17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

SIX YEARS OF HAART IN THE PUBLIC SECTOR OF BOTSWANA

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0204

J.P.A. Puvimanasinghe ¹, N. Ndwapi¹, T. Gaolathe², G. Musuka³, L. Manthe³, T. Moeti³, R. Marlink⁴, K. Seipone^1
1Ministry of Health, HIV/AIDS Prevention and Care, Gaborone, Botswana, ²Botswana Harvard Partnership, Gaborone, Botswana, ³African Comprehensive HIV/AIDS Partnership (ACHAP), Gaborone, Botswana, ⁴Harvard School of Public Health, HIV/AIDS Initiative, Boston, United States

ISSUES: Botswana has a high prevalence of HIV with 32.4% of pregnant females infected with the virus. According to national estimates, about 113,000 HIV-positive patients require treatment with highly-active antiretroviral therapy (HAART).

DESCRIPTION: Botswana established a national treatment program and began providing free treatment to its patients in January 2002. Since then, treatment facilities were rolled out in a phased manner and presently 32 hospitals and 128 satellite clinics offer screening and treatment services. As of December 2007, a total of 92,932 patients were on HAART in Botswana, including 8,336 patients who were out-sourced from the public sector to the private sector and a further 9,514 private sector patients. Of the 75,082 patients on HAART in the public sector of the country, 61% were females. Children ≤ 12 years and adults >50 years accounted for 8% and 10% of the total. A total of 8,402 patients died while on HAART since the start of the program. Nearly 50% of these deaths occurred during the first three-months after treatment initiation. 35% of adults had a CD4 count of <100 cells/ml at HAART initiation. The overall 6-year survival rate of patients was 86% with a better survival for females. Males who initiated treatment with a CD4 count <100 had the worst survival.

LESSONS LEARNED: Unwavering political commitment translated into resources and collaboration of development partners enabled the successful implementation of the program. The roll-out of treatment facilities to districts, training and authorization of nurses to dispense treatment to stable patients and social mobilization enabled high enrolment despite resource constraints. Early initiation of HAART improved treatment success.

NEXT STEPS: Botswana needs to ensure the sustainability of the treatment program including its integration in to the national response and health system. ART services should be further decentralized and collaboration with the private sector and civil society further strengthened.

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2008-08-13
MOAB0204

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