New HIV infections in Botswana could be reduced substantially by offering entire communities voluntary HIV testing, and immediately referring those who test positive for HIV treatment, results from Ya Tsie study have revealed. The encouraging results of the Ya Tsie or Botswana Combination Prevention Project study conducted from 2013 to 2018 were published in the New England Journal of Medicine on the 18 July 2019.
The study found that voluntary HIV testing, and immediately referring those who test positive for HIV treatment in line with local guidelines decreased new HIV infections in Botswana by at least 30 percent within the intervention communities. The community-randomised study involving about 180,000 people sought to discover the effectiveness of the ‘universal test and treat’ and safe male circumcision strategies in reducing new HIV infections. It was led by researchers from the Botswana Harvard AIDS Institute Partnership (BHP), Harvard T.H. Chan School of Public Health, The Centers for Disease Control (CDC) in Botswana and Atlanta, and the Ministry of Health and Wellness in Botswana.
In 2017, around 344 000 people were living with HIV in Botswana. Hailed as a model state in the battle against HIV/AIDS, the country still records an estimated 10 000 new infections every year. Furthermore, the national HIV/AIDS prevalence rate is at 17.6 percent and 25 percent for adults, which makes it the second highest in the world.
Steep reductions in incidence are therefore needed to curb the HIV/AIDS epidemic, in the country and the southern Africa region where the prevalence is higher than anywhere else in the world. Out of the 30 communities involved in the study, 15 were randomised to an HIV prevention package while the other 15 communities received the local standard of care for HIV management. The intervention group received door-to-door voluntary counselling and HIV testing, linkage to care for those who tested positive and the opportunity to immediately begin treatment for the virus, and a suite of proven HIV prevention measures for those who tested negative.
The standard group also received the same services except treatment was provided according to national guidelines. By the end of the study period, investigators found that in the intervention group, the proportion of persons living with HIV, suppressed viral load increased from 70 percent to 88 percent while those in the standard care group increased from 75 percent to 83 per cent. The population level of viral suppression in the intervention group is among the highest to be reported globally. Incidence of HIV infection in the intervention group was 30 percent lower than incidence in the standard care group.
Among the package of methods tried during the intervention however, male circumcision uptake was relatively low and was hence likely the least significant, according to the researchers. The successful HIV testing campaigns, in homes and mobile venues, along with support for linkage to care both contributed to the very high ART initiation and viral suppression achieved. According to the researchers, this in turn likely led to the nearly one-third reduction in the rate of new HIV infections in the intervention communities.
“Using approaches that are feasible in most settings, we achieved levels of HIV diagnosis, treatment, and viral suppression that are among the highest levels reported globally,” said the Principal Investigator and CEO of the Botswana Harvard AIDS Institute Partnership, Dr Joseph Moeketsi Makhema. “These high rates of treatment coverage are a testimony to the long standing commitment that Botswana has shown to tackling HIV. We also believe that our approaches and findings are highly relevant for other countries,” he said.
According to Dr Makhema, the study has provided aspiration that sustained over time, counselling, testing and effective early antiretroviral therapy will help in achieving the UNAIDS target of 90 percent reduction in the rate of new HIV infections by 2030 globally.