Botswana has been a leader in galvanizing an effective regional and global response tothe epidemic. Despite being one of the countries hardest hit by HIV/AIDS, Botswana was one ofthe first countries in Africa to provide free universal public antiretroviral therapy (ART) foreligible citizens. Through proactive policies and programs around HIV/AIDS, Botswana hasmade major gains and has laid the foundation for continued progress against the epidemic.Evaluation of strategic information is necessary to inform the construction, implementation,scale up, and improvement of sustainable programs upon that foundation, while making the best iuse of a set of constrained resources. As the national response matures, new priorities haveemerged for Botswana's National ART Program, known as Masa, the Setswana word for 'newdawn.' These priorities include improving patient outcomes and ensuring the long-termfinancial sustainability of the program, while maintaining adequate health system performanceand patient satisfaction. The proposed study directly addresses these priorities through acomprehensive, mixed methods, and sub-national evaluation which makes use of a rich,longitudinal national registry of Masa patient data, in combination with additional survey data.The proposed study will be conducted by a consortium between the University of BotswanaSchool of Medicine (UB SOM), the Harvard School of Public Health (HSPH) and the BotswanaMinistry of Health (MOH).i Sanders D, Haines A. (2006). Implementation research is needed to achieve international healthgoals. PLoS Med, 3(6): e186.
This study will assess the impact and performance of the Botswana National antiretroviral therapy (ART) Program, known as Masa, a large and critically important national public health program. The Masa program has achieved universal coverage of ART by providing care to more than 80% of individuals who qualify for treatment, servicing over 150 thousand patients. This research will allow the Botswana Ministry of Health to strategically target further scale-up and program improvement efforts based on a rigorous evaluation of the performance of district health services and ART sites with a view to ultimately improve ART patient health outcomes across the country.