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96 Pp Naca Book for Web 2003 Ministry of State President THE NATIONAL AIDS COORDINATING AGENCY (NACA) BOTSWANA 2003 SECOND GENERATION HIV/AIDS SURVEILLANCE A Technical Report December 2003 For further details contact National AIDS Coordinating Agency (NACA) Private Bag 00463 Gaborone Botswana Tel: (+267) 390 31 88 Fax: (+267) 390 32 73 www.naca.gov.bw Photos front cover: O. Mangole - NHARSOC 2003 Design and lay-out: Op design (PTY) LTD Botswana 2003 Second Generation HIV Surveillance Report THE NATIONAL AIDS COORDINATING AGENCY (NACA) BOTSWANA 2003 SECOND GENERATION HIV/AIDS SURVEILLANCE A Technical Report November 2003 www.naca.gov.bw Edited by: Dr. Kereng Masupu (NACA) Dr. Khumo Seipone (AIDS/STD unit) Dr. Thierry Roels (BOTUSA/CDC) Dr. Soyeon Kim (BHP) Mrs. Mpho Mmelesi (NACA) Prof. Ekanem Ekanem (UNDP Consultant) Mrs. Sarah Gaolekwe (NBTS) National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report FOREWORD otswana is often cited as a success economic and Sentinel surveillance has been quite useful over years in good governance story in Africa. Pivotal to this providing information on the magnitude of the problem in success has been health, in which Botswana had the country. There is also a need to closely evaluate the notably reduced its infant and under-five mortal- extent of the scourge and the impact of the national ity and increased its life expectancy in the 90’s. response through special population-based survey. BHowever there has been a threat to these achievements due to the scourge of HIV/AIDS that has reversed notable The nation’s vision 2016 is halting the epidemic; reversing achievements made in the nation’s quality of life. trend in incidence of HIV infection and improving the qual- ity of life of the people. We are facing a situation where every Motswana is either infected or affected; having lost a relative, friend, workmate “Batswana, letsema le thata ka mong wa lona!” or an acquaintance to the pandemic. For Botswana, factors that drive the epidemic are multiple, intertwined and com- Ntwa e bolotse! plex and these have social-cultural and economic antecedents. In realizing the complexity and magnitude of the disease, Government has shown an unprecedented high level of political and economic commitment to its control by declaring war against it, and adopting a multi-sectoral approach. Coupled with this was a call to the international community to assist and this has resulted in tremendous response in the form of funding and technical support. Festus G. Mogae President of the Republic of Botswana Locally, the private sector, civil societies including people liv- (Chairman, National AIDS Council) ing with HIV/AIDS (PLWA) organizations, have risen to the November, 2003 occasion to form a partnership with government in fighting the epidemic. The national response has resulted in setting up prevention programs such as behavior change and com- munication, Voluntary Counseling and Testing, STI Control and prevention of mother to child transmission (PMTCT). Care and support programs have been scaled up to include public provision of Highly Active Antiretroviral Therapy (HAART) and Community Home Based Care Programs. Impact mitigation and reduction in stigma have been addressed at all levels by providing funding for income generating activities, support for orphans and vulnerable children, and greater involvement of PLWA in the national response. i National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report ii National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report PREFACE in 2002, which currently has enrolled 9228 patients out of IV/AIDS is spreading relentlessly worldwide the estimated 110 000 living with AIDS. The success of the with 40 million people infected and over 70 ARV and PMTCT programs are further expected to result in percent of those in sub-Saharan Africa. The increased life expectancy currently estimated at 56 years death toll continues to rise. In many devel- and infant mortality rate at 57 per 1000 years. oping countries HIV/AIDS has become one Hof the leading causes of mortality. Since there is no cure for AIDS at the moment and no vac- cines against the virus are currently available, the impact of Botswana is not spared, with its prevalence among preg- HIV/AIDS will only be reduced through behavior change nant women aged 15-49 in 2003 reaching 37.4%. The combined with the provision of ART to those already affect- prevalence in 2002 was 35.4% and 36.2% in 2001 sug- ed as well as VCT for those with uncertain sero-status. For gesting that the epidemic curve may have reached its Botswana, this is a bigger challenge because PMTCT data plateau state. For Botswana, there is a glimpse of hope that and VCT data reveal low testing rate due to reluctance of the number of new infections may not be increasing dra- the population to access these services. The adoption of matically as in the early phases of the epidemic. This asser- positive attitude to testing is the key to prevention and tion is based on the observation that HIV prevalence in the treatment, hence the reduction of the impact of the epi- 15-19 years old pregnant women has remained fairly stable demic. over the last four years. A disturbing trend however is emerging where rural prevalence is on the increase while urban prevalence is stabilizing. This might be a reflection of the disparity of intervention programmes nationwide and therefore efforts need to be re-enforced to bridge the gap Hon MP, L Motsumi and therefore reverse the trend. Minister of Health Vice Chairperson, National AIDS Council The high prevalence is coupled with an increased number of AIDS, TB and Genital Herpes cases and other AIDS-relat- ed illnesses. The result has been a huge burden in a limited resource health care system, with increased bed occupancy rates to over 100% in most medical wards and increased average length of stay to over 14 days for medical patients over the years. However, this trend is expected to reverse with the introduction of anti retroviral treatment provision iii National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report iv National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report ACKNOWLEDGMENTS Finally I would like to extend my sincere gratitude to all the he National AIDS Coordinating Agency in col- staff of National AIDS Coordinating Agency, the Ministry of laboration with the Ministry of Health, Health, Ministry of Local government, CSO staff and the AIDS/STD Unit, Ministry of Local Government, Data Management Team for the commitment and dedica- Central Statistics Office and all the district tion they have placed in making this document a success. teams would like to pass their sincere gratitude Tto all those who contributed in making the 2003 Second Generation HIV surveillance a success. Our sincere gratitude goes to all district health teams, made A. B. Khan, MD, MPH up of the public health specialists, nurses and laboratory National Coordinator scientists. All these personnel have shown their undivided National AIDS Coordinating Agency (NACA) commitment in making this survey a success despite their day-to-day workload. We would like to thank all those who participated in the data management consensus meetings, which were held in Kasane, Maun and Gaborone for contributions they made towards the compilation of this report. Mention must be made to the notable contributions made by NASTAD and CDC Regional Office in Harare. We are indebted to valuable contributions made by Mr. Peter Carr and Dr Dennis Nash (NASTAD) and Dr A. D. McNaghten (CDC) especially in pro- viding technical support in the area of data management. This report would not have been successful without the technical contribution of institutions such as WHO, BOTUSA/CDC, Botswana Harvard AIDS Institute, NASTAD and other stakeholders. v National AIDS Coordinating Agency (NACA) in collaboration with AIDS/STD Unit, the BOTUSA Project (CDC), District Health Teams, the Botswana Harvard Partnership and WHO Botswana 2003 Second Generation HIV Surveillance Report CONTENTS Foreword i Preface iii Acknowledgements v List of Figures viii List of Tables ix List of Abbreviations x Executive Summary 1 1. Introduction 3 2. Survey Objectives 4 3. Methodology 5 3.1. HIV sentinel survey 5 3.1.1 Sentinel population 5 3.1.2 Sentinel sites 5 3.1.3 Sample size 5 3.1.4 Sampling scheme 5 3.1.5 Duration of survey 6 3.1.6 Training 6 3.1.7 Support visits 6 3.1.8 Specimen handling 7 3.1.9 Laboratory 7 3.1.10. Data management 7 3.1.10.1 Data compilation, data entry and data cleaning: 7 3.1.10.2 Data analysis: 8 3.1.11 Assumptions in estimations 9 3.1.12 Limitations 10 3.2.
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