Perceptions and attitudes towards acceptability of HIV self-testing among female sex workers in Selibe Phikwe, Botswana.

Background: Sub-Saharan Africa accounts for 71% of the global burden of HIV infection. For the general population of Botswana, the estimated HIV prevalence is 18.5%; for female sex workers it is 61.9%. This study explored and documented female sex workers' perceptions and attitudes towards the acceptability of HIV self-testing in Selibe Phikwe, north-eastern Botswana. Methods: Purposive convenience sampling and snowballing approaches were used to recruit 17 participants into the study which was carried out in collaboration with a community-based organisation, the Silence Kills Support Group. Two focus group discussions and five in-depth interviews were conducted. Information was collected on female sex workers' awareness of HIV self-testing, their willingness to use it, their preferred distribution model, and their preferred test kit. Themes and subthemes that emerged were interpreted based on the Integrated Behavioural Model. Results: HIV self-testing (HIVST) was not known to most participants. Participants expressed negative attitude towards HIVST due to a lack of knowledge and confidence to carry out self-testing independently. Participants preferred facility-based services and a blood test over HIVST. Inadequate post-test counselling and lack of assisted HIVST were among their major concerns. Raising community awareness of HIVST through education was suggested. Conclusion: Improving the uptake of HIVST will require community sensitization, the availability of counselling services, close follow-ups, and the introduction of assisted HIVST approaches.

Comparison on treatment outcomes of patients enrolled on anti-retroviral therapy at different levels of the health-care system in a high HIV/AIDS setting.

HIV/AIDS prevalence in Botswana is amongst the highest in the world and remains a significant public health problem. however, the introduction of anti-retroviral therapy (ART) lead to a significant reduction in morbidity and mortality. Decentralization of anti-retroviral therapy has improved access to treatment for people living with HIV. Treatment outcomes for patient initiated on treatment at different levels of care is unknown and this study seeks to compare treatment outcomes of patients enrolled on ART at different levels of the health care. This is a retrospective cross-sectional study that included review of data from January 2017 to December 2018. The study was conducted in 2 health districts in the country. Nine hundred and sixty (960) patient's record were included in analysis. More than half (63%) of patients were enrolled at primary care level while 37% were at tertiary level. Sixty one percent (n = 587) were female while 39% (n = 373) were males. There were no statistically significant differences in viral load suppression after 12 months of treatment between patients enrolled at tertiary level and primary care level, x2 = 0.75, p value = 0.56. Time to initiation was longer at tertiary (median = 126) compared to primary are level (median = 18), p < 0.001. We reccommend further decentralization of ART services to lower levels of the health care system to initiate PLWHIV early on treatment and improve their health outcomes and reduce transmission through treatment by prevention.

Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project.

INTRODUCTION: Achieving widespread knowledge of HIV-positive status is a crucial step to reaching universal ART coverage, population level viral suppression, and ultimately epidemic control. We implemented a multi-modality HIV testing approach to identify 90% or greater of HIV-positive persons in the Botswana Combination Prevention Project (BCPP) intervention communities. METHODS: BCPP is a cluster-randomized trial designed to evaluate the impact of combination prevention interventions on HIV incidence in 30 communities in Botswana. Community case finding and HIV testing that included home and targeted mobile testing were implemented in the 15 intervention communities. We described processes for identifying HIV-positive persons, uptake of HIV testing by age, gender and venue, characteristics of persons newly diagnosed through BCPP, and coverage of knowledge of status reached at the end of study. RESULTS: Of the 61,655 eligible adults assessed in home or mobile settings, 13,328 HIV-positive individuals, or 93% of the estimated 14,270 positive people in the communities were identified through BCPP. Knowledge of status increased by 25% over the course of the study with the greatest increases seen among men (37%) as compared to women (19%) and among youth aged 16-24 (77%) as compared to older age groups (21%). Although more men were tested through mobile than through home-based testing, higher rates of newly diagnosed HIV-positive men were found through home than mobile testing. CONCLUSIONS: Even when HIV testing coverage is high, additional gains can be made using a multi-modality HIV testing strategy to reach different sub-populations who are being missed by non-targeted program activities. Men and youth can be reached and will engage in community testing when services are brought to places they access routinely.