1. Conclusions Background Results Acknowledgements: Methods
Abstract No.: 1017
IMMIGRANTS AND BOTSWANA’S ART PROGRAM: POTENTIAL BARRIERS TO EPIDEMIC CONTROL
Marukutira, T1,7,8, Alwano, MG1, Behel, S2, Jarvis, JN1, Chakalisa, U3, Powis, K4 Bapati, W5, Ussery, G6, Lebelonyane, R7, Bachanas, PJ2
1Centers for Disease Control and Prevention, Gaborone, Botswana; 2Centers for Disease Control and Prevention, Division of Global HIV/AIDS and TB, Atlanta, GA; 3Botswana Harvard Partnership, Gaborone, Botswana 4Harvard School of Public Health, Boston 5Tebelopele Counseling and Testing Center, Gaborone, Botswana; 6Northrop Grumman Corporation, Atlanta, USA; 7Botswana Ministry of Health, Gaborone, 6Burnet Institute, Melbourne, Australia, 8Monash University, Melbourne, Australia
Conclusions
Non-citizens /immigrants have an equally high HIV prevalence compared to citizens.
In contrast to citizens, the vast majority of non-citizens did not know their HIV status, were newly diagnosed by the study, and were not on ART.
Given the high ART coverage rates in the general population in Botswana, lack of free ART coverage for non-citizens may result in a disproportionate contribution to incident HIV infections.
Background
Models suggest that universal HIV testing and immediate antiretroviral therapy (ART) combined with enhanced prevention approaches could achieve epidemic control of HIV in southern Africa.
Botswana may be close to UNAIDS targets according to baseline data from the Botswana Combination Prevention Project (BCPP).
Currently, Botswana’s national HIV treatment program does not provide ART free of charge to non-citizens (immigrants).
Lack of access to free ART services for this population may limit the ability to achieve epidemic control even when targets for Botswana citizens have been achieved.
Results
In the 15 Combination Prevention communities, 48,640 persons were assessed for HIV status (tested or showed documentation of status).
Three percent of participants (1,528/48,640) self-reported being non-citizens.
Fifty-nine percent (901/1,528) of non-citizens were men, 41% (627/1,528) were women
Of the men, 19% (171/901) were ages and 81% (730/901) were 25-64
Of the women, 28% (177/627) were ages and 72% (450/627) were 25-64
Non-cit/migrants
Citizens
Number assessed for HIV status
1,528 (3%)
47,112 (97%)
Males
 901 (59%)
21,163 (45%)
Females
627 (41%)
25,949 (55%)
HIV positives
305 (20%)
10,146 (22%)
133 (15%)
3,287 (16%)  
172 (27%)
6,859 (26%) 
Aware of HIV status (Known positive)
113 (37%)
8,548 (84%)
Unaware of HIV status (Newly diagnosed)
192 (63%)
1,598 (16%)*
On ART
87/305 (29%)
7,189/10,146 (71%)
Twenty percent of non-citizens (305/1,528) were HIV-positive, which is similar to the prevalence rate among citizens (22%; 10,146/47,112)
63% (192/305) of HIV+ non-citizens were not aware of their HIV status and newly identified by the study compared to 16% (1,598/10,146) of the citizens (χ2=465, p<0.001)
Among male non-citizens aged 16-24, 7% (12/171) were HIV+ and 17% (121/730) were HIV+ among males
Among female non-citizens aged 16-24, 12% (21/177) were HIV+ and 34% (151/450) were HIV+ among females
Of the HIV+ non-citizens who were aware of their HIV status 77% (87/113) were on ART compared to 84% (7,189/8,548) of citizens
Of ALL the HIV-positive non-citizens identified, only 29% (87/305) were on ART as compared to 71% (7,189/10,146) of citizens or spouses of citizens assessed.
Although only 3% of the overall population, non-citizens accounted for 11% (192/1790) of HIV+ community residents who were unaware of their HIV status.
Methods
The BCPP is a cluster randomized trial designed to evaluate the impact of a combination prevention package on population level HIV incidence in 30 rural or peri-urban communities in Botswana.
HIV testing campaigns were conducted in the 15 intervention communities covering 80% of the households in each community from October 2013-February 2016 and included home-based and mobile testing.
Interviews and HIV testing were offered to all persons >16 years, including non-citizens/immigrants.
HIV-positive participants not on ART, including non-citizens/immigrants were referred to the local HIV clinic and offered support with linking to care.
Acknowledgements:
Centers for Disease Control and Prevention – Botswana
Centers for Disease Control and Prevention - Atlanta
Botswana Ministry of Health
Tebelopele Voluntary Counseling and Testing Center
Harvard Chan School of Public Health
Botswana-Harvard Partnership
Study Participants
Division of Global HIV/AIDS and TB