Original Research - Special Collection: UNAIDS Targets for 2030

Five years after Treat All implementation: Botswana’s HIV response and future directions in the era of COVID-19

Keith Jefferis, Ava Avalos, Heston Phillips, Mpho Mmelesi, Dinah Ramaabya, Bornapate Nkomo, Charles Muthoga, Joseph N. Jarvis, Siphiwe Ratladi, Robert Selato, John Stover
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1275 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1275 | © 2021 Ava Avalos | This work is licensed under CC Attribution 4.0
Submitted: 17 June 2021 | Published: 15 October 2021

About the author(s)

Keith Jefferis, E-consult Botswana, Gaborone, Botswana
Ava Avalos, Careena Centre for Health, Gaborone, Botswana
Heston Phillips, UNAIDS, Lusaka, Zambia
Mpho Mmelesi, UNAIDS, Gaborone, Botswana
Dinah Ramaabya, Botswana Ministry of Health and Wellness, Gaborone, Botswana
Bornapate Nkomo, Botswana Ministry of Health and Wellness, Gaborone, Botswana
Charles Muthoga, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
Joseph N. Jarvis, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; and, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
Siphiwe Ratladi, National AIDS and Public Health Agency, Gaborone, Botswana
Robert Selato, National AIDS and Public Health Agency, Gaborone, Botswana
John Stover, Avenir Health, Glastonbury, United States of America


Background: As the relentless coronavirus disease-2019 (COVID-19) pandemic continues to spread across Africa, Botswana could face challenges maintaining the pathway towards control of its HIV epidemic.

Objective: Utilising the Spectrum GOALS module (GOALS-2021), the 5-year outcomes from the implementation of the Treat All strategy were analysed and compared with the original 2016 Investment Case (2016-IC) projections. Future impact of adopting the new Joint United Nations Programme on HIV/AIDS (UNAIDS) Global AIDS Strategy (2021–2026) targets and macroeconomic analysis estimating how the financial constraints from the COVID-19 pandemic could impact the available resources for Botswana’s National HIV Response through 2030 were also considered.

Method: Programmatic costs, population demographics, prevention and treatment outputs were determined. Previous 2016-IC data were uploaded for comparison, and inputs for the GOALS, AIM, DemProj, Resource Needs and Family Planning modules were derived from published reports, strategic plans, programmatic data and expert opinion. The economic projections were recalibrated with consideration of the impact of the COVID-19 pandemic.

Results: Decreases in HIV infections, incidence and mortality rates were achieved. Increases in laboratory costs were offset by estimated decreases in the population of people living with HIV (PLWH). Moving forward, young women and others at high risk must be targeted in HIV prevention efforts, as Botswana transitions from a generalised to a more concentrated epidemic.

Conclusion: The Treat All strategy contributed positively to decreases in new HIV infections, mortality and costs. If significant improvements in differentiated service delivery, increases in human resources and HIV prevention can be realised, Botswana could become one of the first countries with a previously high-burdened generalised HIV epidemic to gain epidemic control, despite the demands of the COVID-19 pandemic.


Botswana; Spectrum; GOALS; economic modelling; COVID-19; treat all


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Crossref Citations

1. Southern African Journal of HIV Medicine August 2021
David C. Spencer
Southern African Journal of HIV Medicine  vol: 22  issue: 1  year: 2021  
doi: 10.4102/sajhivmed.v22i1.1309