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Training Manual for Call Centre Operators, January 2002.

Revised on 28 02 2002 by task


force members.

Training Manual for Call

Centre Operators for

the National Call

Centre on

HIV/AIDS
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Training Manual for Call Centre Operators, January 2002.

Note: Bold = new changes


Pls. See at end of each chapter on
comments/additions to be made as discussed.

For brieifing use only – ASU internal document

© COPYRIGHT, January 2002.


AIDS/STD Unit, Ministry of Health

Forfurtherinformation/ any
contributionsyouwouldliketo
maketothis continuing series,
pleasecontact:

TheChief Health Officer


AIDS/ STDUnit
Ministryof Health
PrivateBag00451
Republicof Botswana
Phone:267 -312492
Fax:267 -302033

We would like to thank the following people for their valuable


contributions to this manual:

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Training Manual for Call Centre Operators, January 2002.

Table of Contents

Table of Contents

Contents Page
(s)

Chapter One
HIV/AIDS and Sexually transmitted Diseases
4-9

Chapter Two
Counseling VCT and Support 10-18

Chapter Three
Community Home Based Care 19-
22

Chapter Four
IPT for TB (or Preventive Therapy) 23-24

Chapter Five
Opportunistic Diseases 25-27

Chapter Six
Anti-Retroviral Therapy 28-32

Chapter Seven
Nutrition and HIV/AIDS 33-36

Chapter Eight
Prevention of Mother to Child Transmission 37-
39

Chapter Nine

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Training Manual for Call Centre Operators, January 2002.

Existing Assistance service or other phone referral services 40-


42

Chapter One
HIV/AIDS and Sexually Transmitted Diseases

1. Frequently asked basic questions on HIV

What is HIV?

• HIV is short for Human Immune Deficiency Virus. HIV attacks the
body’s immune system, making it hard to fight off infections.
HIV particularly attacks CD4 cells. The lower a person’s CD4
count, the weaker their immune system will be.

What is AIDS?

• AIDS stand for Acquired Immune Deficiency Syndrome. When a


person’s immune system has been damaged, he or she is open
to other illnesses, especially infections (e.g. tuberculosis and
pneumonia) and cancers, many of which would not normally be a
threat. When some one gets one of these illnesses the person is
often said to have AIDS. However, it is not a term used as widely
anymore. Doctors may instead call this “late stage” or
“advanced HIV infection”.

How is HIV passed on?

• For someone to become infected, a sufficient amount of HIV


must get into their blood. The body fluids which contain enough
HIV to infect someone are blood, semen, vaginal fluids, including
menstrual blood and breast milk.

• Saliva, sweat and urine do not contain enough viruses to infect


someone. HIV cannot pass through intact external skin, or
through the air like a cold or flu virus.

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Training Manual for Call Centre Operators, January 2002.

The main routes of transmission in Botswana are:

• Through sex without a condom. HIV can pass from one person to
another person through unprotected anal or vaginal sex.
• Through injecting drug use. HIV can be passed on by using the
needles or syringes that someone with HIV has already used.
• From mother to baby. A pregnant woman may transmit the virus
to her baby before or during birth, or HIV can be passed on
during breastfeeding.
• Through organ transplant, blood transfusion or blood products.
We know that donated blood might contain HIV, (revise?)
many people with haemophilia became infected through
receiving contaminated blood products. However, these days, all
blood and tissue donations and blood products are screened
worldwide.

How does the HIV test work?

• The most commonly used test is an antibody test. The


body in response to the presence of HIV produces
antibodies, and this test looks for antibodies. (Revise?)

Where can I get tested?

• Please contact Tebelopele’s toll free number 0 800 126 126 for
further information on testing centers and same day result. The
testing is also available in governmental hospitals, clinics, health
and sub-health posts, private hospitals and practitioners.

What is the window period?

• When someone becomes infected with HIV, it can take up to


three months for their immune system to produce enough
antibodies to show up on an HIV test (although in a few cases it
can take up to six months) -- this gap is known as the window
period.
• Because the HIV test looks for antibodies, taking an HIV test less
than three months after possibly getting infected might not give
an accurate rest result.
• However through the window period, the infected person has
enough viruses in the blood, breast milk or sexual fluids to infect
another person even though it will not show in the test.

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Training Manual for Call Centre Operators, January 2002.

• Please contact Tebelopele or you’re nearest health center for


more information and better testing period.

Can you treat HIV?

• There is no vaccine or cure for HIV. However, anti HIV drugs are
available, and taking a combination of anti-HIV drugs can slow
down the damaging effect of HIV on the immune system. It is
possible to live 15-30 years with the medication.

2. About HIV and Sexual Relationships

Is it still possible to have sex and relationships if I have HIV?

• Not only is it still possible to continue to have sex and


relationship, when you are HIV positive, it is very
important that people being supported to continue.
(Revise?)
• The instinct to have sex and be close to someone is an integral
part of being human. These needs do not go away because of
HIV.
• It is inappropriate to try to suppress sexual urges in
order to avoid the spread of the virus, as often this can
put people with HIV in a position where we are less,
rather than more able, to make sure sex is safer, to
protect our own health and that of others. (Revise).

What are my responsibilities as an HIV infected person?

• There is no clear-cut definition when it comes to HIV and sexual


relationships. Some would say that the main responsibility is to
always tell your partner that you have HIV, use condom or other
protection, and if possible, avoid sex without one.

• In reality, the responsibility is shared between both infected and


uninfected people to strive toward avoiding transmission, whilst
continuing to have as full and normal a life as possible.

Is there a risk to my own health in having sex?

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Training Manual for Call Centre Operators, January 2002.

• There are a number of risks to one’s own health as a person with


HIV when it comes to sex. A sexually active person is still at
risk of getting or passing on other sexually transmitted
diseases and infections. These can be more serious for
an HIV positive person, harder to get rid of, and can help
speed up the rate of the HIV damage to the immune
system. (Revise?)

• It is also possible to be re-infected with a more aggressive or


drug-resistant strain of HIV, which can be very hard for some
people with HIV to understand and accept these risks, as they
appear minor compared to having been infected with HIV in the
first place when in fact they are significant.

Are there risks to others?

• The most significant risk that someone with HIV could represent
to an HIV negative person is, of course, that of them becoming
infected with HIV. While this is a real and serious risk, it can only
happen through unprotected sex, sharing injecting equipment or
other invasive procedures where HIV can get into the other
person’s bloodstream. It is important not to exaggerate their risk,
understand HIV, and how to protect yourself and others.

Do you think I should tell people I am HIV positive?

• Many people think that a person with HIV has to tell others by
law or those they do not do so, they are hiding it for malicious
reasons. This is rarely the case.

• Making decisions about whether to tell people is a personal


choice, and not revealing your HIV status should not be confused
with malicious intent, or desire to infect others.

3. About Sexually Transmitted Illnesses

What are sexually transmitted infections (STIs)?

• Sexual activities often involve getting close to another person.


Being close allows infections present in one person to be passed
on to the other. You can’t be much closer to anyone when you
are sexually intimate, so it isn’t surprising if germs can spread
that way.

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Training Manual for Call Centre Operators, January 2002.

There are about 25 different ones. What they all have in common is
they can be spread by sex. This means:

• Vaginal intercourse (where the penis penetrates the vagina).

• Oral sex (where partners kiss or stimulate each other’s genitals


with their tongues).
• Anal sex (where the penis penetrates the anus).

What should I know about STIs?

• STIs can cause some serious and permanent damage to your


health, if untreated.
• Some STIs make people unable to have or bear children.

• STIs must be diagnosed by a qualified doctor and treated.

Where can I ask for treatment information?

• You can ask for treatment information from the nearest health
post, hospital or clinic. There is also a National Centre in
Gaborone run by the AIDS/STD Unit. Their number is
312492 or ?. (add the direct number ?)

How do I know if I am infected?

• If you are infected, you will have unusual vaginal discharge.


• Discharge from the penis.
• Sore or blister near vagina, penis or anus.
• Rash or irritation around the vagina, penis or anus.

• Pain or burning feeling on passing urine.


• Passing urine more often than usual.
• Pain when you have sexual intercourse.

Sometimes you may have no symptoms at all.

How can I avoid STIs?

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Training Manual for Call Centre Operators, January 2002.

• There are several things you can do together to help make


yourself safe or have safe sex. If you want to avoid STIs, even
AIDS then you might find the following helpful:

• Get to you know your partners before you have sex. This lets you
talk to each other about protecting yourselves.

• If either of you have symptoms, including cold sores, on your


lips, don’t have sex until you have been treated.

• Get some condoms in you pocket or purse, which might be


useful when you have sex. Use a spermicidal if can. The
spermicide may help to kill the virus that causes AIDS.

• Tell your partner if you have an infection. That way your partner
can be treated too.

How common are genital warts?

• There are over 100 types of viruses that cause warts. They are
known as human pailoma viruses. An adult can be affected
with more than one type. So please see your doctor or go the
nearest health post for diagnosis.

What about genital warts? Will they stay until I have the right
medication?

• In the majority of cases of Human papiloma virus (HPV), infection


will clear from t he body. One still doesn’t know if the immune
system eliminated the virus or just suppresses it. . There may be
long variations from person to person when the warts will return.
For some people, recurrences are frequent and can go on for
years.

• Without treatment, genital warts may grow, stay the same or to


get smaller. Treatment is usually given to for cosmetic reasons
because of their unsightly appearance. There is a whole range of
treatment options. Ask your doctor about it.

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Training Manual for Call Centre Operators, January 2002.

I have an abnormal or unusual discharge from my vagina. What could


it be?

• The three major categories of abnormal discharge are an


increase amount, abnormal odour or abnormal colour, often
yellow. These do not always reflect abnormal sexual infection. It
could also be due to bacterial vaginosis or trichomoniasis.
Consult a qualified doctor or health worker.

I have an abnormal discharge from my penis. What is it?

• A penis discharge often is due to gonorrhea, Chlamydia, or non-


specific urethritis (NSU). A medical practitioner can tell you
better. Consult one.

Why are these sore like things on my vagina?

• Sores or ulcers in the vagina are commonly due to the herpes


simplex virus (HSV). Less common causes are the venereal
diseases of syphilis and chancroid. Consult a doctor quickly.

Tell me, can I get any sexual infection if I use a condom?

• To be effective, condoms must be applied to their full length,


from the bases to the tip. It must not have any unnatural pores,
and must be intact. The expiry date indicates the period to
which condoms are valid.

• Most sexual diseases including HIV can be prevented by the


correct use of latex or polyurethane condoms.

• However, genital warts are not easily prevented from passing on


to a sexual partner even if condoms are used.

How risky is it to have oral sex?

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Training Manual for Call Centre Operators, January 2002.

• Recent studies show that there is very little chance of catching


HIV transmission through oral sex. But if it is between men and
men, the risk could be between 3-8 %.

• However, unprotected sex can lead to transmission of syphilis.


Unlike HIV, syphilis can be cured completely if diagnosed early.
Oral sex is also known to transmit STIs like gonorrhea and herpes
simples. If you don’t know your partner, stay away from it.

How will I know if I caught anything last night since I had unprotected
sex?

• The only way out is to go for a test. (Put number ... where
should one go?)

Chapter Two

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Training Manual for Call Centre Operators, January 2002.

Counseling, Voluntary Counseling, Testing


and Support

What is counseling?

• Counseling is a helping relationship or a dialogue which intends


to help one to make informed decisions.

• Counseling is a safe and confidential place where you can talk


about your life and ways in which it can be affected by HIV.

What is the importance of counseling?

• Counselling helps you to cope with the situation you find


yourself in.

How can it help me?

Counseling can help you to


• Make sense of your fears and anxieties.
• Feel less alone and down.
• Share your grief and loss.
• Think about and understand your emotions.
• Find stability in a crisis.
• Look at better ways of communicating.

• Begin to find answers to your problems and concerns.


• Discover new perspectives on life.

Where can I get counseling?

• You can get counseling from any counseling center in Botswana


or health facility which has a trained HIV/AIDS counselor.

Who will I see?

• You will always see a trained counsellor with a good knowledge


of HIV issues. The service operates using the ethics and
guidelines of the Ministry of Health.

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Training Manual for Call Centre Operators, January 2002.

This is my first time trying to see a counselor. What should I worry


about? Do I need counseling?

• Counseling is not about reassurance. It is about giving you the


space to look at issues that are troubling you , an together with
the counselor, to think about what is going on in your life and
how things might be different.

• There may be times when any of us need supportive


environment. The counselor is one such person who will help
you.

How long does counseling take ?

• It lasts between 45 minutes to 1 hour.

How can I benefit from counselling?

• Counselling will assist you to make informed decisions.

What if counselling opens up too many painful feelings that I can’t


cope with ?

• Counselling may bring up many different feelings, some of which


may be painful. But it will give you the chance to explore these
feelings, and in doing so, to work through them and understand
them rather than burying them so that they come up you don’t
want to.

I am so depressed I don’t believe any one can help me ?

• Sometimes it may feel as if there’s no way out of your despair.


But despair is partly about feeling completely alone. And talking
to someone who is prepared to listen and can accept your
depression maybe the first step to moving out of it.

Who offers counseling ?

• A trained HIV/AIDS counselor .

Who can be provided counseling ?

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Training Manual for Call Centre Operators, January 2002.

• Anybody who needs counseling i.e. HIV infected people (PLWA)


• Thos who would like to know their status.
• The worried or those doubting their status.
• Affected family members.

Will the information communicated by me to you be kept


confidential ?

• Yes, it will unless you permitted the counselor to


disclose it. (revise ?)

Can I come with somebody for counseling ?

• Yes, if it is a decision made by you to bring another person to


the session. Not imposed on you by the counselor or any other
person. However, it is advisable if it is your sexual partner.

Is counseling a free service ?

• In most cases yes in Botswana. You will only be charged if you


go to a private counselor.

Can I call the counselor to provide counseling at home ?

• Yes, if the need arises.

Can I be counseled at any time ?

• This depends on the availability of a counselor.

How will I know that the information communicated to you by me


during a session will be kept secret or private ?

• Through building a trusting relationship.

Can I receive counseling through the phone ?

• Yes. At Ipoletse, we will provide counseling as well as


provide you with information on where to obtain further
counseling services.

Does AIDS/STD staff offer counseling or can I get counseling from them
?

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Training Manual for Call Centre Operators, January 2002.

• No. The AIDS/STD unit staff counseling unit staff will refer you
to the relevant counseling center.

VOLUNTARY HIV COUNSELLING AND TESTING (VCT)

COMMONLY ASKED QUESTIONS AND WHAT YOU NEED TO KNOW

In the absence of a cure or vaccine, the main strategy for combating


HIV/AIDS is to influence effective, positive change in sexual behaviour
by encouraging individuals and couples know their HIV status.
Voluntary counseling and testing services are now widely available in
Botswana at the Tebelopele VCT centers.

What is HIV counseling and Testing (VCT)?


Voluntary counseling and testing, commonly known as VCT, is the
process by which an individual is helped by a trained person
(counselor) through counseling, to make an informed choice about
being tested for HIV. This decision must be the choice of the individual
and he or she must be assured that the process will be confidential.
VCT provides an opportunity for people to learn and accept their HIV
status in a confidential and friendly environment. The individual
receives counseling before being tested (pre-test counseling) and after
the test, immediately following disclosure of results (post-test
counseling). Those who test HIV positive are counseled about positive
living with HIV and the importance of not infecting others, while those
who test HIV negative are counseled about the importance of
implementing a risk-reduction plan to reduce their chances of getting
infected. With the consent of the individual, referrals are made to
other support agencies for additional care and counseling. VCT has

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Training Manual for Call Centre Operators, January 2002.

been shown to have a role in both preventing further spread of the


virus and as an entry point to early treatment and care.

What would one do if he/she tests HIV positive?


If HIV positive, knowing your status helps you in:
• Receiving good nutritional advice to improve your health status.
This may involve reducing or stopping altogether consumption of
alcohol, cigarettes and other substances that can be harmful to
your body.
• Accessing early treatment and care
• Realizing the importance of regular exercise to keep physically
fit.
• Receiving emotional support through on-going counseling
• Prevention of HIV related illness like TB, through the TB
Preventive Therapy (IPT) program.
• Motivation to initiate or maintain safer sexual practices to avoid
infecting your partner (s) and re-infecting yourself.
• Increasing your knowledge of safer options for reproduction and
infant feeding, through the prevention of mother-to-child
transmission.
• Sharing your life experiences with other people in similar
situations, if you choose to do so, to help prevent further spread
of the HIV virus.
• If you have HIV, knowing you are infected can help you prepare
for your future and for your children’s future.

• Through positive living with HIV, one can lead a productive and
healthy life for many years, thus contributing towards to the
development of his or her family and community at large.
Positive Living means taking care of your health and emotional
well being in order to enhance your life and stay well longer.

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Training Manual for Call Centre Operators, January 2002.

What would one do if he/she tests HIV negative?

• Testing HIV negative is a wonderful opportunity to empower you


to adopt behaviors that will keep you and your partner (s) from
contracting HIV.
• Will help restore your hope for the future.

• Will enable you make decisions about your future sexual


behavior.
• Is essential for you in making informed decisions about future
pregnancies.
• Enable you donate safe blood to the Blood Transfusion Service,
to save lives of your fellow human beings.

• Depending on your life style in the last 3-6 months, you may
require to take a repeat/confirmatory test to determine if your
current negative result is due to the window period. Your
counselor will discuss with you more about the window period. It
means that between this test and the confirmatory /repeat test,
you should not involve yourself in risky behaviour (such as
having unprotected sex with someone whose status you don’t
know).

Knowledge is power. With knowledge of your HIV status, infected or


not, you are increasing your self –awareness and have an opportunity
to encourage others in the community to do the same.

Who should get tested for HIV?


 Anyone who has had unprotected sex with someone whose HIV
status he or she does not know.
 Women and men planning to have a baby.

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Training Manual for Call Centre Operators, January 2002.

 Pregnant women and their partners.


 Women and men planning to get married or have a sexual
relationship.
 Women and men who have recently suffered from sexually
transmitted diseases.
 Women and men who are experiencing AIDS-related illnesses.
 Women and men who believe their partners are having
unprotected sex with other people.
 Those who are advised by their doctor to get tested.
 Married or co-habiting couples who do not know each other’s HIV
status.

About Tebelopele:
• Eventually, there will be 15 Tebelopele centers opened in
Botswana. These include Gaborone, Francistown, Selebi-Phikwe,
Maun, Kasane, Serowe, Palapye, Letlhakane, Lobatse, Jwaneng,
Molepolole, Mochudi, Ghanzi, Mahalapye and Kanye. Please see
attached table for center location, contact person and hours of
operation.
• HIV counseling and testing at the Tebelopele centers is offered:
 On voluntary basis (no one must be coerced or forced to take the
HIV test. It must be your own informed choice to know your
status).
 On anonymous basis (meaning that no name is required, only a
code number is given to each individual).
 Free of charge
 Confidentiality is guaranteed. All that you discuss with the
counselor is kept confidential.

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Training Manual for Call Centre Operators, January 2002.

 HIV test results are available within one visit, the same day of
the test. Rapid HIV tests that were evaluated in Botswana and
found to be as accurate as the ELISA test are used at the
centers.
 No certificate of your HIV test result is given to you; rather, you
read your test results together with your counselor and discuss
what those results mean to you.
 The process of HIV counseling and testing takes an average of 1
hour from the time of seeing the counselor.
 Well- trained counselors are available to help you understand
your risks of contracting HIV and help you develop a risk-
reduction plan, which is appropriate to your life situation.

Where is Tebelopele center in Gaborone located?


The center is located at the main mall, Extension 2, Plot 695 on
Kutlwano Close. It is opposite the Omang Offices. Table 1 attached
will give you details about Tebelopele center locations in the country,
opening hours and contact persons.

How long does it take for one to get tested?


At Tebelopele centers it takes just about 1 hour to receive both HIV
counseling and testing. So, you will make only 1 visit to the center,
results are available same-day. Where the center is a busy one, you
may wait for about 30 minutes or less, before you see the counselor.
But once you are with the counselor, it takes just about 1 hour for both
counseling and testing.

What are the requirements for one to go through the test?

 At Tebelopele, you must first be counseled before you get tested.

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Training Manual for Call Centre Operators, January 2002.

 You should come in voluntarily; no one should have forced you to


take the test.

 You will not be charged any fee.

 You don’t need prior appointment with center staff, you just walk
in during working hours and you will be served.

 You are not required to produce your omang card

 Your name is not requested. You will receive a card with only a
code number on.
 If you have already tested at the Tebelopele center, you are
required to come with the card you received during your first
visit.
 If you come with your partner, the counselor will ask you if you
would like to be counseled and tested together. If you agree,
then you will receive couple counseling and testing together.
Which means you will see each other’s test result. If you change
your mind about being counseled and tested together, then you
will be served individually.

Do you check STDs at Tebelopele centers?


No. We don’t check for STDs at Tebelopele centers. We only test for
HIV. The counselors will refer you to the clinic in case you have STD
concerns.

How important is it to take an HIV test?


How important it is to take an HIV test depends on every individual and
their personal circumstances. But it is important not to walk in the
dark. Knowing your status will help you plan your life accordingly.

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Training Manual for Call Centre Operators, January 2002.

Is it true that all Tebelopele Employees are HIV positive?


We don’t know. Their HIV status is their personal secret, until they
decide to share it with someone else. It is confidential.

Is there confidentiality at the Tebelopele centers?


Yes, in all ways, confidentiality is guaranteed at the centers. Each
client will be counseled and tested in privacy. You will see your test
results in the presence of your counselor only. The counselors are
trained to follow ethical procedures-not to reveal your HIV status to
any one else without your consent. Our services are anonymous-your
name will not be written anywhere. You are assured of confidentiality.

Is there a cure for AIDS?


AIDS is a deadly disease for which there is no cure. No drug has yet
been found that can cure AIDS. No vaccine has yet been found against
HIV/AIDS. Prevention is the only option right now. Abstain from sex, if
you can, or use condoms consistently with your sex partner (s).

Are Tebelopele centers open on weekends?


No. The centers have not begun operating on weekends. With more
staff being available in future. This option will be considered.

Table 1: TEBELOPELE VOLUNTARY COUNSELLING AND TESTING


CENTERS- CONTACTS:
CENTER LOCATION PHONE FAX CONTACT OPENING
PERSON HOURS
Gaborone Extension 2 31402 57048 Mr. Ronald 8.00a.m
Kutlwano Close, 3 7 Molosiwa -6.00 p.m.
Plot 695 (Center Monday to
Director) Friday
Francistown Area G, Guy 21626 21820 Mr. 7.30 a.m –
Street 3 0 Modisaotsile 5.30 p.m.
Plot No 57 Mokomane Monday to

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Training Manual for Call Centre Operators, January 2002.

(Lead Friday
Counsellor)
Selebi- Tshekedi Road, 26005 26005 Mr. Nkopane 8.00 a.m –
Phikwe Plot 2462 13 14 Mfolwe (Lead 5.00 p.m.
Counsellor) Monday to
Friday
Maun Opposite Maun 66504 68000 Setshwano 8.00 a.m –
District 3 86 Aerwa (Lead 5.00 p.m.
Administration counselor) Monday to
Offices-Plot DA13 Friday
Jwaneng Unit G8 38128 38129 Gillian 8.00 a.m –
Plot 746 1 3 Goodwin 5.00 p.m.
(Lead Monday to
Counsellor) Friday
Serowe Goo-Ramoseki 43746 43746 Mbako 8.00 a.m –
Ward; Between 9 8 Tawana 5.00 p.m.
Kagiso Motuary (Counsellor) Monday to
& Mazila Friday
Complex
Kasane Corner-President 62504 62505 Modiri 8.00 a.m –
Av/Rural 88 32 Moremi (Lead 5.00 p.m.
Administration Counsellor) Monday to
Center; Plot Friday
858/859
Lobatse Hillside 53001 53001 Monkie 8.00 a.m –
Jacaranda Plot 68 69 Morake (Lead 5.00 p.m.
1895/13 Counsellor) Monday to
Friday
Letlhakane 27660 27660 Keitumetse 8.00 a.m –
1 0 Legwaila 5.00 p.m.
(Counsellor) Monday to
Friday
Palapye Just Behind 42447 42447 Susan Jorosi 8.00 a.m –
Barclays Bank 4 5 (Lead 5.00 p.m.
and Close to Counsellor) Monday to
House of Hope Friday

NB: Other Tebelopele centers to open in Mochudi, Molepolole, Lobatse,


Ghanzi and Mahalapye

Chapter Three

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Training Manual for Call Centre Operators, January 2002.

Community Home Based Care (CHBC)

What is Community Home Based Care ?

• CHBC is the care provided to chronically and terminally ill


persons at home. Care is provided by family members and
community members. These are assisted by skilled professionals
such as health and welfare officers.

Objectives of CHBC in Botswana

• Provide optimal care for the chronically and terminally ill patients

• Provide appropriate clinical and nursing care for patients at home

• Provide counselling and social support services to patients within


their home environment

• To increase the level of HIV/AIDS awareness in the community

The Rationale for HBC in Botswana

• The rapid increase in both the rate of infection and the number of
AIDS cases.

• The threat that the well developed health delivery system in


Botswana will be stretched thin.

• The family is potentially still the greatest resource for holistic care
of chronically ill patients.

• The family is among the primary targets for HIV/AIDS prevention.

• Patients prefer to die at home.

Services rendered during CHBC

CHBC services are provided by family members. However, they are


assisted by skilled professionals during home visits. Services provided
during CHBC include the following;
• Home nursing (provision of prescribed medication including
bathing patients if necessary)

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Training Manual for Call Centre Operators, January 2002.

• Counselling to patients and family members

• Provision of infection control materials such as gloves, bed pans,


napkins and mackintosh.

• HIV/AIDS Education as well as personal hygiene and cleanliness


of the surrounding.

CHBC services are available and provided in CHBC programmes in all


districts. There are also some Non-governmental organisations,
community-based organisations and support groups through out the
country that provide CHBC services.

Patients on CHBC are free to go back to clinics and hospitals when they
feel that they need more specialized attention that can not effectively
be provided within a home environment

Who qualifies for CHBC ?

CHBC programme provides services to chronically and terminally ill


patients resulting from diverse causes. CHBC is not a programme
sorely for HIV/AIDS patients.

Questions that are likely to be asked regarding CHBC.

Q. Who benefits from the CHBC programme?

• Chronically and terminally ill patients

Q. Who decides on who should go on home based care?

• Personnel from health facilities especially Doctors as they are the


ones who discharge patients. This decision is made with the consent of
the patient.

Q. What kind of help is provided to the client at home?

• Provision of materials for infection control, food, drugs, nursing


care, counselling and referral if necessary.

Q. What help does the family get?

• Support by CHBC personnel and volunteers. Training in caring for


the client and any other relevant support.

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Training Manual for Call Centre Operators, January 2002.

Q. Where can help be obtained for CHBC clients?

• From CHBC personnel, Social Workers in all health facilities and


from volunteers.

Q. How will relatives know that the patient is about to be


discharged ?

• Through care givers who visit the patient at the hospital. The
referral form is sent to the nearest health facility, District health Teams
and the family members have to be informed about the discharge plan
and also Social Workers are to assesse the home environment before
discharge, patients are also given copies of the discharge slip to
present to the nearest health facility.

Q. If a patient has no one to look after him or her at home,


who should be contacted for help?

• CHBC personnel, Social Workers and volunteers. The chief or


Headman of the area can also be contacted.

Q. If a client needs counselling, who can help?

• There are counsellors in health facilities, counselling centers are


available in some areas. Priests and leaders of religious organisations
can also help. Social Workers and nurses who do Home visits can also
assist.

Q. Are there any doctors who visit clients at home?

• No. There is a shortage of doctors in the country. Usually


patients are referred to the nearest health facility for specialized care.

Q. Can one get infected by taking care of HIV/AIDS patients


at home?

• This is not likely. People are however encouraged to practice


universal precautions, not only with HIV/AIDS patients but with every
patient. They have to use gloves at all times when attending to
patients and wash their hands before and after. This practice protects
the patients as well from infection.

Q. Is it possible for patients to die at home before they are


being assisted?

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Training Manual for Call Centre Operators, January 2002.

• It is possible if they had not been reported, but if reported they


are assisted.

Q. What role do volunteers play in CHBC?

• They help in identifying clients who had not been reported. They
also assist caregiver to feed patients, bath and also clean the patient’s
surroundings.

Q. Who takes care of the children of the sick patients?

• Family members are encouraged to take care of them, but they


are also registered as potential orphans, where social welfare officers
assist them.

Q. Are patients forced to be cared for at home?

• Not really. One has to take the consent of the patients into
consideration as they might have some reasons why they do not want
to be cared for at home, such patients need counselling.

Chapter Four
IPT for TB (or Preventive Therapy)

Q: What is TB Preventive Therapy ?

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Training Manual for Call Centre Operators, January 2002.

• TB Preventive Therapy is a treatment given to persons living


with HIV (the virus that causes AIDS) to prevent them from
developing active TB.

Q: Who can get TB Preventive Therapy ?

• Any person who has tested HIV positive can be considered for
preventive therapy.
• HIV positive pregnant women will be offered treatment 6 weeks after
delivery.

What do I need to know about TB and HIV ?

• The leading cause of HIV/AIDS deaths in Botswana is TB..


• Most people in Botswana have silent o hidden TB infections and
are NOT sick.
• HIV lowers the body’s ability to fight infection, so the TB germs
multiply and cause active TB disease.
• People with TB in the lungs spread the TB germ when they
cough, laugh or sneeze.
• People who take correct TB treatment will NOT spread the TB
germ to others.
• TB can by cured even if a person had HIV.

Can TB be prevented in someone with HIV infection ?

• The good news is that persons living with HIV can take Isoniazid
also known as INH to help prevent silent TB infection from becoming
active TB. This is called TB Preventive Therapy which lasts normally
six months.

What if a person with HIV infection has symptoms of active TB


(cough, fever etc) ?

• These people need to be seen by the doctor or the nurse, to be


sure they get the right treatment.
• It is important that people with active TB get full TB treatment
with 4 drugs NOT INH alone.

What good does TB Preventive Therapy do for HIV positive


persons ?
TB Preventive Therapy can prevent silent TB infection from
developing into active TB disease. This may help the person to:

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Training Manual for Call Centre Operators, January 2002.

• Live a longer life


• Not spread TB to their family, co-workers and friends.
• Prevent their children from catching TB germs
• Be healthier to carry on with a normal life.

What are the side effects of TB Preventive Therapy ?

• INH is a safe drug used for many years in Botswana together


with other TB drugs to treat TB.
• Some patients may get an upset stomach, burning sensation of
the hands and feet, fatigue or rash.
• Serious side effects to the liver are rare, but it may cause
yellowish colour of the eyes and severe stomach upset.
• A Vitamin pill called pyridoxine is given with INH to help reduce
side effects.
• Report any side effects that my occur to the health worker.

How long does this treatment take ?

• The treatment will take 6 months.


• The INH together with Vitamin B6 are taken ONCE a day at
home for 6 months.

What does a client have to do ?

Every client must be committed:


• To take the INH and Vitamin B6 pills once a day everyday for 6
months.
• To attend the same clinic once every month to collect the INH,
Bitmain B6 and a regular check-up
• To notifying a health worker if symptoms of TB or drug side
effects occur while taking the drug.
• Not to share their tablets with anyone. It’s dangerous !
(why ?)

How do people qualify for the treatment ?

• You will have to first take a HIV test to qualify. Treatment and
service is free.

Chapter Five
Opportunistic Diseases

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Training Manual for Call Centre Operators, January 2002.

What is an opportunistic disease?

• An “opportunistic” disease occurs when HIV depresses the immune


system to the point where a germ has the “opportunity” to make the
person sick.

How are opportunistic diseases treated?

• The treatment depends on which disease you have. If you have HIV
infection and are sick, consult your health facility to get the
appropriate treatment.

How can opportunistic diseases be prevented?

• Prevention of opportunistic diseases may allow a person living with


HIV infection to live a longer and higher quality life.

Many opportunistic diseases in persons living with HIV infection can be


prevented by:
• Preparing food and drinks properly, including hand washing by food
handlers, since food and water can carry germs which cause illness
• Washing your hands with soap and water before eating
• Avoiding water from a stream or river if possible. Otherwise boil it for
at least 10 minutes if possible.
• Avoiding undercooked, raw, or spoiled meat, poultry, or fish
• Avoiding unpasteurized dairy products
• Using insect repellent or mosquito net where there are a lot of
insects
• Using a condom to prevent new infections spread through sex
(herpes, CMV, etc)
• Avoiding being around persons who may have active, untreated TB.
TB patients who have been on treatment for several weeks usually
do not spread the TB germ to others.
• Consulting with your doctor or health facility to see if you would
benefit from
 HIV drugs. These drugs can greatly reduce opportunistic diseases
because they help prevent damage to the immune system
caused by HIV.
 Isoniazid preventive therapy, or IPT, to reduce the risk of
developing TB. Persons must be evaluated by a health worker to
see if they could benefit from IPT. Sick persons may not be
started on IPT because they could already have TB and may need
the full TB treatment with 4 drugs instead of 1 drug for IPT.

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Training Manual for Call Centre Operators, January 2002.

 Co-trimoxazole prophylaxis to reduce the risk of certain diseases


such as PCP (pnemocystis carnii), toxoplasmosis, pneumonias,
blood infections, and diarrheal diseases.

What are the most common opportunistic diseases in Botswana?

The most common in adults are:


• Tuberculosis
• Pneumonia, often recurrent
• Non-healing genital ulcer
• Chronic and/or recurrent diarrhoea
• Herpes zoster
• Candidiasis or thrush in the mouth and throat
• Fungal infections of the throat and esophagus
• Repeated severe bacterial infections
• Kaposi sarcoma
• Cryptococcal meningitis
• Cytomegalovirus in the esophagus, retina of the eye, and nervous
system

The most common opportunistic diseases in children are:


• Pneumocystis carinii pneumonia in young children
• Other recurrent severe pneumonias
• Chronic or recurrent diarrhea
• Tuberculosis
• Recurrent severe bacterial infections
• Candidiasis or thrush in the mouth and throat
• Recurrent common infections, eg ear infections
• Kaposi sarcoma

When do opportunistic diseases occur?

• Opportunistic diseases occur at various stages of HIV infection,


depending on how depressed the immune system is. Some
diseases, such as cryptococcal meningitis, occur when the immune
system is severely damaged. Others, such as herpes zoster, can
occur relatively early in HIV infection when the immune system is
fairly intact. TB can occur at most any stage of HIV infection, early
or late.

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Training Manual for Call Centre Operators, January 2002.

How do I know if have an opportunistic disease?

• A person infected with HIV can feel unwell because of HIV directly,
but most often they feel unwell because of an opportunistic
disease. Some warning signs of HIV infection or opportunistic
diseases include:
 Rapid weight loss
 Cough
 Recurring fever or night sweats
 Profound and unexplained fatigue
 Swollen lymph glands in the armpits, groin, or neck
 Diarrhea lasting more than 1 week
 White spots or blemishes on the tongue, in the mouth, or in the throat
 Pneumonia
 Red, brown, pink, or purplish blotches on or under the skin or
inside the mouth, nose, or eyelids
 Memory loss, depression, or other problems with the nervous
system
 Severe headache

Note: Nobody should assume they have HIV infection just because
they have some of these symptoms. The only way to know whether
you are infected is to be tested for HIV infection at your health
facility or Tebelopele.

What is the difference between the treatment of HIV and the treatment
of opportunistic diseases?

• Treatment of opportunistic diseases does not treat HIV/AIDS itself


• HIV therapy reduces the occurrence of opportunistic diseases, but
opportunistic diseases need their own specific treatment
• The success rate with treatment of opportunistic diseases, such as
TB, is improved if the person seeks care early
• Consult with your health facility if you have any questions about
treatment of any opportunistic diseases you may have

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Training Manual for Call Centre Operators, January 2002.

Chapter Six
Anti-Retroviral Therapy

POSSIBLE QUESTIONS AND ANSWERS ON ARV'S

Q - What are Anti-retroviral drugs?

• These are medications used to treat HIV build-up. They work by


reducing the amount of HIV i.e. Viral load, thus decreasing or reversing
immune system damage and delaying the onset of illness that
characterize AIDS

Q - How do ARVs help?

• Not a cure.
• Reduce viral load even to undetectable levels. Have a beneficial
clinical effect
i.e HIV related symptoms may disappear,
• The incidence of opportunistic infections is reduced and the
quality of life
improved.
• Decreases number of hospitalization for HIV related
illnesses may thus prolong life of HIV infected.

Q - Who Qualifies for treatment (eligibility/selection criteria)

• ( Await Botswana guidelines on ARV Treatment)

Q - Are children also eligible for ARV Therapy?

• Yes. All HIV infected children less than 12months of age are treated
• regardless of their clinical, immunological or virological status.
• Any symptomatic child is treated. Even symptomatic HIV infected
children

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Training Manual for Call Centre Operators, January 2002.

• who are older than 12 months of age and have normal immune status
should
• be started on ARV Therapy.

Q - What are the advantages of ARV Treatment

• Advantages/Benefits of ARV Treatments


• A longer life
• Disappearance of symptoms, improved quality of life in
symptomatic patients,
• delayed diseases progression, fewer opportunistic infections.
• Decreased risk of hospitalization
• Control of viral replication.

Q - What are the disadvantages?

• Impairment of the quality of life in particular for the


asymptomatic patients
• because of the difficult treatment regimen or adverse reactions.
• Development of drug resistance and cross resistance when
patients are treated
• with a sub optimal (bio or mono therapy) ARV treatment
regimen, when viral load monitoring is not possible (to detect
treatment failure) or when
• Patients do not adhere to ARVs. Such resistance will limit the
treatment
• options in the future and increase the risk of transmission of
resistant strains.
• Raising false hope in a proportion of patients who will either not
respond or
• not tolerate the therapies.
• Potential toxicity during pregnancy.

When to initiate antiretroviral therapy?

• Initiation of treatment depends of three criteria; CD 4 cell count,


viral
• load and the patients clinical condition. Hence laboratory tests
are necessary
• to determine illegibility.(exact figures to be obtained from new
guidelines after they have been published).
• NB Symptomatic patients will any level of CD4 cell or HIV RNA
are to
• treated except for special cases including

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Training Manual for Call Centre Operators, January 2002.

• For asymptomatic patients its better not to take ARV because the
unpleasant regimens may outweigh the benefits at this stage
and long term benefits have not been demonstrated for this
specific group patients

Is it better to start treatment early i.e. while still


asymptomatic or to wait
until one is symptomatic?

• It is better to wait because in asymptomatic patients, ARV may


decrease the qality of life because side effects are common and
taking large numbers of pills at regular time intervals may
interfere with employment and daily activities and can be very
stressful.

• Resistance may develop, reducing treatment options in the


future. Long term strict adherence to ARV treatment may be
difficult to maintain (leading to resistance) asymptomatic
patients may be less willing to adhere to difficult ARV treatment
than symptomatic patients, because improvement to their lives
is not obvious and there are significant side
effects.

Adverse consequences of some ARVs may be life


threatening such a
lacticacidosis and pancreatitis.

• The long term side effects of ARV drugs remain unknown

• For symptomatic patients ARVs are certainly beneficial.


• Opportunities infection occur less etc (refer to section c
advantages).

Q . Do ARVs have side effects, if so what are the common


ones?

• ARV medications have extensive side effects, the common ones


being: nausea or vomiting, diarrhea, abdominal pain, secure
peripheral neuropathy, electrolite abnormalities, headache, fatigue,
skin rash, severe pancreatitis, toxity e.g Liver toxicity, hematologic
toxity, oral ulcers.

Q. What do I do if I experience side effects.

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Training Manual for Call Centre Operators, January 2002.

• Report to a health worker and do not stop medications without


first speaking
to a health care provider. Stopping one or two of the medications
can increase
the likelihood that the person with HIV will become resistant to
those drugs.

Q. Why are ARVs available in only 4 sites ?

• No answer yet as it will go to other pilot districts in time.

Q. Does ARV Therapy have any dietary implications

• Yes Some drugs are affected by the presence of certain types of


foods eaten. Therefore dietary changes may need to be made.
Certain drugs are taken with meals, some before and others after
meals. So it is important for the patient to understand fully and
follow the doctors instructions regarding the taking
of medications.

Q. Can I share treatment with my partner/ spouse?

• No - because each person has to be assessed to see if they meet


the treatment
criteria. Also the amount of drugs you are given are only enough
for one
person.

Q. Do I have to stop drinking if I opt for ARV Therapy?

• Answer to be formulated.

Q. What would happen if one does not adhere to therapy?

• One may develop drug resistant strain of HIV and spread the
resistant virus.
• Lack of adherence will impact on treatment success.

Q - If one is put on treatment is one sure to benefit from


treatment?
• Not always.
Resistance may occur even with triple therapy and adherence.

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Training Manual for Call Centre Operators, January 2002.

In some cases drugs cannot suppress viral replication etc. Hence


the need for monitoring.

Q - I have been getting ARV from a Private Doctor, does that


automatically qualify, because there is a set selection criteria
that one has to meet (Which will be contained in the
guidelines for ARV treatment in Botswana once they become
available).

• Ask your local physician.

Q. Does treatment end or it is lifelong?

It is life long.

Q. If I am going outside the country for a long time, and


am on ARV treatment, what should I do ?

• What you should do is you must have your treatment


regime with you wherever you go. This is the drug
combination you are taking. At arrival at the destination, you
should contact health professionals for continuity of the
treatment. It might well mean that you will have to procure
your own supply once you are outside of Botswana for a long
period.
(revise response ?)

Q . Why is frequent monitoring of patients on ARVs


necessary?

It is necessary for:
• Surveillance for adverse effects of treatment and management
of those effects.
• Confirmation of treatment efficacy.
• To assess drug interactions e.g. interactions between ARV and
drugs used to treat opportunistic infections.
• Assessment for treatment options for patients who fail therapy
which may lead to change of drugs , addition of more drugs
etc.

Q. How often do I have to go for monitoring?

• After the start of therapy - at 6 - 8 weeks to assess initial


efficacy.
• Every 3 - 4 months thereafter

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Training Manual for Call Centre Operators, January 2002.

• Plus 6 - 8 weeks after a change in therapy.


• CD 4 cell counts every 3 - 4 months.

Q. Every time I take ARV it reminds me that I am HIV


positive. What should I
do ?
• It is strongly recommended that you seek additional counseling
support from any qualified medical counsellor. But you should know
that being reminded of your HIV status while being counseled
should not make you feel upset. You should be happy to note that the
treatment is going to correctly improve your Quality of Life and
longevity.

Q. I am worried that my stock will run out. What should I do ?

• Under normal circumstances, you will be supplied with sufficient


stock for a specified period of time. You are not expected to run short
of medication before the next visit. One can only run short, if they
share the medication with othert, which is strongly prohibited.

NB: To verify once new guidelines on ARV treatment are out.

Chapter Seven
Nutrition and HIV/AIDS

I am HIV positive, what kind of food should I eat to keep


healthy ?

• You should eat more energy giving food like bread, rice, sorghum
meal, potato, corn flakes etc.

• Try protein rich food like beef, chicken liver, kidney, fish,
cheese, eggs, beans, ditloo, peanuts etc.

• Use vegetable oils and dairy products to ensure enough


supplies of vitamin A, D, E and K. These can be found in milk,
cheese, butter, margarine, pumpkin, nuts etc.

• Drink plenty of fluids like water and fruit juices.

• Use vitamin and mineral supplements as indicated by your


doctor. High doses can be harmful.

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Training Manual for Call Centre Operators, January 2002.

• Cut down on tea, coffee and alcohol.

• Exercise regularly as this can strengthen your muscles and


immunity. But you should consult your health care provider
before engaging in a strenuous exercise programme.

• Do not eat fatty food.

I have poor appetite, how do I deal with this problem ?

• Try to make meals as appealing as possible.


• Eat small, more frequent meals and snacks throughout the day.
• Eat your meals in the company of your family or friends.
• Vary the flavour and texture of foods to make them more
appetizing.
• Treat food like medicine, make a time table to help you eat
more regularly.
• Eat food that needs little chewing, such as small cuts of beef,
chopped or pureed foods.
• Try not to drink liquids with food as this will fill you up quickly.
Drink nutritious liquids such as fruit juices and pasteurized milk
between meals.

I have a very serious problem of nausea and vomiting, how can I


solve this problem ?

• Try light meals and beverages.


• If medications bring on nausea, check with your health care
provider abut the possibility of timing your meals, so that you
eat before taking medication.
• Eat small frequent meals throughout the day.
• Cold foods may be more acceptable than hot foods, because
cold foods do not have strong smells that may trigger nausea.
• To calm your stomach and relieve nausea, cut a lemon into half,
rub it between your hands and inhale its aroma.

I have a problem of severe diarrhea, how do I go about solving this


problem ?
• Drink a lot of fluids such as diluted fruit juices, oral
rehydration solution (ORS), lucozade, salty soups, rice water,
samp water to prevent dehydration..
• Reduce your intake of milk, as your body may not digest milk
well. Rather use sour milk (madila), mageu, yoghurt, cheese.

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Training Manual for Call Centre Operators, January 2002.

• Reduce high fiber foods temporarily as these promote bowel


movement. Maize meal, banana, rice can help alleviate
diarrhea. Follow the BRAT diet for diarrhea below and see what
works for you best.
• Use sufficient salt in food to meet salt requirements in your
body.
• Avoid alcohol and caffeine, including coffee, black tea and soft
drinks, chocolates and cocoas as they worsen the diarrhea.
• Eat small frequent meals, six to eight small meals a day will be
easier to digest than three big ones.
• Eat food that is low in fat. Boil, steam bake or grill our food
rather than fry it.
• Avoid supplements like Ensure, Sustacal. They are rich in fat
and sugar and can therefore increase diarrhea.

BRAT diet for diarrhea.

• The Brat diet is used to help slow down diarrhea. Do not use this
diet for more than 2 days, as it does not contain all the nutrients
need to stay healthy. All these foods are to be eaten plain. Don’t
add anything to the foods.

B – bananas mashed, boiled potatoes (no skin), maize meal


R – Rice (cooked, plain), pasta, white bread, rice water.
A – Apples (mashed) pumpkin, watermelon.
T – Tea without caffeine, white bread toast.

• Rice water is made by cooking white rice with more water than it
needs. For example, four cups of water added to a cup of rice.
Where the ice is soft pour the extra water into a container, cover
and let it cool. Rice water is easier to drink. When cool, drink the
water and then eat the rice.

• If you have fever, you should drink lots of water so that you can
avoid dehydration.

It becomes painful for me to swallow because I have a sore mouth?


What should I do?
• Choose soft, chopped pureed foods that need minimal chewing.
E.g. soft porridge, mashed potatoes, pumpkins, mashed
vegetables and fruits, scrambled eggs, minced meat.
• Suck on ice cubes before a meal.
• For dry mouth avoid foods that stick to the roof of the mouth
such as peanut butter. Add gravy or yogurt to foods to moisten
the food.

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Training Manual for Call Centre Operators, January 2002.

• Avoid spicy (hot) foods such as curries chili and acidic foods such
as oranges, grape juice, lemon juice and very salty foods.
• Avoid smoking and alcoholic beverages.
• Eat warm foods ad they are more soothing than hot foods.

During the past weeks I have lost a lot of weight. What can I do to
regain back my lost weight?

• Increase the amount and variety of the food you eat.


• Increase the energy content of your food. This can be achieved
by enriching foods such as sauces, soups, gravy and desserts
with added milk, eggs, sugar, butter, and margarine.
• Eat regular meals (small and frequent) nutritious snack. Try to
eat by the time of the day rather than in response to hunger.
• Avoid food or drinks that are empty or low in calories. For
example, have milk based drinks rather than cups of black coffee
or tea, or glasses of water.
• Stay away from fizzy drinks, which are filling and can discourage
further eating.
• Use fermented instead of bland porridge for more energy and to
improve the absorption of iron.
• Slowly introduce the fat content of food.
• Add nuts, pounded water melon seeds, peanut butter to relish or
Morongo.
• Enrich milk by adding one heaped table spoon of skim milk
powder to a cup of milk and mix thoroughly.
• Use milk in drinks, with cereals and in cooking.
• Exercise to build body muscle.

How should I safely store and handle food ?

• Always wash hands, counters and cutting boards with warm and
soapy water before starting food preparation and after contact
with uncooked meats and chicken.
• Use clean and safe water for drinking and preparation of food
(boiled and then cooled).
• Always reheat foods thoroughly before eating to kill any germs,
which may still be there.
• Be very careful with leftovers. Always boil leftovers before
eating.
• If food seems even slightly spoiled, throw it away. Don’t take
chances with your health.
• Do not store uncooked food where it can contaminate cooked
food. For example water or blood from refrigerated meat can

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Training Manual for Call Centre Operators, January 2002.

cause contamination by dripping on to food stored on the lower


shelf of a refrigeration.
• Always throw away food that has crossed its expiry date.
• Remember contaminated food does not always smell or look bad.

Chapter Eight
Prevention of Mother to Child Transmission
HIV Testing
Why are you only interested in my baby ? What’s in this for me
or Why should I know my status ?

• Knowing your status will help prevent the transmission of HIV to


our baby. If yu are negative it will help you stay negative and
take measure.

• If you are HIV positive, you can adopt a good diet and take
other steps to stay health, prevent illness and live a longer life.

• If you do become ill, the health worker will be able to treat you
appropriately. There are also some preventive therapies you

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Training Manual for Call Centre Operators, January 2002.

can take to avoid illness. For instance, IPT is a 6 month course


of drugs that will keep you from getting TB.

Aren’t all babies born to positive mothers infected with HIV ?

• Although HIV can be transmitted to the baby, the majority of


babies will not be infected by their mothers.
• Without treatment, about 40 % of the babies will be infected.

• Although it normally does not happen, sometimes HIV can leak


across the placenta to the baby, but this is uncommon.

• At birth when the baby travels through the mother’s birth canal
damage can occur to the baby’s skin and HIV can be transmitted
when it comes into contact with the mother’s blood. This is why
the time of birth and labour are the most common for HIV to be
transmitted.

• Some babies are only infected after birth through breast milk.

What is the effect of AZT on me as a mother ?

• A short course of AZT or ZDV during pregnancy and delivery


reduces your risk of MTCT and does not harm your pregnancy.
However, it does not offer your body any other help on the HIV
infection.

If a women takes ZDV for PMTCT and then stops won’t her viral load
shoot up and her immunity become much worse ?

• When a mother takes ZDV for PMTCT her viral load (the load of
HIV in her blood) will fall. This is thought to be how
transmission of HIV is prevented.

• When she stops taking it her viral load will return to the level she
had before taking the ZDV. Therefore, although the ZDV a
pregnant mother takes for PMTCT will not help her own HIV
disease, it will not make it worse. It will not make her viral load
increase or her immune system weaken.

Are there not dangers of resistance developing if the pregnant woman


takes ZDV alone ?

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Training Manual for Call Centre Operators, January 2002.

• The risk of developing drug resistant strains of HIV is


considered to be minimal when taking short course of ZDV for
PMTCT.

• In the long term follow-up of women who have taken ZDV for
PMTCT resistance has not been shown to develop after taking
short courses of ZDV.

Can a mother keep taking ZDV (AZT) after the baby is born for her
own health ?

• Unfortunately, taking a single ARV is not effective in


treating HIV disease. A combination of at least 2 and
usually 3 ARVs is needed to treat HIV disease.
Therefore, taking ZDV alone over the long-term will not
be of any benefit. This will also lead to drug resistance.
Triple therapy is currently available from some private
practitioners but maybe available from government
facilities in the near future. (revise response ?).

If I am taking ZDV, I can’t tale Panadol. What do I take then for my


headaches ?
• Although it is not recommended to take paracetamol for a
long period while on ZDV, there is no problem with taking
it occasionally or for short period while taking ZDV for
PMTCT. You can take several short doses while on short
course AZT. (revise response ?)

Can ZDV harm the unborn baby ?

• ZDV used for PMTCT is recommended by the World Health


Organization and is safe for the baby.

Should HIV be positive be discouraged from having children ?

• It is generally accepted that it is every woman’s right to


decide for herself whether or not to have children. The
responsibility of a counsellor is to provide HIV-positive
women and their partners with comprehensive
information about MTCT and PMTCT and to support them
in the decisions they make. ( any additions ?)

If a mother refuses to use infant formula should she be excluded from


the MTCT programme ?

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Training Manual for Call Centre Operators, January 2002.

• For the maximum period, the child must be given formula from
birth if the mother is on PMTCT.

• The mother should be warned of the dangers of mixed feeding,


the mother should stop breast feeding after 6 months and wean
as quickly as possible.

• Beyond six months, the baby will need to begin solid


food and this increases the transmission of HIV from
breast milk. ( Revise this ?)

Chapter Nine
Existing assistance service or other phone
referral services
(Useful Numbers)
Note: Some organizations have field locations, but always refer to the
main number as much as possible.
Location Organization Phone Number
Bobonong Bobonong Primary Hospital 819223
Francistown Jubilee Clinic 211544
Francistown Nyangabgwe Referral Hospital 211000

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Training Manual for Call Centre Operators, January 2002.

Francistown Youth With Destiny 221615


Francistown Peer Approach Counselling by 215385
Gaborone Teens/YWCA 374113/ 353681
Maun 660042
Francistown Tshiriletso Matshelo 212446
Gaborone Botswana Council of Women 306352/352109
Gaborone AIDS/STD Unit 312492
Gaborone Botswana Family Welfare 300489
Kanye Association
Lobatse 332005
Maun 661352
Mochudi 329990
Gaborone Botswana Federation of Trade 356223
Unions
Gaborone BOTUSA 301696
Gaborone Careers and Counselling 352290/1/3/5
Centre, University of Botswana
Gaborone Childline 300900
cell: 72821900
Gaborone Coping Centre for People Living 353221
with HIV
Gaborone Mr. David Ngele 314023
Gaborone Ditshwanelo – The Botswana 306998
Centre for Human Rights
Gaborone Gaborone Private Hospital 301999
Gaborone Holy Cross Hospice 302980
Gaborone Lifeline Botswana 311544
Gaborone Medical Rescue 301601
Gaborone NACA 303881
Gaborone Nurses Association of Botswana 353840
Gaborone Population Services 305265
International
Gaborone Princess Marina Hospital 353221
Gaborone Reetsanang Association of 374821/585110
Community Drama Groups
Gaborone Society of Men Against AIDS 312555
cell: 72164266
Gaborone Society of Women Against AIDS 3553031
Gaborone Tebelopele Voluntary 570487
Francistown Counselling and Testing Centre 216263
0800126126 (works
only in Gaborone)
Gaborone Tirisanyo Catholic Commission 352094/ 316793
Gaborone Tshepong Counselling Network 305554
Gaborone Young Women’s Christian 353681/357783

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Training Manual for Call Centre Operators, January 2002.

Association
Gaborone Youth Matters Cell: 71303476
Ghanzi Chanzi Primary Hospital 596333/4/5
Goodhope Goodhope Primary Hospital 386236
Gumare Gumare Private Hospital 674002/3/4
Gweta Gweta Primary Hospital 612362
Hukuntsi Hukuntsi Primary Hospital 510030
Jwaneng Botswana Jwaneng Mine 380271 x 260
Jwaneng Jwaneng Hospital 380271
Kanye Kanye Medical Mission 340333
Hospital, SDA
Kasane Kasane Primary Hospital 650333
Letlhakane Letlhakane Primary Hospital 278242
Lobatse Lobatse Athlone Hospital 330333/4
Lobatse Lobatse Christian AIDS Centre 506670/330718
Lobatse Tsholofelo Counselling Centre 506670
Mahalapye Mahalapye Hospital 410333
Maun Maun Counselling Centre 661962
Maun Maun Hospital 660444/5/6/7
Maun Women Against Rape 660865
Ministry of Guidance and Counselling 352990
Education Division Curriculum
Gaborone Development and Evaluation
Mmadinare Mmadinare Primary Hospital 817236
Mochudi Deborah Retief Memorial 377333
Hospital
Mochudi Metlhaetsile Women’s 377618/ 377239
Information Centre
Molepolole Keletso Counselling Centre 577001
Molepolole Kweneng Home Based Care 320201
Molepolole Scottish Livingstone Hospital 320333
Orapa Debswana Orapa Mine 270691/272449/272
177
Palapye Palapye Primary Hospital 420331/3
Rakops Rakops Primary Hospital 275111
Ramotoswa Ramotswa Hospice at Home 390212
and Clinic
Ramotswa Emmanuel Counselling Centre 390212
Ramotswa Bamalete Lutheran Hospital 390212
Sefhare Sefhare Primary Hospital 448201
Sehithwa Lesedi Lutheran Church Centre 672000
Selibe-Phikwe Selibe-Phikwe Hospital 810333
Serowe Sekgoma Memorial Hospital 430333/4
Thamaga Thamaga Primary Hospital 399250

46
Training Manual for Call Centre Operators, January 2002.

Tsabong Tsabong Primary Hospital 540232


Tutume Tutume Primary Hospital 287249

Note: For private practitioners, please refer to your yellow


pages.

47

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