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ACHAP Symposium - International AIDS Conference Washington DC, USA 23 rd July 2012

Partners in Innovation – Informing Botswana’s HIV/AIDS Response: Successes and Lessons Learned by the ACHAP Public Private Development Partnership (PPP). ACHAP Symposium - International AIDS Conference Washington DC, USA 23 rd July 2012. Presented by: Themba L Moeti. Presentation outline.

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ACHAP Symposium - International AIDS Conference Washington DC, USA 23 rd July 2012

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  1. Partners in Innovation – Informing Botswana’s HIV/AIDS Response: Successes and Lessons Learned by the ACHAP Public Private Development Partnership (PPP) ACHAP Symposium - International AIDS Conference Washington DC, USA 23rd July 2012 Presented by: Themba L Moeti

  2. Presentation outline • Some key facts about Botswana • ACHAP ; The Partnership • Achievements, lessons learnt

  3. Some key facts about Botswana • Population – 2,038,228 (2011 Census) • Life expectancy – 54.4 years (67 years before HIV/AIDS) • Persons living below the Poverty Datum line 20.7% in 2009/10; previously 30.3% in 2002/3 (CSO, 2011). • 25% population aged 15-49 years HIV+ (BAIS III 2008). • 30.4% pregnant women aged 15-49 years HIV Positive. • National HIV prevalence 17.6% (BAIS III 2008). • 2011 HIV+ Population – 363,105 (Stover 2008).

  4. African Comprehensive HIV/AIDS Partnerships (ACHAP) • Public-private development partnership: Govt of Botswana, Bill & Melinda Gates Foundation and Merck/The Merck Company Foundation. Established 2001 • Country priorities inform strategic direction • Private sector resources leverage government efforts: greater impact, fill capacity or /resource gaps • ACHAP financial, technical, human resources, infrastructure, and logistical support • Catalyze interventions, innovative solutions to program challenges • Equal partnership: Govt strategy & policy guidance, in kind contribution • Consultative approach, agreed governance structure; mutually agreed priorities

  5. A strategic Partnership: – Key HIV Challenges 2001 • 36.2% of pregnant women aged 15–49 HIV+. • No public sector treatment programme • Access to less than 5% in need • AIDS leading mortality cause: 4 fold increase over 10 yrs in adults • Predicted decrease in economic growth; 24–38% by 2021 (BIDPA 2000) • Profound impact on deaths among young people: access to treatment an urgent priority; major gap in response • major questions on operational feasibility, affordability, sustainability • external development assistance greatly reduced with middle income status • Public private partnership important opportunity for national HIV/AIDS response and helping sustain development gains

  6. ACHIEVEMENTS: Impact of Treatment Program 2002 - 2011 By end 2011; • Total of 178,684 patients on treatment (95% needing ART) • Treatment available in every district; • 32 main ART sites • 212 satellite dispensing clinics • Mortality – halved in 5 years; > 53,000 deaths averted 2002 – 2007* • High treatment adherence > 90% • Decentralisation of lab diagnostic and monitoring capacity: • High treatment coverage contributing to reduction in HIV transmission (052) MOH Program data and NACA 2008* : HIV/AIDS in Botswana: Estimated Trends and Implications Based on Surveillance and Modeling

  7. ARV Programme capacity development and health systems strengthening Training – (Partnership: ACHAP, BHP, MOH) • Preceptorship & KITSO AIDS Training Program • > 8000 health workers and >1600 lay personnel: private and public sector • Training; now mainly by locally based personnel Infrastructure: 35 Infectious disease care clinics Human resource support > 250 HCW in various disciplines: doctors, nurses, lab, pharmacy, counsellors • Treatment rolled out to 32 hospitals, catalysed roll out to > 200 primary care facilities, all districts • > 75% of positions supported absorbed into govt establishment Charles Hill Satellite Clinic 2008

  8. Prevention Benefits of Improving Access to HIV Testing and Counseling Estimate (%) of HIV+ women receiving ART for PMTCT • Prior 2004, slow treatment & PMTCT uptake • Issues; stigma, counselling capacity, • Routine HIV testing policy discussion 2003, introduction Jan 2004. • Positive advocacy for policy, test kit provision, (govt and NGOs) data management support, early infant diagnosis • Training & support lay counsellors for PMTCT Source: Botswana HIV Prevention Modes of Transmission Analysis: NACA 2010 • MTCT rate reduced from > 30% to less than 4%

  9. Catalytic support for Blood Safety & Youth HIV Prevention • High HIV prevalence - challenges meeting blood requirement. • Support provided to national blood service 2003 – 2007 to improve safety of blood supply. • Unique youth HIV prevention programme “Pledge 25” to 2009. • Collaboration with Safe Blood for Africa & MOH • Blood donations increased 78% • Discard rate due to TTI and HIV infection reduced from 11.8% 2003 to 2.5% 2010

  10. TB/HIV Co-Epidemics Trends in Botswana (1997-2008)

  11. Support for Broader National HIV Response • Development of the National Strategic Frameworks (2003-2009, and 2010 - 2016) (NSF) • HR support to address critical shortage of skilled staff; • Prevention Support: • HIV testing and counseling capacity development & support • Support to NGOs working in prevention: HR, logistics, programming and infrastructure support • Safe Male Circumcision • TB/HIV • BCC capacity dev; MOH, NACA, BCC strategic plan support; • Research, Monitoring and Evaluation Support

  12. Scaling up effective prevention interventions: Safe Male circumcision • Policy discussion & advocacy 2007 • Decision to implement 2008 • 2008: Collaboration with Futures Institute on “Cost and impact of Male circumcision in Botswana” • Modelling predicted circumcising 80% of eligible men by 2012 could avert 70,000 new infections by 2025 at a cost of US$689 per HIV infection avert • could avert 60,000 new infections with target year of 2015 • Programme launched April 2009 • Support ACHAP, CDC/PEPFAR & implementing partners • Approx 42 000 SMC’s to date *Bolinger et al; The cost and impact of male circumcision on HIV/AIDS in Botswana JIAS 2009

  13. Lessons Learnt • SMC: a programme with great promise; challenging to implement • demand creation, complex interplay socio-cultural challenges and opportunities • Scale up in sparsely populated setting • Each setting unique: challenges & solutions • Key lessons learnt past two years • On threshold of testing of promising SMC devices e.g. PrePex • Treatment: major success of country response and partnership • Saved a generation; averted impending development disaster • Development significance appreciated – macro level to “man in the street” • Important prevention investment • Sustainability challenges • Looking forward; innovating to optimise access: Point of Care CD4, Viral load testing, linkage to care and prevention programmes

  14. Thank you for your attention • Acknowledgements: • Government of Botswana • Other Development Partners • In-country NGO implementing partners • Bill & Melinda Gates Foundation • Merck/The Merck Company Foundation

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