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Gaborone, Botswana

Tafuma T.A.,Ministry of Health | Merrigan M.B.,Family Health International 360 | Okui L.A.,Botswana Harvard Partnership | Lebelonyane R.,Ministry of Health | And 6 more authors.
Sexually Transmitted Diseases | Year: 2014

BACKGROUND: Men who have sex with men (MSM) suffer significant stigma and discrimination; hence, they are reluctant to access health services. The Botswana Second National Strategic Framework for 2010-2016 stipulates the need to increase HIV prevention services for key populations as one of its prevention implementation strategies. We report here the prevalence of HIV and other sexually transmitted infections and risk factors for HIV infection among MSM in Botswana. METHODS: We conducted a cross-sectional survey using respondent driven sampling in 3 districts of Botswana: Gaborone, Francistown, and Kasane. RESULTS: Of the 454 participants recruited, most were Batswana (97.6%) with a mean age of 23.2 years (range, 18-53 years), with 74.9% aged between 20 and 29 years. The overall unadjusted HIV prevalence was 13.1% (95% confidence interval, 10.0-16.3), with 12.3%, 11.7%, and 25.9% in Gaborone, Francistown, and Kasane, respectively. Chlamydia trachomatis prevalence was higher than Neisseria gonorrhoeae in both urine and anal swabs, at 7.1% and 5.9%, respectively, versus 1.4% and 1.7%. Overall, 46.7% of respondents reported having sex with female partners. Men who have sex with men who thought they had a high chance of acquiring HIV had a significantly lower likelihood of using condom consistently than those who reported they had a lower chance of acquiring HIV (odds ratio = 0.4; 95% confidence interval, 0.2-0.7; P = 0.003). CONCLUSION: HIV prevalence of MSM was lower than what has been reported in other sub-Saharan African countries with generalized epidemics; however, their degree of participation in heterosexual sex signifies sexual networks beyond the MSM subpopulation. Copyright © 2014 American Sexually Transmitted Diseases Association All rights reserved.

Ludmir J.,University of Maryland, Baltimore | Mazhani L.,University of Botswana | Cary M.S.,University of Pennsylvania | Chakalisa U.A.,Botswana Harvard Partnership | And 6 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2016

Additional strategies are needed to prevent and treat tuberculosis (TB). Although vitamin D may have antimycobacterial effects, it is unknown whether low vitamin D status confers a risk for active TB in African children. This case-control study assessed serum 25-hydroxyvitamin D (25(OH)D) concentration in children with and without active TB in Gaborone, Botswana. A total of 80 children under 2 years old with and without active TB, seen at hospitals and clinics in the greater Gaborone area between September 2010 and November 2012, were enrolled. Of these, 39 cases did not differ from the 41 controls in median 25(OH)D levels (P = 0.84). The 25(OH)D was < 20 ng/mL in 8/39 (21%) cases and 7/41 (17%) controls (P = 0.69, χ2). Univariate analyses of subject clinical characteristics (other than 25(OH) D levels) showed that any degree of weight loss was associated with a diagnosis of TB (P = 0.047). Other clinical characteristics, including age (P = 0.08) or weight below third percentile (P = 0.58), showed no association with TB. There was no significant difference in vitamin D status between children under 2 years old with and without active TB. Lower vitamin D status did not appear to be a risk factor for TB in this small Gaborone cohort. Copyright © 2016 by The American Society of Tropical Medicine and Hygiene.

Farahani M.,Harvard University | Vable A.,Harvard University | Lebelonyane R.,Ministry of Health | Seipone K.,Ministry of Health | And 11 more authors.
The Lancet Global Health | Year: 2014

Background: Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub-Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have not been made because of the scarcity of available data. We analysed the effect of the implementation of Botswana's national ART programme, known as Masa, from 2002 to 2010. Methods: The Masa programme started on Jan 21, 2002. Patients who were eligible for ART according to national guidelines had their data collected prospectively through a clinical information system developed by the Botswana Ministry of Health. A dataset of all available electronic records for adults (≥18 years) who had enrolled by April 30, 2010, was extracted and sent to the study team. All data were anonymised before analysis. The primary outcome was mortality. To assess the effect of loss to follow-up, we did a series of sensitivity analyses assuming varying proportions of the population lost to follow-up to be dead. Findings: We analysed the records of 126 263 patients, of whom 102 713 had documented initiation of ART. Median follow-up time was 35 months (IQR 14-56), with a median of eight follow-up visits (4-14). 15 270 patients were deemed lost to follow-up by the end of the study. 63% (78 866) of the study population were women; median age at baseline was 34 years for women (IQR 29-41) and 38 years for men (33-45). 10 230 (8%) deaths were documented during the 9 years of the study. Mortality was highest during the first 3 months after treatment initiation at 12·8 deaths per 100 person-years (95% CI 12·4-13·2), but decreased to 1·16 deaths per 100 person-years (1·12-1·2) in the second year of treatment, and to 0·15 deaths per 100 person-years (0·09-0·25) over the next 7 years of follow-up. In each calendar year after the start of the Masa programme in 2002, average CD4 cell counts at enrolment increased (from 101 cells/μL [IQR 44-156] in 2002, to 191 cells/μL [115-239] in 2010). In each year, the proportion of the total enrolled population who died in that year decreased, from 63% (88 of 140) in 2002, to 0·8% (13 of 1599) in 2010. A sensitivity analysis assuming that 60% of the population lost to follow-up had died gave 3000 additional deaths, increasing overall mortality from 8% to 11-13%. Interpretation: The Botswana national HIV/AIDS treatment programme reduced mortality among adults with HIV to levels much the same as in other low-income or middle-income countries. Funding: The African Comprehensive HIV/AIDS Partnerships. © 2014 Farahani et al.

Schaan M.M.,University of KwaZulu - Natal | Taylor M.,University of KwaZulu - Natal | Gungqisa N.,Botswana Harvard Partnership | Marlink R.,Harvard University
Culture, Health and Sexuality | Year: 2015

The social construction of womanhood in Africa can be said to have two central defining elements: being a wife and being a mother. The interplay between HIV and these elements is not well understood outside of prevention efforts. We conducted a qualitative study of womanhood in Botswana; specifically the sexual and reproductive lives of women living with HIV. Twelve focus-group discussions were held with 61 women, with a median age of 35, taking anti-retroviral therapy. Major themes describing womanhood, before and after HIV diagnosis, were identified using grounded theory strategies. Findings illustrate that womanhood is synonymous with motherhood and that women are expected to have sex in order to please a partner. HIV was said to create a barrier to fulfilling these expectations as it caused anxiety over disclosing one’s HIV status and/or infecting the partner. The sense of pride and dignity that traditionally accompanied pregnancy was said to be lost and a common refrain was concern about passing HIV to an unborn child, having pregnancy complications or advancing HIV infection. Fear, shame and stigma play a large role in these negative perceptions. Interventions to address stigma, societal views of women and the integration of holistic family planning into HIV care are needed. © 2015 Taylor & Francis

Baeten J.M.,University of Washington | Lingappa J.,University of Washington | Beck I.,Seattle Childrens Hospital Research Institute | Frenkel L.M.,University of Washington | And 15 more authors.
Journal of Infectious Diseases | Year: 2011

Recent in vitro studies suggest that acyclovir may directly inhibit HIV-1 replication and can select for a specific HIV-1 reverse transcriptase mutation (V75I) with concomitant loss of an anti-HIV-1 effect. We tested for HIV-1 genotypic resistance at reverse transcriptase codon 75 in plasma from 168 HIV-1-infected persons from Botswana, Kenya, Peru, and the United States taking daily acyclovir or valacyclovir for between 8 weeks and 24 months. No V75I cases were detected (95% confidence interval, 0%-2.2%). These prospective in vivo studies suggest that standard-dose acyclovir or valacyclovir does not select for HIV-1 resistance. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.

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