DTBE in Botswana
Capital City: Gaborone
Area*: 582,000 sq. km. (224,710 sq. mi.)
Population (est.), 2011*: 2.06 million
Estimated TB Incidence, 2010**: 503/100,000
Estimated TB Prevalence, 2010**: 380/100,000
Adult HIV Prevalence Rate, 2009***: 24.8%
Number of people living with HIV (PLHIV), 2009***: 320,000
Percent of tested TB patients who were HIV-positive, 2010**: 65%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
Botswana has the second highest HIV prevalence rate in the world, and one of the highest tuberculosis (TB) prevalence rates. In Botswana, 65% of people with TB also have HIV/AIDS. In 1995, the Botswana Ministry of Health, Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination (CDC/DTBE,) and the U.S. Agency for International Development (USAID) established the BOTUSA Project. The BOTUSA Project is a collaborative effort between the U.S. Government (USG) and the Government of Botswana to strengthen TB control through technical support, capacity building, and public health research. Through the years this collaboration evolved to focus primarily on stopping the spread of TB and HIV/AIDS in Botswana. BOTUSA promotes evidence-based best practices, assesses and validates innovative approaches, and supports monitoring and evaluation of prevention, care, and treatment programs for HIV/AIDS and TB.
Recent Accomplishments & Ongoing Collaborations
BOTUSA and its member agencies have completed many successful collaborations over the past 16 years, including infection control assessments, trainings on TB control techniques, technical assistance to complete drug resistance surveys (DRS), updating national surveillance systems, supporting the adoption of surveillance system platforms across southern Africa, and assessing screening and diagnostic algorithms in primary health centers. Select current and ongoing collaborations are detailed below.
Program Strengthening & Epidemiology
RIFAQUIN Trial: BOTUSA is implementing a multi-country clinical trial, coordinated by St. George’s Hospital and the Medical Research Council of the United Kingdom in Botswana, to determine the efficacy of high dose rifapentine coupled with moxifloxacin for the treatment of drug-sensitive TB. The regimens under this study would be shorter and simpler to administer than the current standard regimen. The goal of the trial is to determine if these regimens are similar in efficacy to the current regimens.
TB Transmission Dynamics: By pairing classic epidemiologic techniques with cutting-edge molecular epidemiology BOTUSA is leading a studyto detect differences in TB transmission between high and low HIV prevalence communities. The study also tests the hypothesis that TB is a health facility transmitted disease in high HIV prevalence zones. This study is a multi-year collaboration between the Government of Botswana, University of Pennsylvania, University of KwaZulu Natal (South Africa), and CDC.
Multidrug-resistant (MDR) TB, TB/HIV, and Other At-Risk Populations
Isoniazid Preventive Therapy Trial (IPTT): CDC Botswana and BOTUSA’s work over the past several years yielded a research breakthrough that has informed international guidance on the prevention of HIV-associated TB.From 2004 through 2009, BOTUSA led a study to determine the optimal length of isoniazid treatment in preventing TB disease among people living with HIV, and to determine if certain groups received greater benefit than others. The main findings were that isoniazid preventive therapy (IPT) was highly effective in reducing TB in people with a positive tuberculin skin test (TST) and that 36 months of IPT for this group was much more effective than 6 months in this group (with reduction in incident TB greater than 90%). Antiretroviral therapy alone reduced TB incidence by half. The Botswana Government used these results to design a new IPT Program and inform new World Health Organization (WHO) guidelines regarding the use of TST and IPT in high HIV prevalence settings.