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Article ; Online: Feasibility and acceptability of peer-delivered interventions using mHealth for PrEP services among adolescent girls and young women in DREAMS program in Botswana.

Lavoie, Marie-Claude C / Okui, Lillian / Blanco, Natalia / Stoebenau, Kirsten / Magidson, Jessica F / Gokatweng, Gadzikanani / Ikgopoleng, Kaizer / Charurat, Manhattan E / Ndwapi, Ndwapi

Global health action

2023 Volume 16, Issue 1, Page(s) 2231256

Abstract: Background: Adolescent girls and young women accounted for 25% of all new HIV infections despite representing only 10% of the population in Sub Saharan Africa. PEPFAR has launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe ( ... ...

Abstract	Background: Adolescent girls and young women accounted for 25% of all new HIV infections despite representing only 10% of the population in Sub Saharan Africa. PEPFAR has launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative, a comprehensive HIV prevention program including PrEP services. Among adolescent girls and young women, PrEP adherence is currently sub-optimal. Tailored strategies for adolescent girls and young women to improve access and use of PrEP delivery are urgently needed to maximise its potential. Recommended interventions include peer-delivered interventions using mobile technology. However, data on the feasibility and acceptability of this approach is limited for SSA. Objectives: We assessed the feasibility and perceived acceptability of providing mHealth peer-delivered interventions to support PrEP services among adolescent girls and young women in Botswana. Methods: This cross-sectional study included HIV-negative women aged 18-24 years old seeking health services at DREAMS-supported facilities. Participants completed a survey assessing the feasibility and perceived acceptability of the mHealth peer-delivered interventions, which included the Acceptability of Intervention Measure (AIM). Descriptive analyses were performed. Results: A total of 131 participated in the study. Overall, 89% owned a mobile phone (feasibility). There was no difference in cell phone ownership between participants from rural and urban settings. Among participants, 85% reported interest in participating in a mHealth peer-delivered intervention if it was available to them. Regarding perceived acceptability for mHealthpeer support groups for PrEP, the average score on the AIM was 3.8 out of 5 (SD = 0.8). Conclusion: mHealthpeer-delivered interventions appear to be feasible and perceived acceptable among adolescent girls and young women in Botswana. This modality should be incorporated into PEPFAR's programmatic toolkit of implementation strategies to improve PrEP services.
MeSH term(s)	Humans ; Female ; Adolescent ; Young Adult ; Adult ; HIV Infections/drug therapy ; Botswana ; Cross-Sectional Studies ; Feasibility Studies ; Africa South of the Sahara ; Pre-Exposure Prophylaxis ; Anti-HIV Agents/therapeutic use
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2023-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2540569-X
ISSN	1654-9880 ; 1654-9880
ISSN (online)	1654-9880
ISSN	1654-9880
DOI	10.1080/16549716.2023.2231256
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Article ; Online: Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial.

Bada, Florence / Mansfield, Megan E / Okui, Lillian / Montebatsi, Milton / DiClemente, Carlo / Tapera, Roy / Ikgopoleng, Kaizer / Mokonopi, Selebaleng / Magidson, Jessica F / Onukwugha, Eberechukwu / Ndwapi, Ndwapi / Himelhoch, Seth / Mbongwe, Bontle / Charurat, Man

Implementation science communications

2024 Volume 5, Issue 1, Page(s) 53

Abstract: Background: With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), ...

Abstract	Background: With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. Methods: BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. Discussion: BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. Clinical trial registration: NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.
Language	English
Publishing date	2024-05-08
Publishing country	England
Document type	Journal Article
ISSN	2662-2211
ISSN (online)	2662-2211
DOI	10.1186/s43058-024-00588-7
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Article ; Online: Progress towards the UNAIDS 95-95-95 targets in the Fifth Botswana AIDS Impact Survey (BAIS V 2021): a nationally representative survey.

Mine, Madisa / Stafford, Kristen A / Laws, Rebecca L / Marima, Reson / Lekone, Phenyo / Ramaabya, Dinah / Makhaola, Kgomotso / Patel, Hetal K / Mapondera, Prichard / Wray-Gordon, Floris / Agbakwuru, Chinedu / Okui, Lillian / Matroos, Susan / Onyadile, Eden / Ngidi, Julia / Abimiku, Alash'le / Bagapi, Khuteletso / Nkomo, Bornapate / Bodika, Stephane M /

Kim, Kaylee J / Moloney, Mirna / Mitchell, Andrew / Ehoche, Akipu / Ussery, Faith L / Hong, Steven Y / Keipeile, Stella / Matlhaga, Matshelo / Mathumo, Rapetse / Selato, Robert / Charurat, Manhattan E / Voetsch, Andrew C

The lancet. HIV

2024 Volume 11, Issue 4, Page(s) e245–e254

Abstract: Background: In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were ... ...

Abstract	Background: In 2014, UNAIDS set a goal to end the AIDS epidemic by achieving targets for the percentage of people living with HIV who were aware of their status, on antiretroviral therapy (ART), and virally suppressed. In 2020, these targets were revised to 95% for each measure (known as 95-95-95), to be reached among people living with HIV by 2025. We used data from the Fifth Botswana AIDS Impact Survey (BAIS V) to measure progress towards these testing and treatment targets in Botswana. Methods: BAIS V used a two-stage cluster design to obtain a nationally representative sample of people aged 15-64 years in Botswana. During March-August, 2021, 14 763 consenting participants were interviewed and tested for HIV in their households by survey teams. HIV-positive specimens were tested for viral load, presence of antiretroviral drugs, and recency of infection using the HIV-1 limiting antigen avidity enzyme immunoassay. Estimates of HIV-positive status and use of ART were based on self-report and the analysis of blood specimens for antiretroviral drugs. Viral load suppression was defined as an HIV RNA concentration of less than 1000 copies per mL. HIV incidence was calculated using the recent infection testing algorithm. Data were weighted to account for the complex survey design. Findings: The national HIV prevalence in Botswana among people aged 15-64 years was 20·8% and the annual incidence of HIV infection was 0·2%. 95·1% (men 93·0%, women 96·4%) of people living with HIV aged 15-64 years were aware of their status, 98·0% (men 97·2%, women 98·4%) of those aware were on ART, and 97·9% (men 96·6%, women 98·6%) of those on ART had viral load suppression. Among young people (aged 15-24 years) living with HIV, 84·5% were aware of their status, 98·5% of those aware were on ART, and 91·6% of those on ART had viral load suppression. The prevalance of viral load suppression among all people living with HIV was 91·8%, and varied by district-ranging from 85·3% in Gaborone to 100·0% in Selibe Phikwe. Interpretation: BAIS V is the first population-based survey worldwide to report the achievement of the UNAIDS 95-95-95 goals, both overall and among women. Strategies to reach undiagnosed men and young people, including young women, are needed. Funding: US President's Emergency Plan for AIDS Relief.
MeSH term(s)	Male ; Humans ; Female ; Adolescent ; Acquired Immunodeficiency Syndrome/drug therapy ; Acquired Immunodeficiency Syndrome/epidemiology ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Botswana/epidemiology ; Anti-Retroviral Agents/therapeutic use ; Surveys and Questionnaires ; Viral Load ; Prevalence
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2024-03-08
Publishing country	Netherlands
Document type	Journal Article
ISSN	2352-3018
ISSN (online)	2352-3018
DOI	10.1016/S2352-3018(24)00003-1
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Article ; Online: Phylodynamic analysis of HIV sub-epidemics in Mochudi, Botswana.

Novitsky, Vlad / Kühnert, Denise / Moyo, Sikhulile / Widenfelt, Erik / Okui, Lillian / Essex, M

Epidemics

2015 Volume 13, Page(s) 44–55

Abstract: Southern Africa continues to be the epicenter of the HIV/AIDS epidemic. This HIV-1 subtype C epidemic has a predominantly heterosexual mode of virus transmission and high (>15%) HIV prevalence among adults. The epidemiological dynamics of the HIV-1C ... ...

Abstract	Southern Africa continues to be the epicenter of the HIV/AIDS epidemic. This HIV-1 subtype C epidemic has a predominantly heterosexual mode of virus transmission and high (>15%) HIV prevalence among adults. The epidemiological dynamics of the HIV-1C epidemic in southern Africa are still poorly understood. Here, we aim at a better understanding of HIV transmission dynamics by analyzing HIV-1 subtype C sequences from Mochudi, a peri-urban village in Botswana. HIV-1C env gene sequences (gp120 V1C5) were obtained through enhanced household-based HIV testing and counseling in Mochudi. More than 1200 sequences were generated and phylogenetically distinct sub-epidemics within Mochudi identified. The Bayesian birth-death skyline plot was used to estimate the effective reproductive number, R, and the timing of virus transmission, to classify sub-epidemics as "acute" (those with recent viral transmissions) or "historic" (those without recent viral transmissions). We identified two of the 15 sub-epidemics as "acute." The median estimates of R among the clusters ranged from 0.72 to 1.77. The majority of HIV lineages, 11 out of 15 clusters with 5+ members, appear to have been introduced to Mochudi between 1996 and 2002. The median peak duration of viral transmissions was 7.1 years (range 2.9-9.7 years). The median life span of identified HIV sub-epidemics, i.e., the time between the inferred epidemic origin and its most recent sample, was 13.1 years (range 10.2-22.1 years). Most viral transmissions within the sub-epidemics occurred between 1997 and 2007. The time period during which infected people are infectious appears to have decreased since the introduction of the national ART program in Botswana. Real-time HIV genotyping and breaking down local HIV epidemics into phylogenetically distinct sub-epidemics may help to reveal the structure and dynamics of HIV transmission networks in communities, and aid in the design of targeted interventions for members of the acute sub-epidemics that likely fuel local HIV/AIDS epidemics.
MeSH term(s)	Adolescent ; Adult ; Bayes Theorem ; Botswana/epidemiology ; Epidemics ; Female ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Molecular Epidemiology ; Phylogeny ; Prevalence ; Young Adult
Language	English
Publishing date	2015-08-28
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2467993-8
ISSN	1878-0067 ; 1755-4365
ISSN (online)	1878-0067
ISSN	1755-4365
DOI	10.1016/j.epidem.2015.07.002
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Article ; Online: Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community.

Novitsky, Vlad / Bussmann, Hermann / Okui, Lillian / Logan, Andrew / Moyo, Sikhulile / van Widenfelt, Erik / Mmalane, Mompati / Lei, Quanhong / Holme, Molly P / Makhema, Joseph / Lockman, Shahin / Degruttola, Victor / Essex, M

Journal of the International AIDS Society

2015 Volume 18, Page(s) 19918

Abstract: Introduction: It would be useful to understand which populations are not reached by home-based HIV-1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission.: Methods! ...

Abstract	Introduction: It would be useful to understand which populations are not reached by home-based HIV-1 testing and counselling (HTC) to improve strategies aimed at linking these individuals to care and reducing rates of onward HIV transmission. Methods: We present the results of a baseline home-based HTC (HBHTC) campaign aimed at counselling and testing residents aged 16 to 64 for HIV in the north-eastern sector of Mochudi, a community in Botswana with about 44,000 inhabitants. Collected data were compared with population references for Botswana, the United Nations (UN) estimates based on the National Census data and the Botswana AIDS Impact Survey IV (BAIS-IV). Analyzed data and references were stratified by age and gender. Results: A total of 6238 age-eligible residents were tested for HIV-1; 1247 (20.0%; 95% CI 19.0 to 21.0%) were found to be HIV positive (23.7% of women vs. 13.4% of men). HIV-1 prevalence peaked at 44% in 35- to 39-year-old women and 32% in 40- to 44-year-old men. A lower HIV prevalence rate, 10.9% (95% CI 9.5 to 12.5%), was found among individuals tested for the first time. A significant gender gap was evident in all analyzed subsets. The existing HIV transmission network was analyzed by combining phylogenetic mapping and household structure. Between 62.4 and 71.8% of all HIV-positive individuals had detectable virus. When compared with the UN and BAIS-IV estimates, the proportion of men missed by the testing campaign (48.5%; 95% CI 47.0 to 50.0%) was significantly higher than the proportion of missed women (14.2%; 95% CI 13.2 to 15.3%; p<0.0001). The estimated proportion of missed men peaked at about 60% in the age group 30 to 39 years old. The proportions of missed women were substantially smaller, at approximately 28% within the age groups 30 to 34 and 45 to 49 years old. Conclusions: The HBHTC campaign seems to be an efficient tool for reaching individuals who have never been tested previously in southern African communities. However, about half of men from 16 to 64 years old were not reached by the HBHTC, including about 60% of men between 30 and 40 years old. Alternative HTC strategies should be developed to bring these men to care, which will contribute to reduction of HIV incidence in communities.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Botswana/epidemiology ; Counseling ; Female ; HIV Infections/epidemiology ; HIV-1 ; Humans ; Incidence ; Male ; Middle Aged ; Residence Characteristics
Language	English
Publishing date	2015-05-29
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2467110-1
ISSN	1758-2652 ; 1758-2652
ISSN (online)	1758-2652
ISSN	1758-2652
DOI	10.7448/IAS.18.1.19918
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Article ; Online: HIV Prevalence and Risk Behaviors Among Female Sex Workers in Botswana: Results from the 2012 HIV/STI Bio-Behavioral Study.

Merrigan, Mike B / Tafuma, Taurayi A / Okui, Lillian A / Lebelonyane, Refeletswe / Bolebantswe, Jerry M / Makhaola, Kgomotso / Mine, Madisa / Adhikary, Rajatashuvra / Chabikuli, Nzapfurundi O

AIDS and behavior

2015 Volume 19, Issue 5, Page(s) 899–908

Abstract: To evaluate HIV/STI prevalence among female sex workers (FSWs) in Botswana, and assess HIV-related risk behaviors. Cross-sectional study using time-location sampling in three districts of Botswana. Adjusted HIV prevalence at district level ranged from 53. ...

Abstract	To evaluate HIV/STI prevalence among female sex workers (FSWs) in Botswana, and assess HIV-related risk behaviors. Cross-sectional study using time-location sampling in three districts of Botswana. Adjusted HIV prevalence at district level ranged from 53.5 to 68.5 %. Syphilis prevalence ranged from 3.7 to 14.5 %; chlamydia prevalence ranged from 4.8 to 16.3 %; and gonorrhoea prevalence ranged from 8.3 to 11.7 %. FSWs had been practicing sex work for a mean of 4.7 years, and had a mean of 7.6 sex partners in the week before the survey. While 67.1 % of FSWs surveyed reported always using condoms with clients in the past month. 59.5 % reported one or more of the following: being paid more not to use a condom, having a condom break, or being forced not to use a condom by clients. Predictors of HIV infection in the multivariate analysis included: age (over 30 years), perceiving oneself to be at high risk of HIV, selling sex for 2 or more years, and having a mean of 11 or more partners in the last week. High HIV prevalence, high rates of partner exchange, a sizable population, and Inconsistent condom use combine together help fuel the country's hyper epidemic. HIV prevention interventions need to take into account the important influence of clients and boyfriends on condom use behavior.
MeSH term(s)	Adult ; Botswana/epidemiology ; Condoms/utilization ; Cross-Sectional Studies ; Female ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Safe Sex/statistics & numerical data ; Sex Work/statistics & numerical data ; Sex Workers/statistics & numerical data ; Sexual Behavior/statistics & numerical data ; Sexual Partners ; Sexually Transmitted Diseases/epidemiology ; Surveys and Questionnaires ; Unsafe Sex/statistics & numerical data ; Young Adult
Language	English
Publishing date	2015-05
Publishing country	United States
Document type	Evaluation Studies ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-014-0858-0
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Article ; Online: HIV/sexually transmitted infection prevalence and sexual behavior of men who have sex with men in 3 districts of Botswana: results from the 2012 biobehavioral survey.

Tafuma, Taurayi Adriano / Merrigan, Mike B / Okui, Lillian A / Lebelonyane, Refiletswe / Bolebantswe, Jerry / Mine, Madisa / Chishala, Samule / Moyo, Sikhulilekho / Thela, Telefo / Rajatashuvra, Adhikary

Sexually transmitted diseases

2014 Volume 41, Issue 8, Page(s) 480–485

Abstract: Background: Men who have sex with men (MSM) suffer significant stigma and discrimination; hence, they are reluctant to access health services. The Botswana Second National Strategic Framework for 2010-2016 stipulates the need to increase HIV prevention ... ...

Abstract	Background: Men who have sex with men (MSM) suffer significant stigma and discrimination; hence, they are reluctant to access health services. The Botswana Second National Strategic Framework for 2010-2016 stipulates the need to increase HIV prevention services for key populations as one of its prevention implementation strategies. We report here the prevalence of HIV and other sexually transmitted infections and risk factors for HIV infection among MSM in Botswana. Methods: We conducted a cross-sectional survey using respondent driven sampling in 3 districts of Botswana: Gaborone, Francistown, and Kasane. Results: Of the 454 participants recruited, most were Batswana (97.6%) with a mean age of 23.2 years (range, 18-53 years), with 74.9% aged between 20 and 29 years. The overall unadjusted HIV prevalence was 13.1% (95% confidence interval, 10.0-16.3), with 12.3%, 11.7%, and 25.9% in Gaborone, Francistown, and Kasane, respectively. Chlamydia trachomatis prevalence was higher than Neisseria gonorrhoeae in both urine and anal swabs, at 7.1% and 5.9%, respectively, versus 1.4% and 1.7%. Overall, 46.7% of respondents reported having sex with female partners. Men who have sex with men who thought they had a high chance of acquiring HIV had a significantly lower likelihood of using condom consistently than those who reported they had a lower chance of acquiring HIV (odds ratio = 0.4; 95% confidence interval, 0.2-0.7; P = 0.003). Conclusion: HIV prevalence of MSM was lower than what has been reported in other sub-Saharan African countries with generalized epidemics; however, their degree of participation in heterosexual sex signifies sexual networks beyond the MSM subpopulation.
MeSH term(s)	Adolescent ; Adult ; Botswana/epidemiology ; Condoms/utilization ; Cross-Sectional Studies ; Female ; HIV Seropositivity/epidemiology ; HIV Seropositivity/psychology ; Health Knowledge, Attitudes, Practice ; Homosexuality, Male ; Humans ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Risk-Taking ; Sexual Behavior/psychology ; Sexual Behavior/statistics & numerical data ; Sexual Partners/psychology ; Sexually Transmitted Diseases/epidemiology ; Sexually Transmitted Diseases/prevention & control ; Sexually Transmitted Diseases/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2014-08
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	435191-5
ISSN	1537-4521 ; 0148-5717
ISSN (online)	1537-4521
ISSN	0148-5717
DOI	10.1097/OLQ.0000000000000160
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Article ; Online: Acceptability of male circumcision among adolescent boys and their parents, Botswana.

Jayeoba, Oluwemimo / Dryden-Peterson, Scott / Okui, Lillian / Smeaton, Laura / Magetse, Jane / Makori, Lillian / Modikwa, Venice / Mogodi, Mpho / Plank, Rebeca / Lockman, Shahin

AIDS and behavior

2011 Volume 16, Issue 2, Page(s) 340–349

Abstract: Little is known of the acceptability of male circumcision (MC) to adolescent boys, a key target group for HIV prevention. We conducted a cluster design survey among adolescent boys and their parents/guardians in two villages in Botswana. Of 1300 ... ...

Abstract	Little is known of the acceptability of male circumcision (MC) to adolescent boys, a key target group for HIV prevention. We conducted a cluster design survey among adolescent boys and their parents/guardians in two villages in Botswana. Of 1300 households visited, 398 boys were eligible; 269 boys and 210 parents/guardians participated. MC was described correctly by 80% of boys, and 76% identified that MC reduces the risk of male HIV acquisition. After a brief informational session, 75% of boys stated that they would definitely want to be circumcised and 96% of parents/guardians would want their boy circumcised. Boys most frequently reported pain (49%) and possible health problems (19%) as concerns undergoing MC; concerns about peer or partner acceptance, sexual function, or cultural appropriateness were uncommon. Adolescent MC is likely to be highly acceptable in Botswana if done safely, for free and with adequate pain control in a hospital setting.
MeSH term(s)	Adolescent ; Botswana/epidemiology ; Circumcision, Male/statistics & numerical data ; Cluster Analysis ; Communicable Disease Control/methods ; Cross-Sectional Studies ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Humans ; Male ; Medicine, African Traditional/adverse effects ; Medicine, African Traditional/methods ; Parents ; Patient Acceptance of Health Care/statistics & numerical data ; Risk Factors ; Rural Health
Language	English
Publishing date	2011-03-21
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-011-9929-7
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Article ; Online: Phylogenetic relatedness of circulating HIV-1C variants in Mochudi, Botswana.

Novitsky, Vladimir / Bussmann, Hermann / Logan, Andrew / Moyo, Sikhulile / van Widenfelt, Erik / Okui, Lillian / Mmalane, Mompati / Baca, Jeannie / Buck, Lauren / Phillips, Eleanor / Tim, David / McLane, Mary Fran / Lei, Quanhong / Wang, Rui / Makhema, Joseph / Lockman, Shahin / DeGruttola, Victor / Essex, M

PloS one

2013 Volume 8, Issue 12, Page(s) e80589

Abstract: Background: Determining patterns of HIV transmission is increasingly important for the most efficient use of modern prevention interventions. HIV phylogeny can provide a better understanding of the mechanisms underlying HIV transmission networks in ... ...

Abstract	Background: Determining patterns of HIV transmission is increasingly important for the most efficient use of modern prevention interventions. HIV phylogeny can provide a better understanding of the mechanisms underlying HIV transmission networks in communities. Methods: To reconstruct the structure and dynamics of a local HIV/AIDS epidemic, the phylogenetic relatedness of HIV-1 subtype C env sequences obtained from 785 HIV-infected community residents in the northeastern sector of Mochudi, Botswana, during 2010-2013 was estimated. The genotyping coverage was estimated at 44%. Clusters were defined based on relatedness of HIV-1C env sequences and bootstrap support of splits. Results: The overall proportion of clustered HIV-1C env sequences was 19.1% (95% CI 17.5% to 20.8%). The proportion of clustered sequences from Mochudi was significantly higher than the proportion of non-Mochudi sequences that clustered, 27.0% vs. 14.7% (p = 5.8E-12; Fisher exact test). The majority of clustered Mochudi sequences (90.1%; 95% CI 85.1% to 93.6%) were found in the Mochudi-unique clusters. None of the sequences from Mochudi clustered with any of the 1,244 non-Botswana HIV-1C sequences. At least 83 distinct HIV-1C variants, or chains of HIV transmission, in Mochudi were enumerated, and their sequence signatures were reconstructed. Seven of 20 genotyped seroconverters were found in 7 distinct clusters. Conclusions: The study provides essential characteristics of the HIV transmission network in a community in Botswana, suggests the importance of high sampling coverage, and highlights the need for broad HIV genotyping to determine the spread of community-unique and community-mixed viral variants circulating in local epidemics. The proposed methodology of cluster analysis enumerates circulating HIV variants and can work well for surveillance of HIV transmission networks. HIV genotyping at the community level can help to optimize and balance HIV prevention strategies in trials and combined intervention packages.
MeSH term(s)	Botswana ; Genes, env/genetics ; Genotype ; HIV Infections/transmission ; HIV Infections/virology ; HIV-1/classification ; HIV-1/genetics ; HIV-1/pathogenicity ; Humans ; Phylogeny
Language	English
Publishing date	2013-12-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0080589
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Article ; Online: Universal Testing, Expanded Treatment, and Incidence of HIV Infection in Botswana.

Makhema, Joseph / Wirth, Kathleen E / Pretorius Holme, Molly / Gaolathe, Tendani / Mmalane, Mompati / Kadima, Etienne / Chakalisa, Unoda / Bennett, Kara / Leidner, Jean / Manyake, Kutlo / Mbikiwa, Atang M / Simon, Selebaleng V / Letlhogile, Rona / Mukokomani, Kutlwano / van Widenfelt, Erik / Moyo, Sikhulile / Lebelonyane, Refeletswe / Alwano, Mary G / Powis, Kathleen M /

Dryden-Peterson, Scott L / Kgathi, Coulson / Novitsky, Vlad / Moore, Janet / Bachanas, Pamela / Abrams, William / Block, Lisa / El-Halabi, Shenaaz / Marukutira, Tafireyi / Mills, Lisa A / Sexton, Connie / Raizes, Elliot / Gaseitsiwe, Simani / Bussmann, Hermann / Okui, Lillian / John, Oaitse / Shapiro, Roger L / Pals, Sherri / Michael, Haben / Roland, Michelle / DeGruttola, Victor / Lei, Quanhong / Wang, Rui / Tchetgen Tchetgen, Eric / Essex, M / Lockman, Shahin

The New England journal of medicine

2019 Volume 381, Issue 3, Page(s) 230–242

Abstract: Background: The feasibility of reducing the population-level incidence of human immunodeficiency virus (HIV) infection by increasing community coverage of antiretroviral therapy (ART) and male circumcision is unknown.: Methods: We conducted a pair- ... ...

Abstract	Background: The feasibility of reducing the population-level incidence of human immunodeficiency virus (HIV) infection by increasing community coverage of antiretroviral therapy (ART) and male circumcision is unknown. Methods: We conducted a pair-matched, community-randomized trial in 30 rural or periurban communities in Botswana from 2013 to 2018. Participants in 15 villages in the intervention group received HIV testing and counseling, linkage to care, ART (started at a higher CD4 count than in standard care), and increased access to male circumcision services. The standard-care group also consisted of 15 villages. Universal ART became available in both groups in mid-2016. We enrolled a random sample of participants from approximately 20% of households in each community and measured the incidence of HIV infection through testing performed approximately once per year. The prespecified primary analysis was a permutation test of HIV incidence ratios. Pair-stratified Cox models were used to calculate 95% confidence intervals. Results: Of 12,610 enrollees (81% of eligible household members), 29% were HIV-positive. Of the 8974 HIV-negative persons (4487 per group), 95% were retested for HIV infection over a median of 29 months. A total of 57 participants in the intervention group and 90 participants in the standard-care group acquired HIV infection (annualized HIV incidence, 0.59% and 0.92%, respectively). The unadjusted HIV incidence ratio in the intervention group as compared with the standard-care group was 0.69 (P = 0.09) by permutation test (95% confidence interval [CI], 0.46 to 0.90 by pair-stratified Cox model). An end-of-trial survey in six communities (three per group) showed a significantly greater increase in the percentage of HIV-positive participants with an HIV-1 RNA level of 400 copies per milliliter or less in the intervention group (18 percentage points, from 70% to 88%) than in the standard-care group (8 percentage points, from 75% to 83%) (relative risk, 1.12; 95% CI, 1.09 to 1.16). The percentage of men who underwent circumcision increased by 10 percentage points in the intervention group and 2 percentage points in the standard-care group (relative risk, 1.26; 95% CI, 1.17 to 1.35). Conclusions: Expanded HIV testing, linkage to care, and ART coverage were associated with increased population viral suppression. (Funded by the President's Emergency Plan for AIDS Relief and others; Ya Tsie ClinicalTrials.gov number, NCT01965470.).
MeSH term(s)	Adolescent ; Adult ; Anti-Retroviral Agents/therapeutic use ; Botswana/epidemiology ; Circumcision, Male/statistics & numerical data ; Female ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Humans ; Incidence ; Male ; Mass Drug Administration ; Mass Screening ; Middle Aged ; Proportional Hazards Models ; Rural Population ; Socioeconomic Factors ; Viral Load ; Young Adult
Chemical Substances	Anti-Retroviral Agents
Language	English
Publishing date	2019-07-03
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMoa1812281
Database	MEDical Literature Analysis and Retrieval System OnLINE

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