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Randomized Controlled Trial
. 2022 Sep 1;91(1):9-16.
doi: 10.1097/QAI.0000000000003017.

HIV Incidence in Botswana Rural Communities With High Antiretroviral Treatment Coverage: Results From the Botswana Combination Prevention Project, 2013-2017

Faith Ussery  1 , Pamela Bachanas  1 , Mary Grace Alwano  2 , Refeletswe Lebelonyane  3 , Lisa Block  4 , Kathleen Wirth  5 , Gene Ussery  4 , Baraedi Sento  6 , Tendani Gaolathe  7 , Etienne Kadima  7 , William Abrams  2 , Tebogo Segolodi  2 , Shannon Hader  8 , Shahin Lockman  5   7   9 , Janet Moore  1
Affiliations
Randomized Controlled Trial

HIV Incidence in Botswana Rural Communities With High Antiretroviral Treatment Coverage: Results From the Botswana Combination Prevention Project, 2013-2017

Faith Ussery et al. J Acquir Immune Defic Syndr. .

Abstract

Background and setting: The Botswana Combination Prevention Project demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the Joint United Nations Programme on HIV/AIDS 90-90-90 targets. We report rates and characteristics of incident HIV infections.

Methods: The Botswana Combination Prevention Project was a community-randomized controlled trial conducted in 30 rural/periurban Botswana communities from 2013 to 2017. Home-based and mobile HIV-testing campaigns were conducted in 15 intervention communities, with 39% of participants testing at least twice. We assessed the HIV incidence rate [IR; number of new HIV infections per 100 person-years (py) at risk] among repeat testers and risk factors with a Cox proportional hazards regression model.

Results: During 27,517 py, 195 (women: 79%) of 18,597 became HIV-infected (0.71/100 py). Women had a higher IR (1.01/100 py; 95% confidence interval: 0.99 to 1.02) than men (0.34/100 py; 95% confidence interval: 0.33 to 0.35). The highest IRs were among women aged 16-24 years (1.87/100 py) and men aged 25-34 years (0.56/100 py). The lowest IRs were among those aged 35-64 years (women: 0.41/100 py; men: 0.20/100 py). The hazard of incident infection was the highest among women aged 16-24 years (hazard ratio = 7.05). Sex and age were significantly associated with incidence (both P < 0.0001).

Conclusions: Despite an overall reduction in HIV incidence and approaching the United Nations Programme on HIV/AIDS 95-95-95 targets, high HIV incidence was observed in adolescent girls and young women. These findings highlight the need for additional prevention services (pre-exposure prophylaxis and DREAMS) to achieve epidemic control in this subpopulation and increased efforts with men with undiagnosed HIV.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Summary of HIV Testing in 15 Intervention Communities During the BCPP Study, Botswana, 2013–2017 * Participant knew HIV-positive status and provided documentation of HIV status (e.g., ART pill bottle, clinic card) and chose not to test.
See this image and copyright information in PMC

References

    1. UNAIDS. Joint United Nations Programme on HIV/AIDS. 90-90-90-An ambitious treatment target to help end the AIDS epidemic. March 17, 2021, 2021. 2021. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf
    1. Havlir DV, Balzer LB, Charlebois ED, et al. HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa. N Engl J Med. Jul 18 2019;381(3):219–229. doi:10.1056/NEJMoa1809866 - DOI - PMC - PubMed
    1. Hayes RJ, Donnell D, Floyd S, et al. Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART). N Engl J Med. Jul 18 2019;381(3):207–218. doi:10.1056/NEJMoa1814556 - DOI - PMC - PubMed
    1. Iwuji CC, Orne-Gliemann J, Larmarange J, et al. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial. Lancet HIV. Mar 2018;5(3):e116–e125. doi:10.1016/S2352-3018(17)30205-9 - DOI - PubMed
    1. Makhema J, Wirth KE, Pretorius Holme M, et al. Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana. N Engl J Med. Jul 18 2019;381(3):230–242. doi:10.1056/NEJMoa1812281 - DOI - PMC - PubMed

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