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. 2020 Jan 15;15(1):e0226422.
doi: 10.1371/journal.pone.0226422. eCollection 2020.

Modelling the impact of migrants on the success of the HIV care and treatment program in Botswana

Tafireyi Marukutira  1   2 , Nick Scott  1 , Sherrie L Kelly  1 , Charles Birungi  3   4 , Joseph M Makhema  5 , Suzanne Crowe  1   2 , Mark Stoove  1   2 , Margaret Hellard  1   2
Affiliations

Modelling the impact of migrants on the success of the HIV care and treatment program in Botswana

Tafireyi Marukutira et al. PLoS One. .

Abstract

Introduction: Botswana offers publicly financed HIV treatment to citizens, but not migrants, who comprised about 7% of the population in 2016. However, HIV incidence is not declining in proportion to Botswana's HIV response. In 2018, Botswana had 86% of citizens living with HIV diagnosed, 95% of people diagnosed on treatment, and 95% viral suppression among those on treatment. We hypothesised that continued exclusion of migrants is hampering reduction of HIV incidence in Botswana. Hence, we modelled the impact of including migrants in Botswana's HIV response on achieving 90-90-90 and 95-95-95 Fast-Track targets by 2020 and 2030, respectively.

Methods: The Optima HIV model, with demographic, epidemiological, and behavioural inputs, was applied to citizens of and migrants to Botswana. Projections of new HIV infections and HIV-related deaths were compared for three scenarios to the end of 2030: (1) continued status quo for HIV testing and treatment coverage, and maintenance of levels of linkage to care, loss to follow-up, and viral suppression among citizens and migrants (baseline); (2) with scaled-up budget, optimised to achieve 90-90-90 and 95-95-95 Fast-Track targets by 2020 and 2030, respectively, for citizens only; and (3) scaled-up optimised budget to achieve these targets for both citizens and migrants.

Results: A baseline of 172,000 new HIV infections and 8,400 HIV-related deaths was projected over 2020-2030. Scaling up to achieve targets among citizens only averted an estimated 48,000 infections and 1,700 deaths. Achieving targets for both citizens and migrants averted 16,000 (34%) more infections and 442 (26%) more deaths. Scaling up for both populations reduced numbers of new HIV infections and deaths by 44% and 39% respectively compared with 2010 levels. Treating migrants when scaling up in both populations was estimated to cost USD 74 million over 2020-2030.

Conclusions: Providing HIV services to migrants in Botswana could lead to further reductions in HIV incidence and deaths. However, even with an increased, optimised budget that achieves 95-95-95 targets for both citizens and migrants by 2030, the 90% incidence reduction target for 2020 will be missed. Further efficiencies and innovations will be needed to meet HIV targets in Botswana.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. HIV infections and HIV-related deaths averted.
HIV infections and HIV-related deaths that could be averted if 2030 95-95-95 targets are achieved for citizens only or both citizens and migrants (all) compared to baseline scenario, 2020–30
Fig 2
Fig 2. New HIV infections.
Projected new HIV infections in the total population, citizens, and immigrants per different scenarios: baseline, 95-95-95 in citizens only, and 95-95-95 in all population groups.
Fig 3
Fig 3. HIV-related deaths.
Projected new HIV-related deaths in the total population, citizens, and immigrants per different scenarios: baseline, 95-95-95 in citizens only, and 95-95-95 in all population groups.
Fig 4
Fig 4. Migrants living with HIV and cost of treatment per year.
Annual cost of treating the projected number of immigrants between 2020 and 2030
See this image and copyright information in PMC

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