Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Botswana, with a relatively small population of 1.6-1.7 million, is in the unenviable situation of having the highest adult prevalence of HIV in the world (estimated 38.5% of the 15-49 age group). The Government of Botswana (GOB) therefore decided to provide anti-retroviral drugs (ARV Therapy) to all eligible citizens through the public health system to avoid human and economic losses of a devastating and unacceptable magnitude.

Using eligibility criteria of a CD4 count of ≤200 and/or presence of an AIDS defining illness, 110,000 people require ARV Therapy. Besides approx. 4,500 patients receiving treatment in the private sector, capacity (personnel, infrastructure, systems) was inadequate to serve this demand. The GOB therefore decided to prioritise 4 initial patient groups and implement a staggered launch of 4 strategically located treatment facilities with a capacity build-up target of 19,000 for the first year. This would require expanding existing capacity by 8%- 2500% (depending on specific resource considered) and fulfilment of the following key work streams:

• Establishing policies, procedures and guidelines to support the national provision of ARV Therapy
  
• Procurement storage and distribution of drugs
  
• Recruitment, retention and training of staff
  
• Implementing public information, education and communication campaign
  
• Implementing national patient, pharmacy and laboratory management IT system
  
• Establishing nationwide laboratory and testing infrastructure
  
• Procuring and upgrading space for treatment, counselling, pharmacy, personnel and storage
  
• Cross-sectoral coordination, mobilization and alignment of key stakeholder group activities and management of interfaces
  
• Monitoring and evaluating program activities, outcomes and impact
  

The provision of ARV therapy began in January 2002 and as of September 2000 the following results have been achieved:

To date, loss to follow-up is less than 3%.

Key lessons from early experience in Botswana:

• Strong political will of leadership, public-private partnerships and early cross-sectoral mobilization is critical for success
  
• Although finance is a critical hurdle, capacity building at all levels (including managerial) is the most formidable challenge
  
• Human resources represent the most critical bottleneck and training is the rate determining step for future scale-up
  
• Hands-on, onsite, preceptor training is most cost effective and efficacious in human resource limited settings
  
• A electronic patient, laboratory sample and pharmacy management IT system should be implemented early (even if very rudimentary)
  
• Vast majority of patients presenting very late (average CD4 count of 50) and when symptomatic resulting in high revisit rates which exacerbate staffing shortages
  
• There is a strong need to develop even leaner, cheaper, innovative and more cost effective models of HIV/AIDS care if program is to be sustainable
  

Presenting author:

Download Conferences Abstracts

1 African Comprehensive HIV/AIDS Partnerships, Garborone, Botswana.

2002-11-17
PL4-3

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