Botswana-UPenn Partnership

The Government of Botswana, the University of Botswana and the University of Pennsylvania formed the Botswana-UPenn Partnership to build capacity in Botswana in response to the HIV/AIDS epidemic. UPenn is taking a broad interdisciplinary approach to train health care personnel throughout Botswana in prevention and treatment of HIV/AIDS and its complications, to develop outstanding post-graduate training programs at the University of Botswana with an emphasis on Internal Medicine and its subspecialties, to offer experience in global health to Penn trainees, and to develop joint research programs that address issues relevant to the health and welfare of the citizens of Botswana.




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Now showing 1 - 10 of 48
  • Publication
    Bartonella Infection in Immunocompromised Hosts: Immunology of Vascular Infection and Vasoproliferation
    (2012-01-01) Mosepele, Mosepele; Mazo, Dana; Cohn, Jennifer
    Most infections by genus Bartonella in immunocompromised patients are caused by B. henselae and B. quintana. Unlike immunocompetent hosts who usually develop milder diseases such as cat scratch disease and trench fever, immunocompromised patients, including those living with HIV/AIDS and posttransplant patients, are more likely to develop different and severe life-threatening disease. This paper will discuss Bartonella's manifestations in immunosuppressed patients and will examine Bartonella's interaction with the immune system including its mechanisms of establishing infection and immune escape. Gaps in current understanding of the immunology of Bartonella infection in immunocompromised hosts will be highlighted.
  • Publication
    Isoniazid Resistance and Death in Patients With Tuberculous Meningitis: Retrospective Cohort Study
    (2010-07-12) Vinnard, Christopher; Wileyto, E. Paul; MacGregor, Rob Roy; Bisson, Gregory P; Winston, Carla A
    Objective To determine whether initial isoniazid resistance is associated with death during the treatment of tuberculous meningitis. Design Retrospective cohort study. Setting National Tuberculosis Surveillance System at the Centers for Disease Control in the United States. Participants Patients with a clinical diagnosis of tuberculous meningitis, reported to the National Tuberculosis Surveillance System between 1 January 1993 and 31 December 2005. Main outcome measure All cause mortality during antituberculous treatment. Results Between 1993 and 2005, 1896 patients had a clinical diagnosis of tuberculous meningitis and positive cultures from any site. In 123 (6%) of these patients, isoniazid resistance was present on initial susceptibility testing. The unadjusted association between initial isoniazid resistance and subsequent death among these 1896 patients did not reach statistical significance (odds ratio 1.38, 95% confidence interval 0.94 to 2.02). However, among 1614 patients with positive cerebrospinal fluid cultures, a significant unadjusted association was found between initial isoniazid resistance and subsequent death (odds ratio 1.61, 1.08 to 2.40). This association increased after adjustment for age, race, sex, and HIV status (odds ratio 2.07, 1.30 to 3.29). Conclusions Isoniazid resistance on initial susceptibility testing was associated with subsequent death among cases of tuberculous meningitis with positive cerebrospinal fluid cultures. Randomised controlled trials are needed to evaluate the optimal empirical regimen for treating patients with tuberculous meningitis who are at high risk for both initial isoniazid resistance and poor clinical outcomes.
  • Publication
    Leveraging a Rapid, Round-the-Clock HIV Testing System to Screen for Acute HIV Infection in a Large Urban Public Medical Center
    (2013-02-01) Christopoulos, Katerina A; Zetola, Nicola M; Klausner, Jeffrey D; Haller, Barbara; Louie, Brian; Hare, Bradley; Pandori, Mark; Nassos, Patricia; Roemer, Marguerite; Pilcher, Christopher D
    Methods The hospital laboratory performed round-the-clock rapid HIV antibody testing on venipuncture specimens from patients undergoing HIV testing in hospital and community clinics, inpatient settings, and the emergency department. For patients with negative results, a public health laboratory conducted pooled HIV RNA testing for acute HIV infection. The laboratories communicated positive results from the hospital campus to a linkage team. Linkage was defined as one outpatient HIV-related visit. Results Among 7,927 patients, 8,550 rapid tests resulted in 137 cases of HIV infection (1.7%, 95% CI 1.5%–2.0%), of whom 46 were new HIV diagnoses (0.58%, 95% CI 0.43%–0.77%). Pooled HIV RNA testing of 6,704 specimens (78.4%) resulted in 3 cases of acute HIV infection (0.05%, 95% CI 0.01%–0.14) and increased HIV case detection by 3.5%. Half of new HIV diagnoses and 2/3 of acute infections were detected in the emergency department and urgent care clinic. Rapid test sensitivity was 98.9% (95% CI 93.8%– 99.8%); specificity was 99.9% (95% CI 99.7%–99.9%). Over 95% of newly diagnosed and out-of-care HIV-infected patients were linked to care. Conclusions Patients undergoing HIV testing in emergency departments and urgent care clinics may benefit from being simultaneously screened for acute HIV infection.
  • Publication
    Mucosal Herpes Immunity and Immunopathology to Ocular and Genital Herpes Simplex Virus Infections
    (2012-11-20) Chentoufi, Aziz A; BenMohamed, Lbachir
    Herpes simplex viruses type 1 and type 2 (HSV-1 and HSV-2) are amongst the most common human infectious viral pathogens capable of causing serious clinical diseases at every stage of life, from fatal disseminated disease in newborns to cold sores genital ulcerations and blinding eye disease. Primary mucocutaneous infection with HSV-1 & HSV-2 is followed by a lifelong viral latency in the sensory ganglia. In the majority of cases, herpes infections are clinically asymptomatic. However, in symptomatic individuals, the latent HSV can spontaneously and frequently reactivate, reinfecting the muco-cutaneous surfaces and causing painful recurrent diseases. The innate and adaptive mucosal immunities to herpes infections and disease remain to be fully characterized. The understanding of innate and adaptive immune mechanisms operating at muco-cutaneous surfaces is fundamental to the design of next-generation herpes vaccines. In this paper, the phenotypic and functional properties of innate and adaptive mucosal immune cells, their role in antiherpes immunity, and immunopathology are reviewed. The progress and limitations in developing a safe and efficient mucosal herpes vaccine are discussed.
  • Publication
    The Challenges of HIV/AIDS Criminal Legislation in Botswana
    (2012-03-01) Kebonang, Zein
    In an attempt to halt the spread of the HIV epidemic, the Government of Botswana amended in 1998 the country’s criminal code to provide for stiffer penalties for those charged and convicted of the offence of rape. In particular, there was to be compulsory HIV testing of perpetrators and much stiffer sentences for those who tested positive to the HIV virus. In this paper, I argue that the amendment not only vitiates the right to voluntarily submit to an HIV test, it invades the right to privacy and leads to unwarranted disclosure of confidential information. In addition, I contend that the punitive criminal sentences that follow a positive HIV test are not an appropriate way of preventing transmission as these are not likely to encourage people to voluntarily test for HIV. Punitive sanctions are only justified where it can be shown that a person acted intentionally to transmit the disease.
  • Publication
    Epidemiology of Methicillin‐Resistant Staphylococcus aureus Bacteremia in Gaborone, Botswana
    (2009-08-01) Shah, Samir S; Wood, Sarah; Meaney, Peter A; Bafana, Maragaret; Ratner, Adam J; Steenhoff, Andrew P; Malefho, Kolaatamo C.S
    This cross‐sectional study at a tertiary‐care hospital in Botswana from 2000 to 2007 was performed to determine the epidemiologic characteristics of Staphylococcus aureus bacteremia. We identified a high prevalence (11.2% of bacteremia cases) of methicillin‐resistant S. aureus (MRSA) bacteremia. MRSA isolates had higher proportions of resistance to commonly used antimicrobials than did methicillin‐susceptible isolates, emphasizing the need to revise empiric prescribing practices in Botswana.
  • Publication
    Subtype Distribution of Human Papillomavirus in HIV-Infected Women With Cervical Intraepithelial Neoplasia Stages 2 and 3 in Botswana
    (2011-11-01) Ramogola-Masire, Doreen; McGrath, Cindy M; Barnhart, Kurt T; Friedman, Harvey M; Zetola, Nicola M
    Human papillomavirus (HPV) vaccines containing types 16 and 18 are likely to be effective in preventing cervical cancer associated with these HPV types. No information currently exists in Botswana concerning the HPV types causing precancerous or cancerous lesions. Our goal was to determine the prevalence of HPV types associated with precancerous cervical intraepithelial neoplasia (CIN) stages 2 and 3 in HIV-infected women in Gaborone, Botswana. HIV-infected women referred to our clinic with high-grade intraepithelial lesion on the Pap smear were enrolled in the study. HPV typing was only performed if the histopathology results showed CIN stage 2 or 3 disease using linear array genotyping (CE-IVD, Roche Diagnostics).One hundred HIV-infected women were identified with CIN stages 2 or 3 between August 11, 2009 and September 29, 2010. Eighty-two of 100 women enrolled had coinfection by multiple HPV subtypes (range, 2 to 12). Of the remaining 18 women, 14 were infected with a single high-risk subtype and 4 had no HPV detected. Overall, 92 (92%) women were infected with at least 1 high-risk HPV subtype, and 56 were coinfected with more than 1 high-risk HPV type (range, 2 to 5). Fifty-one (51%) women had HPV subtypes 16, 18, or both. HPV 16 and 18 are the most common types in HIV-infected women with CIN 2 or 3 in Gaborone, Botswana, suggesting that the implementation of HPV vaccination programs could have a significant impact on the reduction of cervical cancer incidence. However, given the relative lack of knowledge on the natural history of cervical cancer in HIV-infected women and the significant prevalence of infection and coinfection with other high-risk HPV types in our sample, the true impact and cost-effectiveness of such vaccination programs need to be evaluated.
  • Publication
    Building Research Capacity in Botswana: A Randomized Trial Comparing Training Methodologies in the Botswana Ethics Training Initiative
    (2013-02-01) Kasimatis-Singleton, Megan; Barchi, Francis Harper; Kasule, Mary; Merz, Jon F; Khulumani, Pilate
    Background Little empirical data are available on the extent to which capacity-building programs in research ethics prepare trainees to apply ethical reasoning skills to the design, conduct, or review of research. A randomized controlled trial was conducted in Botswana in 2010 to assess the effectiveness of a case-based intervention using email to augment in-person seminars. Methods University faculty and current and prospective IRB/REC members took part in a semester-long training program in research ethics. Participants attended two 2-day seminars and were assigned at random to one of two on-line arms of the trial. Participants in both arms completed on-line international modules from the Collaborative Institutional Training Initiative. Between seminars, intervention-arm participants were also emailed a weekly case to analyze in response to set questions; responses and individualized faculty feedback were exchanged via email. Tests assessing ethics knowledge were administered at the start of each seminar. The post-test included an additional section in which participants were asked to identify the ethical issues highlighted in five case studies from a list of multiple-choice responses. Results were analyzed using regression and ANOVA. Results Of the 71 participants (36 control, 35 intervention) enrolled at the first seminar, 41 (57.7%) attended the second seminar (19 control, 22 intervention). In the intervention arm, 19 (54.3%) participants fully completed and 8 (22.9%) partially completed all six weekly cases. The mean score was higher on the post-test (30.3/40) than on the pre-test (28.0/40), and individual post- and pre-test scores were highly correlated (r = 0.65, p < 0.0001). Group assignment alone did not have an effect on test scores (p > 0.84), but intervention-arm subjects who completed all assigned cases answered an average of 3.2 more questions correctly on the post-test than others, controlling for pre-test scores (p = 0.003). Conclusions Completion of the case-based intervention improved respondents' test scores, with those who completed all six email cases scoring roughly 10% better than those who failed to complete this task and those in the control arm. There was only suggestive evidence that intensive case work improved ethical issue identification, although there was limited ability to assess this outcome due to a high drop-out rate.
  • Publication
    Cryptococcus and Lymphocytic Meningitis in Botswana
    (2008-08-06) Bisson, Gregory P; Lukes, John; MacGregor, Rob Roy; Mtoni, Isaac
    We retrospectively reviewed microbiology data from a tertiary care hospital in Botswana and found that Cryptococcus neoformans was cultured from 15% (193/1307) of all cerebrospinal (CSF) fluid specimens submitted for analysis, making it the most common diagnosed cause of meningitis in this population. Moreover, almost 70% of CSF samples with significant lymphocytosis did not yield a pathogen, suggesting that many causes of lymphocytic meningitis are going undiagnosed.
  • Publication
    Staphylococcus aureus Skin and Soft Tissue Infections at a Tertiary Hospital in Botswana
    (2011-05-25) Truong, Hong; Shah, Samir S; Ludmir, Johnathan; Tawanana, Ephraim O; Bafana, Margaret; Wood, Sarah M; Moffat, Howard; Steenhoff, Andrew P
    Objectives. To study the epidemiology of Staphylococcus aureus skin and soft-tissue infections (SSTIs) in hospitalised children and adults in Gaborone, Botswana, and to describe the changes in antimicrobial susceptibilities of S. aureus isolates over time. Methods. A retrospective cohort study evaluated SSTI isolates from January 2000 to December 2007 at Princess Marina Hospital (PMH), a large tertiary referral centre in Gaborone. Eligible subjects were those hospitalised at PMH during the study period who had a skin or soft-tissue culture yielding a bacterial or fungal pathogen. The primary outcome measure was a skin or soft-tissue culture yielding S. aureus. Secondary outcomes were the organism’s antimicrobial susceptibilities. Results. S. aureus was detected in 857 (35.8%) of single-organism SSTI cultures, and 194 (22.6%) of these isolates were methicillin resistant (MRSA). The proportion of MRSA isolates increased over time (linear test of trend: p=0.03 from 2000 to 2003), and MRSA isolates were more likely than methicillin-susceptible isolates to be resistant to commonly used antimicrobials recommended by the national SSTI treatment guideline. Conclusions. We report a high and increasing proportion of MRSA SSTIs in Gaborone. This high rate of MRSA resistance to currently recommended empiric antibiotics for SSTIs dictates the need for revising national guidelines and ongoing prospective surveillance of SSTIs in this setting.