The Ministry of Health, in collaboration with the Botswana Havard AIDS Institute Partnership (BHP), will soon launch the 2012 Botswana National HIV/AIDS Treatment Guidelines to reduce mortality and morbidity and improve the quality of life for people living with the virus.
The 2012 guidelines will involve all age group HIV infection diagnosis, CD4 Cell Count and Viral Load Testing, as well as Toxicity Monitoring guaranteeing user friendly and more potent drug regimens, to name some.
Although this is a welcome development it comes at tremendous cost, especially taking into account the new drug regimens, laboratory testing and review of CD4 count. Although no comments could be received by the time of going to print, clinicians subscribe to the fact that with the launch of the new guidelines and the costs of ARV treatment would be revised upwards from the current P15 000 to P20 000 per patient per annum.
The launch of the (MASA or DAWN) Highly Active Antiretroviral Therapy (HAART) guidelines, which falls in line with the “zero infections by 2016”, will be done through the Ministry of Health Monitoring & Evaluation Unit of the HIV/AIDS Information Management Division of Department of HIV & AIDS Prevention and Care.
The fact that a cumulative total of 19, 851 patients have died while on HAART since inception of the ARV programme in 2002, proves the efficacy of treatment.
Dr. Madisa Mine, the BHP-PEPFAR Laboratory Master Trainer Coordinator, said that with the Botswana Clinical Laboratory Training Manual with the ever-increasing number of patients on therapy, the quality and capacity of Botswana’s Clinical laboratories was under spotlight. There has arisen urgent need to expand the laboratory infrastructure, testing technologies and equipments, supplies and numbers and staff competencies. The increase in the number of patients on treatment means the need for better testing methodologies, given the pressure mounted on the laboratory system resulting in long turnaround times and huge testing backlogs.
A number of initiatives have been undertaken to avert the bottleneck: decentralization of testing, hiring more staff and training. However, the success of all these initiatives hinges on staff being able to deliver competently.
Based on November 2011 statistics, HIV constitutes a major health problem in Botswana with a prevalence of 17.6 percent in the general population and 31.8 percent among pregnant women.
Botswana is one of the countries in Africa that has led a very high responses to the epidemic through a range of multi-level of interventions, including the widespread access to antiretrovirals (ARVs) and has over the years built capacity to conduct international prevention, treatment and vaccine trials.
The end of March 2012 Monitoring and Evaluation (M&E) Unit statistics indicate: “Out of the 153, 312 patients on HAART in the public sector, 62.1 percent were females, and 5.5 percent or 8, 424 children under 13 years. A further 16, 704 patients were treated in the private sector under the Government’s Outsourcing Programme. An additional 14, 672 patients were being treated in the private sector by Medical Aid Schemes and workplace Programmes. This gives a total of 184, 058 patients currently receiving HAART amounting to 96.6 percent of the projected 190, 525 adults and children in need of ART at the end of March 2012. There were 1, 821 new clients started on HAART in the public sector during the month of which 77 percent were initiated in clinics.”
The statistics show that the projected numbers of patients with advanced HIV infection in need of ARV treatment updated in July 2010 for the end of December 2010, 2011 and 2012 were 170┬á617; 185, 963 and 204, 212, respectively. Linear extrapolation between these estimates produce the monthly estimates of the number of patients with advanced HIV infection in need of ARV treatments ranging from an impressive 94.5 percent to 96.6 percent.
The (M&E) Unit monthly data flow consists of satellite clinics reporting to the “mother hospital” in turn combining electronically populated ART data sites, Gaborone, Francistown, Serowe and Maun, using the Integrated Patient Management System (IPMS), which has also been rolled out to Molepolole, Mahalapye and Gantsi. Satellite clinics not on IPMS use the PIMS II electronic system for data transmission.
The 2012 guidelines are a follow up to the 2008 National HIV/AIDS guidelines, modified to reflect the country’s ongoing HIV/AIDS experience. Since the first case of AIDS in Botswana in 1985, the government has made tremendous response to the epidemic. Botswana’s political leadership has proven commitment and come up with a series of interventions and treatment programmes, such as the 1987 to 1989 provision of safe blood for transfusion; 1989 to 1997, introduction of the information and communication campaign; 1993, the first Medium Term Plan and National Policy on AIDS; 1999, the National AIDS Coordinating Agency coordinating a multisectoral approach to HIV and AIDS; 2002, launch of the first national ARV programme (MASA) 2002/2006, a total of 32 sites had 54, 969 patients on ARV.