With findings that 82 percent of people with HIV in a random representative population sample in Botswana had been diagnosed and were aware of their status, 86 percent were on antiretroviral treatment, and that treatment effectively suppressed the virus in 95 percent of those, a presentation in Boston Wednesday showed that the middle-income southern African country is poised to meet ambitious UNAIDS targets considered critical to ending HIV as a global public health threat by 2030. The UNAIDS targets set for 2020 aim for at least 90 percent of all people living with HIV to be diagnosed, at least 90 percent of those to receive antiretroviral therapy, and for treatment to be effective and consistent enough in at least 90 percent of those patients to suppress their viruses.
“These are some of the highest treatment coverage rates found globally,” said Dr.Tendani Gaolathe of the Harvard AIDS Botswana Partnership, presenting the findings. The findings came from an analysis of data from the larger Botswana Combination Prevention Project funded by PEPFAR.
The project recruited and interviewed a random sample of adults aged 16-64 years old in 24 communities to evaluate treatment coverage and impact. The 81 percent of eligible household members who agreed to participate provided blood samples and filled out a survey. Twenty-eight percent of the participants were HIV positive and 83 percent of these individuals were aware of their status. Of those where were HIV-infected, 82 percent were already taking antiretroviral therapy and 96 percent of those on treatment were virally suppressed. Notably, the results were found in the context of national treatment guidelines providing access to free antiretroviral treatment only for individuals with an immune, or CD4 cell count under 350 per cubic millimeter of blood, while the World Health Organization now recommends access to antiretroviral treatment for all people diagnosed with HIV, regardless of immune cell count. Botswana’s policy also limits access to free antiretroviral treatment to citizens.
Younger age was the strongest predictor of being undiagnosed or not on antiretroviral therapy, and being male and single were associated with not being virally suppressed, according to Gaolathe. She also noted that Botswana is one of the first countries to institute a viral load monitoring system and to decentralize its HIV services, and that the country would soon to moving to immediate treatment, or test and treat, for all HIV-infected citizens.