HIV prevalence in Botswana is high, despite efforts by government to increase access to testing, treatment, and preventive services.
However, Ya Tsie study also known as Botswana Combination Prevention Project has revealed that Botswana can reach the UNAIDS 90-90-90 target. This could come about if services such as community volunteering HIV testing, ART, suppression of HIV in positive people and positive people do not default on treatment.
In the quest to reduce the swelling occurrence of HIV epidemic in the country, Botswana Harvard AIDS Institute Partnership (BHAIP) in collaboration with various stakeholders introduced the Ya Tsie Botswana Prevention Project. The arrangement was where a pair-matched community-randomised trial evaluated the impact of prevention interventions on HIV incidence in 30 rural and semi-urban communities throughout Botswana, from 2013-2018.
In 2017, about 344, 000 people were living with HIV in Botswana. The country also records an estimated 10, 000 new infections every year. The communities with a total population of approximately 180,000 were matched for HIV prevalence, population size, and Health Care Facilities.
During the trial, 15 communities were randomised to an HIV prevention package while 15 communities received the local standard of care for HIV management.
The intervention package included HIV counselling and testing, with support for accessing care and rapid initiation of treatment for HIV infection in all adult consenting residents aged 16-64.
There was also increased access to male circumcision services lowering the risk of acquiring HIV. The strategy was effective in increasing population viral suppression to very high levels meaning that the virus becomes undetectable and cannot be transmitted while taking effective treatment. The intervention also contributed to approximately one-third reduction in the incidence of HIV infection in participating communities.
“The intervention strategy included community wide, standardised, home-based and mobile HIV testing campaigns, enhancement of routine testing in health facilities and young persons ageing between 15 to 24 years, as well as active linkage to care at local clinics for HIV-positive persons who were not receiving ART. Increased access to male circumcision services was also provided,” it states.
Ya Tsie project affirmed that Expanded Community Counselling with HIV testing, linkage to care, increased Antiretroviral Therapy (ART) coverage and viral suppression decreased new HIV infections in Botswana by at least 30% within the intervention communities
Expanded ART coverage also increased population viral suppression within the intervention communities to among the highest levels reported globally exceeding the UNAIDS 90-90-90 targets and attaining new 95-95-95 targets. These targets are that 95% of HIV infected individuals know their HIV status, 95% of these are started on anti-retroviral therapy and 95% on ART have HIV viral suppression.
According to the report, by the end of the study period, in the intervention group, the proportion of persons living with HIV who had a suppressed viral load increased from 70% to 88%, while those in the standard care group increased from 75% to 83%. The population level of viral suppression in the intervention group is among the highest to be reported globally.
The incidence of HIV infection in the intervention group was 30% lower than incidence in the standard care group. The successful HIV testing campaigns, in homes and mobile venues, along with support for linkage to care both contributed to the very high ART initiation and viral suppression achieved.
The study indicates that universal HIV testing and treatment could contribute substantially toward improving health and reducing the rate of new HIV infections. It provides aspiration that sustained over time, counselling, testing and effective early antiretroviral therapy will help us achieve the UNAIDS target of 90% reduction in the rate of new HIV infections by 2030 globally