CDC in Botswana
Botswana at a Glance
- Population: 2,033,000
- Per capita income: $12,840
- Life expectancy at birth women/men: 52/54 yrs
- Infant mortality rate: 36/1000 live births
The Centers for Disease Control and Prevention (CDC) has collaborated with the government of Botswana (GOB) since 1995 to strengthen tuberculosis (TB) control through public health research. In 2001 the partnership expanded to include HIV/AIDS programs. CDC is an implementing agency of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) providing technical assistance and financial support.
Tuberculosis HIV Research
The TB-HIV research program includes clinical trials, epidemiology and surveillance, and integrating HIV and TB programs to improve quality, coverage, and impact of Botswana's TB and HIV national response. The program recently expanded to include treatment improvement, TB diagnosis and management, and TB transmission characteristics.
CDC provides funding, technical advice, and ongoing collaboration with the GOB, including the Ministry of Health (MoH) and other ministries to build local capacity and maximize the quality, coverage, and impact of the HIV/AIDS response described in the following paragraphs:
Safe Male Circumcision (SMC) – SMC is globally identified as a highly effective biomedical intervention to reduce HIV acquisition among men. CDC provides comprehensive support to scale-up and implement SMC services throughout Botswana.
HIV Testing and Counseling (HTC) - HTC is viewed as the gateway to all other HIV services. CDC provides financial and technical assistance to support wide coverage of client-initiated and provider-initiated HTC services.
Impact in Botswana
- Groundbreaking CDC clinical trial of isoniazid prevention therapy (IPT) to prevent TB found:
- --risk of TB disease in persons with positive TB skin test decreased 30-60% with 6 mos treatment
- --36 mos was more effective than 6 to prevent TB disease
- --Botswana used results to design new IPT program and to form WHO guidelines for using TB skin tests and IPT in high HIV areas
- More than 90% of HIV-infected pregnant Botswana women received antiretroviral prophylaxis
- Mother-to-child HIV transmission was reduced to less than 4%
- Botswana achieved over 95% coverage for antiretroviral therapy in eligible HIV-infected persons
Blood Safety - A safe and adequate blood supply is crucial to reducing mortality and maintaining health. CDC provides support and technical assistance to the National Blood Transfusion Service to screen all units of blood and to recruit non-HIV infected donors.
Injection Safety - CDC works with the GOB establishing best practice protocols reducing medical transmission of HIV among health workers and improves access to post-exposure prophylaxis in cases of occupational exposure to HIV.
Care and Treatment
The HIV care and treatment program is a great success story for Botswana with 96% of eligible persons receiving treatment. Botswana recently adopted WHO 2010 treatment guidelines which make an estimated 25,000 additional people eligible for treatment. CDC provides guidance and technical assistance, including support for provider training and the procurement of essential supplies. HIV care and support activities link persons living with HIV/AIDS to appropriate services while working with a variety of HIV clinical programs with various focuses, such as safe motherhood, palliative care ( to relieve and prevent the suffering of patients), and treatment of HIV-related illness (e.g. cervical cancer, meningitis).
Tuberculosis and HIV - In Botswana, TB causes the most deaths in persons with HIV/AIDS, and about 67% of persons with TB are co-infected with HIV. CDC works with GOB to improve impact and implement international recommendations.
Orphans and Vulnerable Children – CDC supports essential services to families and children affected by HIV.
Prevention of Mother-to-Child Transmission - Widely cited as an HIV prevention success story, Botswana has lowered the transmission rate to less than 4% with CDC assistance through testing, antiretroviral treatment, laboratory capacity, early infant diagnosis, and infant feeding.
Monitoring and Evaluation (M&E) - CDC supports the development of a national M&E framework, conducts analysis of national and PEPFAR program data, and provides technical assistance and training to strengthen national and district M&E capacity.
Surveillance and Research - CDC supports national surveillance capacity including the Botswana AIDS Impact Survey, Botswana Youth Risk Behavioral Survey, and Sentinel Antenatal Clinic Surveys, and research capacity through the coordination of public health evaluations in specific program areas.
Health Information Systems (HIS) - CDC supports the development of a national HIS strategy, a national HIS coordinating body, electronic capture of HIV program data, integration of health-related data, and the use of technology to improve health service delivery and efficiency.
Health Systems Strengthening
Service Delivery - CDC builds capacity in the MoH through support for developing and implementing quality management systems, processing improvement initiatives, and accrediting laboratories and health facilities. Working with the GOB, CDC improves national and local laboratory HIV-related capacity for essential services.
Human Resources for Health (HRH) – CDC provides support for human resource management, HRH information systems, retention strategies, pre-service and in-service training of health workers, and capacity building of the two professional regulatory councils for health care workers.
HIV Prevention Research
In addition to PEPFAR funded programs, CDC collaborated on a study of the safety and efficacy of taking antiretroviral medication to prevent HIV infection. This clinical trial showed that a combination of antiretroviral medications reduced HIV spread among heterosexual adults in Botswana by nearly 70%.
Top 10 Causes of Death in BotswanaSource: Rearranged data from the Botswana Central Statistics Office, Health Statistics Report 2007. ICD10 coding used.
- HIV Diseases 30%
- Influenza and Pneumonia 7%
- Heart Disease (Hypertensive 47%) 7%
- Viral – not HIV 5%
- Neonatal deaths 5%
- Diarrhea-thought infectious 5%
- Malignant Neoplasms 4%
- Tuberculosism 4%
- External Causes 3%
- Cerebrovascular Disease 3%
CDC office (physical presence)
105 Locally Employed