The partnership between CDC and the Government of Botswana began in 1995, with the goal of strengthening tuberculosis (TB) prevention and control. It has since flourished to include HIV prevention, care, and treatment, with a focus on strategic program development to maximize the quality, coverage, and impact of Botswana’s national response to the HIV epidemic. Over the past 10 years, CDC’s global HIV/AIDS focus has transitioned from an emergency response approach to one of sustainability and shared responsibility. The Botswana program is moving towards a technical assistance model, while continuing to invest in evidence-based, high-impact interventions.
Optimizing the combination prevention approach (antiretroviral therapy, prevention of mother-to-child transmission, condoms, and voluntary medical male circumcision) to HIV prevention is one of PEPFAR’s core activities to maximize epidemic impact. In 2013, CDC launched a four-year study called the Botswana Combination Prevention Project (BCPP) in partnership with the Ministry of Health and the Harvard School of Public Health. The overall goal of the study is to evaluate whether coordinated and strengthened HIV biomedical interventions will significantly reduce new HIV infections at the community level and whether this reduction will be cost-effective.
Building on the success of Botswana’s prevention of mother-to-child transmission program, another focus area is providing technical and direct assistance to the newly adopted Option B+ program to prevent infant infections, save mothers’ lives, and reduce the number of orphans in Botswana. CDC also provides assistance to improve epidemiology, surveillance, laboratory operations, research, and workforce capacity.
Key Activities and Accomplishments
Prevention of mother-to-child transmission coverage in Botswana has reached 97.5 percent.
Botswana is one of only a few countries where the HIV epidemic has passed the “tipping point” – the point where for every one new person on treatment, there is less than one person newly infected.
Nearly half of all 15-49 year-olds have been tested for HIV within the last 12 months and know their status (Botswana AIDS Indicator Survey, 2013).
Between April 2013 and April 2014, Botswana’s Safe Male Circumcision program recorded 46,315 circumcisions, about 90% of its annual target and 10,000 more than the previous year.
Antiretroviral therapy uptake among dually infected HIV/TB patients has increased from under 15% in 2006 to 64% in 2012.
Botswana Combination Prevention Project (BCPP)
The 2013 launch of a joint U.S.-Botswana combination prevention trial underscores the global value of our bilateral HIV/AIDS partnership with Botswana. Through BCPP, CDC, the Botswana Ministry of Health, and the Harvard University School of Public Health (through the Botswana-Harvard Partnership) will determine whether providing communities with a package of coordinated HIV biomedical interventions will significantly reduce new HIV infections at the community level and whether this reduction will be cost-effective.
Voluntary Medical Male Circumcision (VMMC)
Between April 2013 and February 2014, Botwana’s VMMC program recorded 42,679 circumcisions, about 85% of its annual target and 10,000 more than the previous year. These significant improvements can be attributed to improved operational efficiencies, increased outreach, and increased demand for PrePex, a new male circumcision device being piloted in Botswana. CDC supports the national VMMC program through technical assistance, service delivery, demand creation, and commodity supply.
For stories about CDC’s work in Botswana, read Tsogang (April 2014), a public health magazine published by CDC-Botswana.