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Reaching 90-90-90 in Botswana.

M Essex1,2, Joseph Makhema1,2, Shahin Lockman1,2,3

  • 1Harvard T.H. Chan School of Public Health AIDS Initiative, Boston, Massachusetts, USA.

Current Opinion in HIV and AIDS
|August 27, 2019
PubMed
Summary

Botswana

Area of Science:

  • Public Health
  • Epidemiology
  • Infectious Diseases

Background:

  • Botswana has faced a high prevalence of HIV since the mid-1990s.
  • A national HIV/AIDS treatment program utilizing antiretroviral drugs (ARVs) was initiated in 2002.
  • The program expanded nationwide, incorporating an 'opt-out' HIV testing system by 2004.

Purpose of the Study:

  • To analyze Botswana's response to the HIV epidemic.
  • To understand how Botswana became an early achiever of the 90-90-90 targets.

Main Methods:

  • The Ya Tsie or Botswana Combination Prevention Project (BCCP) was a cluster randomized trial involving 100,000 adults.
  • The trial included enhanced testing, linkage to care, and ARV treatment in intervention villages.
  • Baseline and end-of-study surveys assessed HIV prevalence, treatment status, and viral suppression.

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Main Results:

  • A 2013-2015 baseline survey showed 29% HIV prevalence, with combined progress toward 90-90-90 targets at 70.2%.
  • Antiretroviral therapy (ART) regimens evolved, with low levels of drug resistance observed.
  • HIV incidence decreased by approximately 30% during the trial period.

Conclusions:

  • Botswana's comprehensive HIV/AIDS response demonstrates the possibility of achieving 90-90-90 targets even in high-prevalence settings.
  • The country is estimated to be on track to reach 95-95-95 targets.
  • Successful strategies include widespread ARV access and integrated prevention efforts.