Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project

Autoři: Mary Grace Alwano aff001;  Pamela Bachanas aff002;  Lisa Block aff003;  Michelle Roland aff001;  Baraedi Sento aff004;  Stephanie Behel aff002;  Refeletswe Lebelonyane aff005;  Kathleen Wirth aff006;  Faith Ussery aff002;  William Bapati aff004;  Catherine Motswere-Chirwa aff001;  William Abrams aff001;  Gene Ussery aff003;  James A. Miller aff003;  Ebi Bile aff001;  Peter Fonjungo aff002;  Agisanag Kgwadu aff004;  Molly Pretorius Holme aff006;  Lisetta Del Castillo aff001;  Tendani Gaolathe aff007;  Kelebemang Leme aff004;  Nokuthula Majingo aff005;  Shahin Lockman aff006;  Joseph Makhema aff007;  Naomi Bock aff002;  Janet Moore aff002
Působiště autorů: U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Gaborone, Botswana aff001;  U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Atlanta, Georgia, United States of America aff002;  Northrop Grumman, Atlanta, Georgia, United States of America aff003;  Tebelopele HIV Counseling and Testing Center, Gaborone, Botswana aff004;  Botswana Ministry of Health and Wellness, Gaborone, Botswana aff005;  Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff006;  Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana aff007;  Brigham and Women’s Hospital, Boston, Massachusetts, United States of America aff008
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225076



Achieving widespread knowledge of HIV-positive status is a crucial step to reaching universal ART coverage, population level viral suppression, and ultimately epidemic control. We implemented a multi-modality HIV testing approach to identify 90% or greater of HIV-positive persons in the Botswana Combination Prevention Project (BCPP) intervention communities.


BCPP is a cluster-randomized trial designed to evaluate the impact of combination prevention interventions on HIV incidence in 30 communities in Botswana. Community case finding and HIV testing that included home and targeted mobile testing were implemented in the 15 intervention communities. We described processes for identifying HIV-positive persons, uptake of HIV testing by age, gender and venue, characteristics of persons newly diagnosed through BCPP, and coverage of knowledge of status reached at the end of study.


Of the 61,655 eligible adults assessed in home or mobile settings, 13,328 HIV-positive individuals, or 93% of the estimated 14,270 positive people in the communities were identified through BCPP. Knowledge of status increased by 25% over the course of the study with the greatest increases seen among men (37%) as compared to women (19%) and among youth aged 16–24 (77%) as compared to older age groups (21%). Although more men were tested through mobile than through home-based testing, higher rates of newly diagnosed HIV-positive men were found through home than mobile testing.


Even when HIV testing coverage is high, additional gains can be made using a multi-modality HIV testing strategy to reach different sub-populations who are being missed by non-targeted program activities. Men and youth can be reached and will engage in community testing when services are brought to places they access routinely.

Klíčová slova:

Community based intervention – HIV diagnosis and management – HIV epidemiology – HIV infections – HIV prevention – Botswana


1. UNAIDS. Global HIV & AIDS statistics—2018 fact sheet. Geneva, Switzerland: UNAIDS; 2018.

2. Petersen M, Balzer L, Kwarisiima D, Sang N, Chamie G, Ayieko J, et al. Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antirotroviral therapy, and viral suppression in East Africa. JAMA. 2017;317(21):2196–2206. doi: 10.1001/jama.2017.5705 28586888

3. Iwuji CC, Orne-Gliemann J, Larmarange J, Balestre E, Thiebaut R, Tanser F, et al. Universal test and treat and the HIV epidemic in rural South Africa: A phase 4, open-label, community cluster randomised trial. Lancet HIV. 2018;5:e116–25. doi: 10.1016/S2352-3018(17)30205-9 29199100

4. Barnabas R, van Rooyen H, Tumwesigye E, Brantley J, Baeten J, van Heerden A, et al. Uptake of antiretroviral therapy and male circumcision after community-based testing and strategies for linkage to care versus standard clinic referral: a multisite, open-label, randomised controlled trial in South Africa and Uganda. Lancet HIV. 2016;3:e212–20. doi: 10.1016/S2352-3018(16)00020-5 27126488

5. Iwuji CC, Orne-Gliemann J, Larmarange L, Okesola N, Tanser F, Thiebaut R. et al. Uptake of home-based HIV testing, linkage to care, and community attitudes about ART in rural KwaZulu-Natal, South Africa: Descriptive results from the first phase of ANRS 12249 TasP cluster-randomised trial. PLoS Med. 2016;13(8):e1002117. doi: 10.1371/journal.pmed.1002117

6. UNAIDS. Ending AIDS: Progress towards the 90-90-90. Geneva, Switzerland: UNAIDS; 2017.

7. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528:S77–85. doi: 10.1038/nature16044 26633769

8. Suthar A, Ford N, Bachanas P, Wong V, Rajan J, Saltzman A, et al. Towards universal voluntary HIV testing and counselling: A systematic review and meta-analysis of community-based approaches. PLOS Medicine. 2013;10(8):e1001496. doi: 10.1371/journal.pmed.1001496 23966838

9. Hensen B, Taoka S, Lewis JJ, Weiss HA, Hargreaves J. Systematic review of strategies to increase men’s HIV-testing in Sub-Saharan Africa. AIDS. 2014;28:2133–45. doi: 10.1097/QAD.0000000000000395 25062091

10. Shanuabe K, Schaap A, Floyd S, Phiri M, Griffith S, Chaila J, et al. What works–reaching universal HIV testing: lessons from the HPTN 071 (PopART) trial in Zambia. AIDS. 2017;31:1555–64. doi: 10.1097/QAD.0000000000001514 28471766

11. Hayes R, Floyd S, Schaap A, Shanuabe K, Bock P, Sabapathy K, et al. A universal testing and treatment intervention to improve HIV control: One-year results from intervention communities in Zambia in the HPTN 071 (PopART) cluster -randomised trial. PLoS Med. 2017;14(5):e1002292. doi: 10.1371/journal.pmed.1002292 28464041

12. Gaolathe T, Wirth KE, Holme MP, Makhema J, Moyo S, Chakalisa U, et al. Botswana’s progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virologic suppression goals: A population-based survey. Lancet HIV. 2016;3(5):e221–30. doi: 10.1016/S2352-3018(16)00037-0 27126489

13. Maman D, Chilima B, Masiku C, Ayouda A, Masson S, Szumilin E, et al. Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study. JIAS. 2016;19:20673.

14. Barnabas R, van Rooyen H, Tumwesigye E, Murnane P, Baeten J, Humphries H, et al. Initiation of antiretroviral therapy and viral suppression after home HIV testing in KwaZulu-Natal, South Africa, and Mbarara district, Uganda. Lancet HIV. 2014;1(2):e68–76. doi: 10.1016/S2352-3018(14)70024-4 25601912

15. van Rooyen H, Barnabas R, Baeten J, Phakathi Z, Joseph P, Krows M, et al. High HIV testing uptake and linkage to care in a novel program of home-based HIV counseling and testing with facilitated referral in KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2013;64(1):e1–8. doi: 10.1097/QAI.0b013e31829b567d 23714740

16. Chamie G, Clark TD, Kabami J, Kadede K, Ssemondo E, Steinfeld R, et al. A hybrid mobile HIV testing approach for population wide HIV testing in rural East Africa: An observational study. Lancet HIV. 2016;3(3):e111–19. doi: 10.1016/S2352-3018(15)00251-9 26939734

17. Chamie G, Kwarisiima D, Clark TD, Kabami J, Jain V, Geng E, et al. Uptake of community HIV testing during a multi-disease health campaign in rural Uganda. PLoS ONE. 2014;9(1):e84317. doi: 10.1371/journal.pone.0084317 24392124

18. Sabapathy K, Van den Bergh R, Fidler S, Hayes R, Ford N. Uptake of home-based voluntary HIV testing in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med. 2012;9(12): e1001351. doi: 10.1371/journal.pmed.1001351 23226107

19. Novitsky V, Bussman H, Okui L, Logan A, Moyo S, van Widenfelt E, et al. Estimated age and gender profile of individuals missed by a home-based HIV testing and counseling campiagn in a Botswana community. J. Int. AIDS Soc. 2015;18:19918. doi: 10.7448/IAS.18.1.19918 26028155

20. Botswana Statistics. Botswana AIDS Impact Survey (BAIS) IV. Gaborone, Botswana: Statistics Botswana; 2013.

21. Makhema J, Wirth K, Pretorius Holme M, Gaolathe T, Mmalane M, Kadima E, et al. Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana. N Eng J Med. 2019 Jul 18;381(3):230–42.

22. Lasry A, Bachanas P, Suraratdecha C, Alwano MG, Behel S, Pals S, et al. Cost of community-based HIV testing activities to reach saturation in Botswana. AIDS Behav. 2019;23(4):875–82. doi: 10.1007/s10461-019-02408-9 30673897

23. UNAIDS. The Gap Report. Geneva, Switzerland: UNAIDS; 2015.

24. WHO. Consolidated Guidelines on HIV Testing Services. Geneva: World Health Organization; 2015.

25. Shanuabe K, Schaap A, Chaila M.J, Floyd S, Mackworth-Young C, Hoddinott G, et al. Community intervention improves knowledge of HIV status of adolescents in Zambia: Findings from HPTN 071 –PoPART for Youth Study. AIDS. 2017;31(suppl.3):S221–32.

26. Karim Q, Baxter C, and Birx D. Prevention of HIV in adolescent girls and young women: Key to an AIDS-Free Generation. J Acquir Immune Defic Syndr. 2017;75:S17–26. doi: 10.1097/QAI.0000000000001316 28398993

27. Choko A, Desmond N, Webb E, Chavula K, Napierala-Mavedzenge S, Gaydos C, et al.The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence settings: A cross-sectional feasibility study in Blantyre, Malawi. PLOS Med. 2011;8(10):e1001102. doi: 10.1371/journal.pmed.1001102 21990966

28. Kadede K, Ruel T, Kabami J, Ssemondo E, Sang N, Kwarisiima D, et al. Increased adolescent HIV testing with a hybrid mobile strategy in Uganda and Kenya. AIDS. 2016;30(14):2121–26. doi: 10.1097/QAD.0000000000001180 27258399

Článek vyšel v časopise


2019 Číslo 11