Abstract and Introduction
Abstract
Background: Botswana was the first African country to introduce routine HIV testing (RHT).
Objective: To report program data for the first 2.5 years of RHT.
Methods: RHT was introduced in 2004. Rapid HIV tests were introduced later the same year and are widely available. The main criteria for RHT are symptoms of HIV/AIDS, pregnancy, sexually transmitted infection, and attendance for medical examination. Testing may also be self-initiated.
Findings: There has been a rapid scale-up of RHT. A total of 60,846 persons were tested through RHT in 2004 versus 157,894 in 2005 and 88,218 in the first half of 2006. Testing rates in the population through RHT were 40 per 1000 persons, 93 per 1000 persons, and 104 per 1000 persons, respectively. In 2005, 89% of those offered testing accepted, with 69% of those tested being female and 31% male. The proportion of men who tested HIV-positive was 34% versus 30% for women. The main reasons for testing in 2005 were patient's wish (50%), pregnancy (25%), medical examination (7%), clinical suspicion (6%), and sexually transmitted infection (2%). Attendance at voluntary counseling and testing centers has increased parallel to the scale-up of RHT.
Conclusions: RHT has been widely accepted by the population, and no adverse effects or instances have been reported. It has provided increased access to preventive services and earlier assessment for antiretroviral treatment. We believe the benefits of RHT clearly outweigh the risks.
Introduction
Since the late 1990s, Botswana (population of 1.7 million) has had one of the highest HIV prevalences in the world. The rate in pregnant women peaked in 2003, with an adjusted prevalence rate of 37.4%. The 2005 sentinel surveillance study showed an adjusted prevalence rate of 33.4%, indicating a possible decrease, although interpretation of prevalence figures may be confounded by the widespread availability of highly active antiretroviral therapy (HAART) in the public sector since 2002, which has substantially reduced the mortality of HIV/AIDS.
A nationwide prevention of mother-to-child transmission of HIV (PMTCT) program was launched in 1999 and provided in all districts by 2001. Antiretroviral treatment (ART) was offered in selected health facilities in 2002 and has been rolled out nationwide thereafter. By the end of June 2006, more than 70,000 Batswana were on ART. It is estimated that up to 110,000 might be eligible for treatment, provided that everybody is tested for HIV.