Field: International Studies & Global Health
Title of research project: Feasibility of the Routine HIV Testing Program in Botswana
RESEARCH PROPOSAL
Abstract: In 2004, the government of Botswana introduced a routine HIV testing (RHT) program into all
government-run hospitals and clinics. I will be studying the progress of RHT in several government
health facilities in the capital city of Gaborone, Botswana. Little if any literature is available on the
progress of the RHT program in Botswana since 2008. I will investigate how the RHT program has been
implemented in clinics in Gaborone since 2008, and how its implementation has affected the functioning
of other clinical programs, in both positive and negative ways. The objectives of my research are to
evaluate how clinical staff have implemented the program in the past four years, whether their attitudes
towards the feasibility of RHT have changed now that the program has been in affect for eight years, what
barriers have been found in the process of implementing the RHT program, and how the program has
affected other clinical programs. My research will also reveal whether, after having been in place for
almost eight years, the program has been successful or whether new implementation methods are needed
to make the RHT program feasible in clinics that must also care for patients not participating in the
program. I am also conducting this study in order to gain international experience working in the global
health field in order to receive a Certificate in Global Health from the University of Iowa. This research
will ultimately help me to further pursue my goal of obtaining a law degree specifically focusing on
issues relating to human rights within the field of international health.
Main Research Question: I will ask the following question: What effects, if any, has the administration
of the RHT program had on the effectiveness of other clinical programs (i.e. primary, emergency and
maternal care) in five clinics in Gaborone: Bontleng Clinic, Extension 2 clinic, Block 9 Clinic, Gaborone
West Clinic and Phase 2 Clinic.
Methods: I will be doing a qualitative study structured around questions such as how do doctors divide
their time between patients participating in the RHT and those seeking other types of clinical care? In
addition, I will consider the number of patients that are seen daily, the average waiting room times, and
the budget costs for the RHT program in comparison to budgets of other clinical programs. My interview
subjects will be doctors, nurse practitioners and community health workers who work in the five clinics
listed above. Specifically, I will be interviewing clinical staff that have experience in administering the
RHT program. In addition, speaking to doctors, nurses and community health workers individually will
give me the opportunity to ask questions concerning how the RHT program has affected their ability to
fulfill other clinical duties. I have been assured that all doctors and nurses will speak English because of
the location of the five clinics in an urban capital city.
The number of clinical workers that I could potentially interview depends mainly on the size of each of
the five clinics. My understanding is that most of the clinics have three nurses and one visiting doctor.
Since there are a limited number of doctors in Gaborone, they rotate through clinics. However they do
appear at least once a week in each of the five clinics where I will be conducting my research. The largest
of the five clinics, Extension 2, because of its size and central location in Gaborone, will most likely have
10 nurses and two full time doctors on staff. I will have access to these clinics through a Council on
International Educational Exchange (CIEE) Summer Community Public Health Study Abroad Program.
Information from this sample will provide me with detailed data on how clinical staff have implemented
the RHT program in each of the five clinics, the different implementation and administration practices
that have been employed, and how different modes of implementation have affected the clinical staff’s
ability to successfully care for patients not participating in the RHT program.
In addition to conducting interviews while in the clinics, I will also be observing first hand how the RHT
program functions in the clinics, and how other clinical programs are functioning alongside the RHT
program. I will be observing the manner in which healthcare providers allocate their time in the clinics,
and whether the time used to conduct the routine HIV tests is taking time away from other patients in
need of care. I will conduct this observational portion of my research during times that I am unable to
interview clinical staff individually. My observations will provide me with data regarding, for example,
how long it takes to administer an HIV test, how many clinical staff members are required to care for a
single patient through the program, and which other types of patient care may be short-staffed due to the
presence of the RHT program. This observational data will contribute to answering my research question
because it will provide me with data regarding how the RHT program functions on a daily basis, the
consistency of implementation and the feasibility of the program alongside other patient care programs in
the clinics.
I will not have any direct contact with patients and, since the topic of HIV is very sensitive, all interviews
performed, records reviewed, and data collected through observations will be held anonymous and
confidential. Upon completion, I will perform a descriptive analysis of the qualitative data that I have
collected in order to assess the consequences of the RHT program for non-HIV patient care in the five
clinics in Gaborone.
Detailed Plan of Research in Botswana: I will be in Botswana for seven weeks, from May 27, 2013 to
June 15, 2013, with the CIEE Community Public Health Program. I will be taking classes at the
University of Botswana for five hours each week. I will spend 31 hours a week in the clinics conducting
my research. Although the study abroad program will provide me with access to the clinics, my research
will be completely independent of the CIEE Study Abroad Program. This grant would be used solely to
fund my research study, and would be used for: 1) air travel expenses 2) transportation costs when I go
back to the clinics during the afternoon by myself, and 3) hospital charges in order to interview doctors. I
have consulted qualitative methodologists to insure that my research questions are feasible and the
methods used are in accordance with ethical guidelines and regulations needed to obtain appropriate IRB
approval for my research.
My research project on how the RHT program is affecting other clinical programs in Gaborone will shed
light on the ability of clinical staff to administer and implement the program in a manner that permits
them to continue to care for non-HIV patients. My research also can help in analyzing whether this sort of
HIV prevention and treatment method can be utilized in other African countries with a high HIV/AIDS
prevalence rate. I plan on documenting my research in a report to be completed during the fall of 2013. I
will submit my report to the Global Health Studies Program at the University of Iowa so other individuals
interested in this area of study can review it. My research findings will ultimately contribute to the thesis
that I will complete in order to graduate with a B.A. in International Studies.