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Botswana achieved the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets: results from the Fifth Botswana HIV/AIDS Impact Survey (BAIS V), 2021

Title
Botswana achieved the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets: results from the Fifth Botswana HIV/AIDS Impact Survey (BAIS V), 2021
Presenter
Madisa Mine
Authors
M. Mine * (1), K. Stafford (2), R.L. Laws (3), R. Marima (4), P. Lekone (5), D. Ramaabya (1), K. Makhaola (5), P. Mapondera (4), F. Wray-Gordon (3), C. Agbakwuru (2), L. Okui (4), E. Onyadile (6), J. Ngidi (1), A. Abimiku (2), K. Bagapi (5), B. Nkomo (1), S. Bodika (3), S.Y. Hong (5), S. Matroos (6), M. Charurat (2), R. Selato (7), A.C. Voetsch (3), BAIS V group
Institutions
(1) Ministry of Health and Wellness, Gaborone, Botswana, (2) Ciheb, School of Medicine, University of Maryland Baltimore, Baltimore, United States, (3) Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, United States, (4) Ciheb, MGIC-Botswana an affiliate of University of Maryland Baltimore, Gaborone, Botswana, (5) Division of Global HIV and TB, Centers for Disease Control and Prevention, Gaborone, Botswana, (6) Statistics Botswana, Gaborone, Botswana, (7) National AIDS and Health Promotion Agency, Gaborone, Botswana

BACKGROUND: In 2002, Botswana was the first African country to offer free HIV treatment to citizens. Since then, Botswana has expanded treatment coverage and adopted evidence-based practices, including test-and-start and dolutegravir treatment. The BAIS V survey was used to measure national progress toward UNAIDS 95-95-95 targets (percent of persons living with HIV (PLHIV) aware of status, on treatment, virally suppressed).
METHODS: BAIS V used a two-stage cluster design to obtain a nationally representative sample of adults 15'64 years. During March'August 2021, survey teams consented 14,763 participants in their households, administered questionnaires, and tested blood specimens for HIV. Viral load and presence of antiretrovirals (ARVs) in blood were measured. The first and second 95 estimates were based on self-report and adjusted for detectable ARVs. Viral load suppression (VLS) was defined as HIV RNA <1,000 copies per milliliter. Data were weighted to account for complex survey design, and jackknife methods were used to estimate variance.
RESULTS: National HIV prevalence was 20.8% (men: 15.2%; women: 26.2%). Among PLHIV, 95.1% (men: 93.0%; women: 96.4%) were aware of their status, 98.0% (men: 97.2%; women: 98.4%) of those aware were on ART, and 97.9% (men: 96.6%; women: 98.6%) of those on ART achieved VLS (Table). Among PLHIV 15'24 years, 84.5% were aware of their status, 98.5% of those aware were on ART, and 91.6% of those on ART achieved VLS. VLS among all PLHIV was 91.8% (men: 88.1%; women: 94.0%).


Aware of Status
N; Weighted % (95% CI)
On Treatment
N; Weighted % (95% CI)
Virally Suppressed
N; Weighted % (95% CI)
Men, 15'64 years98993.0 (90.8'95.2)
92097.2 (95.7'98.8)
89996.6 (95.2'98.0)
15'24 years3989.1 (77.3'100.0)
34*100.0 (100.0'100.0
3491.8 (83.9'99.8)
25'44 years36088.7 (85.0'92.5)
31594.2 (90.4'98.0)
30294.9 (91.5'98.4)
45'64 years59096.4 (93.6'99.2)
57199.2 (98.4'100.0)
56398.0 (97.2'98.8)
Women, 15'64 years
2,42896.4 (95.0'97.7)
2,34298.4 (97.5'99.2)
2,30998.6 (98.0'99.2)
15'24 years11882.3 (70.1'94.5)
9997.8 (94.4'100.0)
9691.5 (84.2'98.8)
25'44 years1,30297.1 (95.9'98.2)
1,25698.4 (97.7'99.1)
1,23598.8 (98.2'99.4)
45'64 years1,00897.0 (95.0'99.0)
98798.3 (96.3'100.0)
97899.1 (97.9'100.0)
Total, 15'64 years
3,41795.1 (93.8'96.5)
3,26298.0 (97.2'98.7)
3,20897.9 (97.2'98.6)

CONCLUSIONS: BAIS V is the first population-based survey to confirm achievement of UNAIDS 95-95-95 goals, overall and among women. Men have achieved the second and third 95 targets and surpassed 90% for the first. Gaps remain in awareness among men 25'44 years and younger adults, particularly young women. Botswana has made tremendous progress in 20 years and is well-positioned to end the AIDS epidemic by 2030.

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