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Despite model ART program, advanced HIV persists in Botswana
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Although Botswana has a widely available national ART program, advanced HIV disease remains a significant burden because the program is failing to link people to care, according to researchers.
Botswana was the first country in Africa to establish a national ART program, which is close to achieving “90-90-90” goals set by Joint United Nations Program on HIV and AIDS (UNAIDS), the researchers said. However, they found a significantly higher incidence of cryptococcal meningitis (CM) among people living with HIV compared with that of the general population.
“Our findings suggest a key population of individuals, often men, are developing advanced disease and associated opportunistic infections due to a failure to effectively engage in care, highlighting the need for differentiated care models,” Mark W. Tenforde, MD, of the University of Washington, division of allergy and infectious diseases, and colleagues wrote in Clinical Infectious Diseases.
The researchers gathered data on CM cases recorded between 2000 and 2014 from facilities registered under the Botswana National Health Laboratory, as well as data on the prevalence of HIV in the general population.
They found 5,296 cases of CM in 4,702 individuals. Altogether, 4,248 patients (90.3%) had experienced only one case of the infection. The median patient age at the time of diagnosis was 36 years, and 60.6% of patients were men.
In the general population, the rate of CM infection in 2013 and 2014 was 17.8 cases per 100,000 person-years. Among those with HIV, it was 96.8 cases per 100,000 person-years.
The rate was 135.4 cases per 100,000 person-years among men with HIV, compared with 66.3 cases per 100,000 person-years among women with the virus.
The incidence of CM in patients with HIV in Botswana was similar to that in pre-ART South Africa, which was 95 cases per 100,000 person-years. The researchers added that, according to the last Botswana AIDS Indicator Survey, about 30% of the country’s population aged 10 to 64 years had not been tested for HIV in 2013, and the ART program needed to reach an additional 100,000 people as of 2015.
The researchers suggested adjusting the program to fit the needs of specific populations in a country in which an estimated 25% of adults are living with HIV.
“To avoid leaving vulnerable individuals behind, differentiated care models should be considered to streamline care for populations with well-controlled disease and focus more intensive resources on those with higher need who are now driving the epidemic,” they wrote. – by Joe Green
Disclosure: Tenforde reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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