title: Sharp increase in rates of HIV transmitted drug resistance at antenatal clinics in Botswana demonstrates the need for routine surveillance.
abstract: OBJECTIVE
  The aim of the study was to evaluate for the presence of drug resistance to HIV medications in treatment-naive individuals in Botswana.
  
  
  METHODS
  Two different populations were evaluated for evidence of HIV drug resistance at three different geographical locations in Botswana. In the first study population, consisting of pregnant females diagnosed with HIV during pregnancy, participants were enrolled at the time of their HIV diagnosis. The second population included pre-ART enrollees at Infectious Diseases Care Clinics (IDCCs) who had a CD4 T cell count >350 cells/μL.
  
  
  RESULTS
  A total of 422 genotypes were determined: 234 for samples from antenatal clinic (ANC) participants and 188 for samples from IDCC participants. Between 2012 and 2014, 6 of 172 (3.5%) genotypes from ANC participants exhibited transmitted drug resistance (TDR), with 3 (1.7%) showing resistance to first-line ART. In a subset of samples from Gaborone, Botswana's capital and largest city, the TDR rate was 3 in 105 (2.9%), but only 1 in 105 (1.0%) showed first-line ART resistance. Between December 2014 and April 2015, the rate of resistance to any ART in Gaborone was 6 in 62 (9.7%), with 5 (8.1%) exhibiting first-line ART resistance.
  
  
  CONCLUSIONS
  These data demonstrate that TDR rates for HIV differ geographically and temporally in Botswana, with significant increases in TDR observed at ANCs in Gaborone between 2012 and 2015. These findings stress the importance of continued testing for TDR, particularly as access to HIV treatment increases and guidelines recommend treatment at the time of HIV diagnosis.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard School of Public Health, Boston, MA, USA crowley1@bidmc.harvard.edu.
authors.forename: C F
authors.initials: CF
authors.lastname: Rowley
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: I J
authors.initials: IJ
authors.lastname: MacLeod
authors.affiliation: Botswana Harvard AIDS Institute, Gaborone, Botswana.
authors.forename: D
authors.initials: D
authors.lastname: Maruapula
authors.affiliation: Botswana Harvard AIDS Institute, Gaborone, Botswana.
authors.forename: B
authors.initials: B
authors.lastname: Lekoko
authors.affiliation: Botswana Harvard AIDS Institute, Gaborone, Botswana.
authors.forename: S
authors.initials: S
authors.lastname: Gaseitsiwe
authors.affiliation: Botswana Ministry of Health, Gaborone, Botswana.
authors.forename: M
authors.initials: M
authors.lastname: Mine
authors.affiliation: Harvard School of Public Health, Boston, MA, USA Botswana Harvard AIDS Institute, Gaborone, Botswana.
authors.forename: M
authors.initials: M
authors.lastname: Essex
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001902:Botswana / Q000453:epidemiology; D024882:Drug Resistance, Viral; D062665:Epidemiological Monitoring; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D055815:Young Adult