implemented at the COEs. Teams began frequent disinfection of high-touch surfaces in the COEs and provided staff with PPE to wear while seeing patients. All who entered the facility – staff, visitors and patients – were screened for symptoms and those with symptoms suggestive of COVID–19 were directed to a special isolation area to be evaluated safely. To reduce patients’ risk of acquiring COVID–19, staff made sure that all patients who were eligible to receive multiple months of medication were able to do so, decreasing the number of times patients had to travel to visit the clinics. The COEs also implemented social distancing in the waiting and reception areas.
Despite the unprecedented difficulty of the COVID-19 pandemic, Baylor-Tanzania staff and patients were able to successfully adapt to the new challenges. Specifically, Baylor-Tanzania’s staff and patients’ unique experiences addressing the HIV/AIDS epidemic gave them the resilience and resourcefulness they needed to find solutions to the new problems posed by the COVID-19 pandemic. And Baylor-Tanzania’s organizational flexibility allowed the program to rapidly make changes to keep staff and patients safe. As the COVID-19 pandemic continues to develop, Baylor-Tanzania will utilize their personal and organizational skills to keep addressing the new challenges in the months and years ahead.