|Prevention and Control
of the HIV Epidemic in Botswana:
Surveillance, Modeling and Implementation of Interventions
From June 12-15, 2008 participants convened in Gaborone, Botswana for the conference, Prevention and Control of the HIV Epidemic in Botswana: Surveillance, Modeling and Implementation of Interventions.
The conference brought together epidemiologists, virologists, biostatisticians, behavioral scientists, clinicians, community representatives, government officials and experts from the Botswana Ministry of Health, the World Health Organization, and the U.S. Centers for Disease Control. Representatives were from Botswana, South Africa, the U.S. and other countries. The conference was designed to stimulate discussion about HIV surveillance and prevention strategies. 54 participants attended. (See Participant List).
Sessions were led by experienced HIV/AIDS experts who are intimately involved in HIV research and surveillance initiatives or play key roles in establishing and/or advising national treatment and prevention programs. (See Program.) The meeting emphasized open discussion and comparative analysis.
Sessions covered the following areas:
1. Status of International Programs: Surveillance and Prevention
2. Status of National Programs on Surveillance and Prevention in Botswana
3. Status of Potential Non-Vaccine Interventions for Reduction of Incidence
4. Methodological Challenges in Estimating and Tracking HIV Incidence Rates and Integration of Modeling for Prevention
Areas of Agreement
Botswana has been a global leader in HIV/AIDS policy and treatment. Now, as the Government puts an increasing focus on prevention, researchers and policy makers must work together to implement effective prevention programs. We need to rethink efforts on how to improve prevention methods, as well as improve efforts at measuring the impacts of prevention through surveillance in ways that are both timely and cost effective.
Areas of general agreement among participants were as follows:
Male circumcision is effective in reducing transmission of HIV.
Antiretroviral drugs are an effective means of both treatment and prevention of HIV.
For prevention, ARVs are effective for mother- infant chemo-prophylaxis, PeP, PrEP, and treatment of index cases. Additional uses of ARVs for prevention purposes warrant further investigation.
There must be open engaged communication between policy makers and researchers, between national and international agencies, especially in the discussions of which drug regimens are best for therapy in comparison with those that are best for transmission prevention using chemo-prophylaxis.
The most effective prevention efforts combine a number of complementary interventions, rather than relying on a single intervention.
Prevention programs should target those most at risk of becoming infected with HIV, especially teenagers and young adults.
Better surveillance is needed for measuring incidence.
Identification of acute infections represents an under-utilized tool in the fight against HIV.
We should look at issues of pooling as a means to reduce surveillance costs of screening for recent infections.
Modeling is critical to predict which prevention methods may be most effective.
Models should help determine in real time which programs are succeeding and which are failing and how best to make midpoint corrections. It is important to validate or correct models by using actual surveillance data.
Prevention programs should be country specific, taking into account local contexts and culture.
We need better ways to study the influence of communities and community norms on individual behavior. We need to understand why people behave in certain ways.
We need to understand the dynamics of sexual networks, which may help in understanding community dynamics. This would help in targeting interventions.
At a population level, we need to determine which intervention methods will lead to behavior change that will help to decrease the rate of new infections.
Policy makers should be a part of all discussions.
This conference was generously supported by The African Comprehensive HIV/AIDS Partnerships (ACHAP).