title: Botswana's progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: a population-based survey.
abstract: BACKGROUND
  HIV programmes face challenges achieving high rates of HIV testing and treatment needed to optimise health and to reduce transmission. We used data from the Botswana Combination Prevention Project study survey to assess Botswana's progress toward achieving UNAIDS targets for 2020: 90% of all people living with HIV knowing their status, 90% of these receiving sustained antiretroviral therapy (ART), and 90% of those having virological suppression (90-90-90).
  
  
  METHODS
  A population-based sample of individuals was recruited and interviewed in 30 rural and periurban communities from Oct 30, 2013, to Nov 24, 2015, as part of a large, ongoing community-randomised trial designed to assess the effect of a combination prevention package on HIV incidence. A random sample of about 20% of households in each community was selected. Consenting household residents aged 16-64 years who were Botswana citizens or spouses of citizens responded to a questionnaire and had blood drawn for HIV testing in the absence of documentation of positive HIV status. Viral load testing was done in all HIV-infected participants, irrespective of treatment status. We used modified Poisson generalised estimating equations to obtain prevalence ratios, corresponding Huber robust SEs, and 95% Wald CIs to examine associations between individual sociodemographic factors and a binary outcome indicating achievement of the three individual and combined overall 90-90-90 targets. The study is registered at ClinicalTrials.gov, number NCT01965470.
  
  
  RESULTS
  81% of enumerated eligible household members took part in the survey (10% refused and 9% were absent). Among 12 610 participants surveyed, 3596 (29%) were infected with HIV, and 2995 (83·3%, 95% CI 81·4-85·2) of these individuals already knew their HIV status. Among those who knew their HIV status, 2617 (87·4%, 95% CI 85·8-89·0) were receiving ART (95% of those eligible by national guidelines, and 73% of all infected people). Of the 2609 individuals receiving ART with a viral load measurement, 2517 (96·5%, 95% CI 96·0-97·0) had viral load of 400 copies per mL or less. Overall, 70·2% (95% CI 67·5-73·0) of HIV-infected people had virological suppression, close to the UNAIDS target of 73%.
  
  
  CONCLUSIONS
  UNAIDS 90-90-90 targets are achievable even in resource-constrained settings with high HIV burden.
  
  
  BACKGROUND
  US President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention.
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Tendani
authors.initials: T
authors.lastname: Gaolathe
authors.affiliation: Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Wirth
authors.affiliation: Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Molly Pretorius
authors.initials: MP
authors.lastname: Holme
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Sikhulile
authors.initials: S
authors.lastname: Moyo
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Unoda
authors.initials: U
authors.lastname: Chakalisa
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Etienne Kadima
authors.initials: EK
authors.lastname: Yankinda
authors.affiliation: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Quanhong
authors.initials: Q
authors.lastname: Lei
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Mompati
authors.initials: M
authors.lastname: Mmalane
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Vlad
authors.initials: V
authors.lastname: Novitsky
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Lillian
authors.initials: L
authors.lastname: Okui
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
authors.forename: Erik
authors.initials: E
authors.lastname: van Widenfelt
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Powis
authors.affiliation: Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Nealia
authors.initials: N
authors.lastname: Khan
authors.affiliation: Bennett Statistical Consulting, Inc, Ballston Lake, NY, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Hermann
authors.initials: H
authors.lastname: Bussmann
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Dryden-Peterson
authors.affiliation: Ministry of Health, Republic of Botswana, Gaborone, Botswana.
authors.forename: Refeletswe
authors.initials: R
authors.lastname: Lebelonyane
authors.affiliation: Ministry of Health, Republic of Botswana, Gaborone, Botswana.
authors.forename: Shenaaz
authors.initials: S
authors.lastname: El-Halabi
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention Botswana, Gaborone, Botswana.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mills
authors.affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention Botswana, Gaborone, Botswana.
authors.forename: Tafireyi
authors.initials: T
authors.lastname: Marukutira
authors.affiliation: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Eric J Tchetgen
authors.initials: EJ
authors.lastname: Tchetgen
authors.affiliation: Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: DeGruttola
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA. Electronic address: messex@hsph.harvard.edu.
authors.forename: M
authors.initials: M
authors.lastname: Essex
authors.affiliation: Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Harvard T H Chan School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001902:Botswana / Q000453:epidemiology; D003153:Community Health Services / Q000706:statistics & numerical data; D005191:Family Characteristics; D005260:Female; D006040:Goals; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood; D012424:Rural Population; D011795:Surveys and Questionnaires; D014480:United Nations; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral