Botswana aspires to end its HIV epidemic, one of the most severe in the world, by 2030. To do so, it plans, by 2023, to reach the UNAIDS 95 95 95 treatment targets; 95% of people living with HIV (PLHIV) diagnosed, 95% of diagnosed people in treatment, and 95% of treated people virally suppressed (together termed the Treatment Cascade, TC). Under these treatment targets, UNAIDS elimination goals are to achieve a treatment coverage of 90% and a prevalence of viral suppression (PVS) of 86%. UNAIDS estimates from 2018, however, suggest that Botswana is far from where it wants to be, with treatment coverage at only 67% and a PVS of 65%. This project, a collaboration between US investigators and Botswana's ACHAP (African Comprehensive HIV/AIDS Partnerships) aims to work with the Government of Botswana (GB) to help achieve these targets/goals by conducting a series of analyses centered on a new dataset, the 2020 Botswana AIDS Impact Survey (BAIS V). These analyses will enable us to complete three aims: (1) Quantify the current severity of the HIV epidemic in Botswana: (a) estimating the burden of disease, mapping geographic variation in the severity of the epidemic, and identifying HotSpots and ColdSpots of prevalence and factors that potentially explain their existence, and (b) identifying risk, and protective, factors associated with acquiring infection. (2) Determine how close Botswana is to achieving the 95 95 95 treatment targets: (a) estimating current levels of treatment coverage and the PVS throughout the country and at the level of local healthcare districts (HCDs), and predicting fine-scale geographic variation in coverage and PVS, (b) identifying the level, and geographic location, of failures in the TC throughout Botswana, and (c) identifying individual-level, community-level and structural factors that are associated with, and barriers to, accessing the continuum of care (from diagnosis, to treatment, to achieving viral suppression). (3) Test the hypotheses that high rates of Internal Migration of the General Population (IMGP) and/or geographic inaccessibility of healthcare are major barriers to reaching UNAIDS' treatment coverage goal. We will both quantify (using spatial error regression models) the effects of high rates of IMGP and distance to healthcare (defined in terms of travel-time) on limiting treatment coverage throughout Botswana, and provide the first country-level test that one or both factors are major barriers to HIV elimination. The project will rapidly provide results to the GB, leveraging ACHAP's central role in Botswana's HIV programs to obtain an immediate impact.
This project will evaluate Botswana's progress towards UNAIDS 95 95 95 treatment targets that it aims to achieve by 2023 and end its HIV epidemic, one of the most severe worldwide, by 2030. We will analyze up-to-the minute countrywide data to estimate and map geographical variation in: (1) the severity of the epidemic; (2) Botswana's current level of achievement towards each treatment target. We will also investigate the importance of migration and distance to healthcare as factors impeding Botswana's ability to reach its treatment coverage goals.
