Curbing HIV Through Combination Prevention Programs in Botswana
In 2000, Botswana had one of the highest rates of HIV worldwide with an estimated 35% HIV-infected adults. Botwana’s then President Festus Mogae even acknowledged at the AIDS Conference held in Durban, South Africa, the same year that his country was “threatened with extinction” due to the high mortality rate. Fifteen years later, HIV prevalence has decreased to 22.2%. Today, Botswana is an example that achieving the UNAIDS 90-90-90 targets is indeed a possibility, despite the resource challenged setting and high HIV prevalence. Data from the President’s Emergency Plan for AIDS Relief (PEPFAR)-funded Botswana Combination Prevention Project (BCPP) study suggest that among the group of HIV positive patients receiving ART that had their HIV viral load monitored, 96% were confirmed to have a suppressed HIV viral load.
A collaboration among the U.S. CDC-Botswana, the Government of Botswana, the Harvard AIDS Initiative, the Botswana Harvard AIDS Institute Partnership, and PEPFAR partners that include ASM, the BCPP is a four-year study testing the hypothesis that implementing an enhanced combination prevention package that includes ART as prevention for HIV-infected individuals will impact the HIV/AIDS epidemic by significantly reducing the population-level, cumulative HIV incidence in a defined geographic area over the study period and will be cost-effective. Since the BCPP was initiated in 2013, and in support of PEPFAR, ASM has played a critical role in BCPP’s quality diagnostics services through the delivery of quality management system training workshops, where laboratory technicians from BCPP- participating laboratories reviewed best practices and procedures. ASM also supported the U.S. CDC Botswana team’s endeavors to develop and strengthen the cold supply chain and the blood specimen referral system through the procurement and delivery of life saving equipment, supplies, and other essential consumables. These critical elements in training, supply chain, and procurement were utilized by clinics and laboratories from 14 districts across Botswana to assure functionality and reliability of HIV testing results from BCPP’s study.
The BCPP study has demonstrated key components towards eliminating HIV in Botswana include vital partnerships that are focused on technical excellence, commitment from the national government, enhanced quality testing, and cold supply chain development through procurement. Best practices from the study may also serve as excellent examples to other developed and resource challenged nations with high HIV prevalence. Reaching an AIDS-free generation by stemming the epidemic in Botswana may be a reality in years to come.
For this and more HIV/AIDS resources from ASM please visit www.asm.org/HIV.