Seventh International Congress on Drug Therapy in HIV Infection Glasgow, UK - 14-17 November 2004

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL4.5

Segolame Lekoko Ramotlhwa
Ministry of Health, Garabone, Botswana

The National Anti-retroviral Therapy (ART) Program in Botswana is called Masa. Masa is a Setswana (local language) word for new dawn and the program was given this name in 2001 as a reflection of new hope for people living with HIV/AIDS (PLWA'S).

The Masa ART Program was launched in August 2001 following a Consultancy by Mckinsey and Co.; a management consultant company which was engaged to: i) establish/project the demand for Highly Active Anti-retroviral Therapy (HAART) in Botswana at the time ii) determine the necessary resources/supply to service the projected demand and iii) determine the necessary logistics, policies and administrative structure that would be required in order to provide/run such a program.

The Mckinsey Consultancy projected that about 110,000 patients were in need of HAART out of the estimated 300,000 HIV positive people in the country. The projected number (110,000) of eligible patients was derived from using the thenprevalence of HIV in the country together with some degree of modeling/re-modeling plus the treatment eligibility criteria of either or both of (i) CD4 cell count of 200 or less, (ii) presence of an AIDS Defining Illness and (iii) HIV Positive Children. It is important to appreciate that at the time of the consultancy, far more than 90% of the projected individuals did not know their HIV status.

Given the projected number of patients in need of HAART, it became quite clear that the country did not have the required capacity to service the projected demand if all eligible patients were to present to health facilities immediately. The limited capacity was with respect to several identified work streams including human resources (recruitment and training), infrastructure (consultation space, counseling space, secure drug storage and dispensing space, etc.), laboratory equipment and testing, information technology (IT) as a basis for monitoring and evaluation (M & E), information education and communication (IEC), limited NGO/civil society capacity and, relevant policies and or administrative structure for implementation. In view of the identified deficiencies, a deliberate decision was taken by Government of Botswana to introduce the Masa National ART Program in a phased manner so that capacity could be gradually built as the program evolved; for the first year the program was only launched in four (4) sites, namely, Gaborone, Francistown, Serowe and Maun as per Government decision.

The program has not yet been rolled out to the rest of the country but the number of ARV Sites and patients on the program have been increasing over the years. As of 30 August, there were twenty-one (21) operating sites providing HAART under the Masa National ART Program to more than 21,000 patients. In addition to this, there are at least 7,000 patients on HAART in the private sector. So far our national program has done well despite having started well in the middle of a mature epidemic where initially the average CD4 cell count at time of initiation of HAART was 50 to 60 (currently about 85). We have an average mortality of patients already started HAART of less than 10%, adherence of >85% (with zero tolerance of any deviation), patient follow-up >90%, 86% of patients are rendered viral load negative (i.e. VL<400) at six (6) months. These achievements could not have been realized without the leadership and commitment of Botswana Government at the highest level, relevant project management model, commitment of people on the ground, and the support from our development partners.

Botswana's Achievements were accompanied by a lot of challenges related to stigma (at times more of fear) and the work streams already elaborated in this document especially human resource management, infrastructure, project coordination and management, the need to continuously negotiate with pharmaceutical suppliers in order for the country to benefit from the lowest prices offered by suppliers for both drugs and laboratory reagents.

SESSION 4: RESOURCE-POOR SETTINGS [IAS SESSION]

2004-11-14
PL4.5

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