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  • 1
    Online Resource
    Online Resource
    Clinical outcomes of a cohort of migrants and citizens living with human immunodeficiency virus in Botswana: implications for Joint United Nation Program on HIV and AIDS 90-90-90 targets
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Medicine Vol. 98, No. 23 ( 2019-06), p. e15994-
    Details
    In: Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 98, No. 23 ( 2019-06), p. e15994-
    Abstract: The aim of the study was to evaluate the human immunodeficiency virus (HIV) treatment cascade and mortality in migrants and citizens living with HIV in Botswana. Retrospective 2002 to 2016 cohort study using electronic medical records from a single center managing a high migrant case load. Records for 768 migrants and 3274 citizens living with HIV were included. Maipelo Trust, a nongovernmental organization, funded care for most migrants (70%); most citizens (85%) had personal health insurance. Seventy percent of migrants and 93% of citizens had received antiretroviral therapy (ART). At study end, 44% and 27% of migrants and citizens, respectively were retained in care at the clinic ( P   〈  .001). Among the 35% and 60% of migrants and citizens on ART respectively with viral load (VL) results in 2016, viral suppression was lower among migrants (82%) than citizens (95%) ( P   〈  .001). Citizens on ART had a median 157-unit [95% confidence interval (CI) 122–192] greater increase in CD4+ T-cell count (last minus first recorded count) than migrants after adjusting for baseline count ( P   〈  .001). Five-year survival was 92% (95% CI = 87.6–94.8) for migrants and 96% (95% CI = 95.4–97.2) for citizens. Migrants had higher mortality than citizens after entry into care (hazard ratio = 2.3, 95% CI = 1.34–3.89, P  = .002) and ART initiation (hazard ratio = 2.2, 95% CI = 1.24–3.78, P  = .01). Fewer migrants than citizens living with HIV in Botswana were on ART, accessed VL monitoring, achieved viral suppression, and survived. The HIV treatment cascade appears suboptimal for migrants, undermining local 90-90-90 targets. These results highlight the need to include migrants in mainstream-funded HIV treatment programs, as microepidemics can slow HIV epidemic control.
    Type of Medium: Online Resource
    ISSN: 0025-7974 , 1536-5964
    URL: Article
    DOI: 10.1097/MD.0000000000015994
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2049818-4
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  • 2
    Online Resource
    Online Resource
    Frequent Detection of Undiagnosed HIV Within Emergency Departments in Botswana
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Sexually Transmitted Diseases Vol. 48, No. 7 ( 2021-7), p. e97-e100
    Details
    In: Sexually Transmitted Diseases, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 7 ( 2021-7), p. e97-e100
    Abstract: Among 130,161 HIV testing records from unique individuals at 149 programmatic sites in Botswana, frequency of detecting undiagnosed HIV infection within emergency departments (EDs) was 4.7% (455/9695), 2-fold higher than other clinic-based HIV counseling and testing. Men and noncitizens less frequently initiated same-day antiretroviral therapy after testing HIV positive within emergency departments.
    Type of Medium: Online Resource
    ISSN: 1537-4521 , 0148-5717
    URL: Article
    DOI: 10.1097/OLQ.0000000000001312
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2055170-8
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  • 3
    Online Resource
    Online Resource
    Intensified Assisted Partner Notification Implementation in Botswana Increased Partner Identification but Not HIV Case-Finding: Findings Highlight the Need for Improved Data Monitoring
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 87, No. 3 ( 2021-07-1), p. 951-958
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 87, No. 3 ( 2021-07-1), p. 951-958
    Abstract: How to implement and monitor assisted partner services (APS) programs for HIV infection as they go to scale-up is uncertain. Setting: Forty Botswana Ministry of Health clinics, 2018–2020. Methods: We compared 2 APS implementation phases. During phase 1, training, supervision, and data collection were minimal; only newly diagnosed HIV-positive persons received APS, and APS recipients notified partners themselves or jointly with counselors. Phase 2 included the following: intensified training and supervision; APS provision to previously diagnosed, untreated persons; structured interview records; and counselors offering to notify partners directly. Results: Five thousand one hundred seventy-five and 1265 newly diagnosed HIV-positive persons received APS in phases 1 and 2, respectively. Comparing the phases, program reach (percentage of newly diagnosed cases receiving APS) increased from 86% to 93%, the contact index (sex partners named per case) increased from 0.85 to 1.32, and the percentage of cases with an identified HIV-positive partner increased from 12.6% to 60% ( P 〈 0.001, all outcomes). The testing index (partners tested per case) was higher in phase 1 (0.56 vs. 0.45, P = 0.05), whereas the case-finding index (partners testing HIV-positive per case) did not change (0.13 vs. 0.14, P = 0.50). Five hundred seventy-eight (76%) of 756 HIV-positive partners in phase 2 were previously diagnosed; cases identified only 15% of these partners as HIV-positive at their initial interview. Conclusions: APS scale-up increased reach, the contact index, and the identification of previously diagnosed sex partners but not HIV case-finding. Improved, more comprehensive data likely explain the absence of increased case-finding, highlighting the need for more comprehensive data collection.
    Type of Medium: Online Resource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002673
    RVK:
    XA 10000
    RVK:
    XA 51942
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2038673-4
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  • 4
    Online Resource
    Online Resource
    Implementation of a National Workplace Wellness Program for Health Workers in Botswana
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Journal of Occupational & Environmental Medicine Vol. 59, No. 9 ( 2017-09), p. 867-874
    Details
    In: Journal of Occupational & Environmental Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 59, No. 9 ( 2017-09), p. 867-874
    Type of Medium: Online Resource
    ISSN: 1076-2752
    URL: Article
    DOI: 10.1097/JOM.0000000000001028
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2070230-9
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  • 5
    Online Resource
    Online Resource
    HIV testing criteria to reduce testing volume and increase positivity in Botswana
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  AIDS Vol. 35, No. 12 ( 2021-10-1), p. 2007-2015
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 12 ( 2021-10-1), p. 2007-2015
    Abstract: We used data from a routine HIV testing program to develop risk scores to identify patients with undiagnosed HIV infection while reducing the number of total tests performed. Design: Multivariate logistic regression. Methods: We included demographic factors from HIV testing data collected in 134 Botswana Ministry of Health & Wellness facilities during two periods (1 October 2018– 19 August 2019 and 1 December 2019 to 30 March 2020). In period 2, the program collected additional demographic and risk factors. We randomly split each period into prediction/validation datasets and used multivariate logistic regression to identify factors associated with positivity; factors with adjusted odds ratios at least 1.5 were included in the risk score with weights equal to their coefficient. We applied a range of risk score cutoffs to validation datasets to determine tests averted, test positivity, positives missed, and costs averted. Results: In period 1, three factors were significantly associated with HIV positivity (coefficients range 0.44–0.87). In period 2, 12 such factors were identified (coefficients range 0.44–1.37). In period 1, application of risk score cutoff at least 1.0 would result in 50% fewer tests performed and capture 61% of positives. In period 2, a cutoff at least 1.0 would result in 13% fewer tests and capture 96% of positives; a cutoff at least 2.0 would result in 40% fewer tests and capture 83% of positives. Costs averted ranged from 12.1 to 52.3%. Conclusion: Botswana's testing program could decrease testing volume but may delay diagnosis of some positive patients. Whether this trade-off is worthwhile depends on operational considerations, impact of testing volume on program costs, and implications of delayed diagnoses.
    Type of Medium: Online Resource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000002997
    RVK:
    XA 16838
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2012212-3
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  • 6
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    Comparing COVID-19 physical distancing policies: results from a physical distancing intensity coding framework for Botswana, India, Jamaica, Mozambique, Namibia, Ukraine, and the United States
    Springer Science and Business Media LLC ; 2021
    In:  Globalization and Health Vol. 17, No. 1 ( 2021-12)
    Details
    In: Globalization and Health, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2021-12)
    Abstract: Understanding the differences in timing and composition of physical distancing policies is important to evaluate the early global response to COVID-19. A physical distancing intensity monitoring framework comprising 16 domains was recently published to compare physical distancing approaches across 12 U.S. States. We applied this framework to a diverse set of low and middle-income countries (LMICs) (Botswana, India, Jamaica, Mozambique, Namibia, and Ukraine) to test the appropriateness of this framework in the global context and to compare the policy responses in these LMICs with a sample of U.S. States during the first 100-days of the pandemic. Results The LMICs in our sample adopted wide ranging physical distancing policies. The highest peak daily physical distancing intensity during this period was: Botswana (4.60); India (4.40); Ukraine (4.40); Namibia (4.20); Mozambique (3.87), and Jamaica (3.80). The number of days each country stayed at peak policy intensity ranged from 12-days (Jamaica) to more than 67-days (Mozambique). We found some key similarities and differences, including substantial differences in whether and how countries expressly required certain groups to stay at home. Despite the much higher number of cases in the US, the physical distancing responses in our LMIC sample were generally more intense than in the U.S. States, but results vary depending on the U.S. State. The peak policy intensity for the U.S. 12-state average was 3.84, which would place it lower than every LMIC in this sample except Jamaica. The LMIC sample countries also reached peak physical distancing intensity earlier in outbreak progression compared to the U.S. states sample. The easing of physical distancing policies in the LMIC sample did not discernably correlate with change in COVID-19 incidence. Conclusions This physical distancing intensity framework was appropriate for the LMIC context with only minor adaptations. This framework may be useful for ongoing monitoring of physical distancing policy approaches and for use in effectiveness analyses. This analysis helps to highlight the differing paths taken by the countries in this sample and may provide lessons to other countries regarding options for structuring physical distancing policies in response to COVID-19 and future outbreaks.
    Type of Medium: Online Resource
    ISSN: 1744-8603
    URL: Article
    DOI: 10.1186/s12992-021-00770-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2185774-X
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  • 7
    Online Resource
    Online Resource
    Using routine programmatic data to measure HIV incidence among pregnant women in Botswana
    Springer Science and Business Media LLC ; 2022
    In:  Population Health Metrics Vol. 20, No. 1 ( 2022-12)
    Details
    In: Population Health Metrics, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2022-12)
    Abstract: Pregnant women in sub-Saharan Africa have high risk of HIV acquisition, yet approaches for measuring maternal HIV incidence using routine surveillance systems are undefined. We used programmatic data from routine antenatal care (ANC) HIV testing in Botswana to measure real-world HIV incidence during pregnancy. Methods From January 2018 to September 2019, the Botswana Ministry of Health and Wellness implemented an HIV testing program at 139 ANC clinics. The program captured information on testers’ age, testing date and result, and antiretroviral treatment (ART) initiation. In our analysis, we excluded individuals who previously tested HIV-positive prior to their first ANC visit. We defined incident HIV infection as testing HIV-positive at an ANC visit after a prior HIV-negative result within ANC. Results Overall, 29,570 pregnant women (median age 26 years, IQR 22–31) tested for HIV at ANC clinics: 3% (836) tested HIV-positive at their first recorded ANC visit and 97% tested HIV-negative (28,734). Of those who tested HIV-negative, 28% (7940/28,734) had a repeat HIV test recorded at ANC. The median time to HIV re-testing was 92 days (IQR 70–112). In total, 17 previously undiagnosed HIV infections were detected (HIV incidence 8 per 1000 person-years, 95% CI 0.5–1.3). ART initiation among women newly diagnosed with HIV at ANC (853) was 88% (671/762). Conclusions In Botswana, real-world HIV incidence among pregnant women at ANC remains above levels of HIV epidemic control (≤ 1 per 1000 person-years). This study shows how HIV programmatic data can answer timely population-level epidemiological questions and inform ongoing implementation of HIV prevention and treatment programs.
    Type of Medium: Online Resource
    ISSN: 1478-7954
    URL: Article
    DOI: 10.1186/s12963-022-00287-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2127230-X
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  • 8
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    Early resumption of sex after voluntary medical male circumcision for HIV prevention within a programmatic delivery setting in Botswana
    SAGE Publications ; 2019
    In:  International Journal of STD & AIDS Vol. 30, No. 13 ( 2019-11), p. 1275-1283
    Details
    In: International Journal of STD & AIDS, SAGE Publications, Vol. 30, No. 13 ( 2019-11), p. 1275-1283
    Abstract: To maximize the public health benefits of voluntary medical male circumcision (VMMC) in real-world settings, sexual abstinence is recommended for six weeks following VMMC to ensure complete wound healing. We determined the frequency and predictors of early resumption of sex among a cohort of HIV-negative, sexually active men 18–49 years who underwent VMMC within a public-sector clinic in Botswana. Multivariate robust Poisson regression methods were used to identify predictors of having any sexual intercourse in the last six weeks since undergoing VMMC. In total, 433/519 (83%) men had data available on sexual activity at six weeks post-VMMC. Median age was 27 years, 57% had a higher than secondary education, 72% were employed, and 9% were married. Overall, 122/433 (28%) men had sexual intercourse within the six weeks since VMMC, of whom 36% reported inconsistent condom use. Compared to men ≥34 years, men aged 〈 30 years (adjusted risk ratio [aRR] = 1.71, 95% CI 0.95–3.08) and men 30–34 years had a two-fold higher likelihood of resuming sexual activity early in multivariate analyses (aRR = 2.31, 95% CI 1.26–4.25, Wald p = 0.018). Employed men were more likely to resume sexual activity early than unemployed men (aRR = 1.58, 95% CI 1.02–2.44, p = 0.039). Additional interventions are needed to encourage abstinence until complete wound healing.
    Type of Medium: Online Resource
    ISSN: 0956-4624 , 1758-1052
    URL: Article
    DOI: 10.1177/0956462419866051
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2009782-7
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  • 9
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    Associations between healthcare worker participation in workplace wellness activities and job satisfaction, occupational stress and burnout: a cross-sectional study in Botswana
    BMJ ; 2018
    In:  BMJ Open Vol. 8, No. 3 ( 2018-03), p. e018492-
    Details
    In: BMJ Open, BMJ, Vol. 8, No. 3 ( 2018-03), p. e018492-
    Abstract: Healthcare workers (HWs) are prone to high levels of stress and burnout, particularly when caring for people with HIV/AIDS. This study assessed whether participation in Botswana’s Workplace Wellness Programme (WWP) for HWs was associated with job satisfaction, occupational stress, well-being and burnout. Methods Using multistage sampling, a paper-based questionnaire was distributed to 1856 randomly selected HWs at 135 public facilities across Botswana. Well-validated scales assessed key outcomes. Analysis of covariance models were built for psychosocial factors associated with WWP participation, controlling for associated demographics. Results Response rate was 73% (n=1348). The majority of respondents were female (62%), not married (65%) and had children (84%). Mean age was 40.0 years (SD±9.9). Respondents were roughly split between participation in no WWP activities (29.4%), 1–6 WWP activities (38.9%) and seven or more WWP activities (31.7%) in the past year. High participation was associated with older age, being a doctor or other professional, working at hospitals or District Health Management Teams, working longer in health services or working longer at a facility. In unadjusted analyses, high participation was significantly associated (P 〈 0.05) with higher satisfaction with overall job, work, supervision, promotion, pay and professional efficacy and lower stress, exhaustion and cynicism. All associations remained significant in controlled analyses except cynicism. Conclusions Results from this study suggest that participation in workplace wellness activities is associated with higher satisfaction with multiple job facets and lower stress, exhaustion and cynicism. Introduction of these activities may help ameliorate high occupational stress levels among HWs.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2017-018492
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2599832-8
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  • 10
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    Voluntary Medical Male Circumcision and Perceived Sexual Functioning, Satisfaction, and Risk Behavior: A Qualitative Study in Botswana
    Springer Science and Business Media LLC ; 2020
    In:  Archives of Sexual Behavior Vol. 49, No. 3 ( 2020-04), p. 983-998
    Details
    In: Archives of Sexual Behavior, Springer Science and Business Media LLC, Vol. 49, No. 3 ( 2020-04), p. 983-998
    Type of Medium: Online Resource
    ISSN: 0004-0002 , 1573-2800
    URL: Article
    DOI: 10.1007/s10508-019-01589-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2014932-3
    SSG: 12
    SSG: 5,2
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