The TB/HIV Research Division is responsible for CDC Botswana’s role in public health research targeting tuberculosis and HIV/AIDS. The TB efforts at CDC Botswana are a collaborative effort of the Botswana National TB Program (BNTP), the National TB Reference Laboratory and the CDC Atlanta Division of TB Elimination (DTBE). The goal of this partnership is to generate information to improve TB control efforts in Botswana and elsewhere in the face of the TB/HIV co-epidemic. The TB/HIV Research Division has employees in three main sections: Clinical Trials/Treatment, Improved Case Finding, and Infection Control.

Current TB/HIV studies:

• Xpert Package Rollout Evaluation Study (XPRES): An evaluation to assess the performance of a new diagnostic tool called Xpert MTB/RIF. For more information, visit the CDC website.
• KOPANYO: In collaboration with UPENN, the objective of KOPANYO is to describe the transmission dynamics of TB in western and southern Botswana.

Visit CDC website for more information.

A decade ago, the world was in the midst of an AIDS pandemic and Africa was the epicenter. Nearly 30 million people had the AIDS virus, including 3 million children and over 8,000 people were dying every day. The American people saw the need and answered the call with the creation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) which is the U.S. Government’s initiative to support partner nations around the world in responding to HIV and AIDS. It is the largest commitment by any nation in history to combat a single disease internationally.

Since PEPFAR’s inception, Botswana has received more than $706 million in health assistance from the U.S. Government in the fight against HIV and AIDS. At CDC Botswana, PEPFAR is administered through the Global AIDS Program or GAP. It collaborates with the Government of Botswana, multilateral institutions, nongovernmental organizations (NGOs), and the private sector to help the country maximize the quality, coverage and impact of its HIV/AIDS response. This collaboration takes place in the areas of capacity building, prevention, and treatment.

Capacity Building

CDC in conjunction with the U.S. Agency for International Development (USAID) supports Health Systems Strengthening activities in specific HIV/AIDS programs within various ministries of the government and key civil society groups.  These efforts address underlying deficiencies in human resources, policy and guidelines, management, leadership and organizational capacity.

The Strategic Information program provides support, training, and technical assistance to the Ministries of Health, Local Government, and Education and to the National AIDS Coordinating Agency (NACA) in the areas of monitoring and evaluation, surveillance, statistics, and health information systems.

The program helped to initiate a national network of Monitoring and Evaluation (M&E) officers in all health districts, facilitating the reporting of national health data.  CDC Botswana also provides ongoing support to conduct the Botswana AIDS Indicator Survey (BAIS) to monitor the HIV epidemic in Botswana.  CDC Botswana supports the implementation of electronic registers to capture data from care and treatment, routine HIV testing, and PMTCT programs.

Laboratory activities are focused on support for research projects and working with the Ministry of Health on efforts to accredit laboratory facilities, both public and private.

Prevention

CDC Botswana supports the promotion and implementation of safe male circumcision programs in collaboration with the Ministry of Health, NGOs, university partners and other major donors.

CDC is a long-time supporter of a local NGO, Tebelopele, which provides training, mentoring programs and quality assurance visits that support Botswana’s voluntary counseling and testing program.  Tebelopele now provides an estimated 150,000 same-day HIV results annually and conducts activities to increase the demand for HIV testing.

Through community and mass-media outreach, CDC Botswana supports local and international NGOs, local community-based organizations, and the Ministries of Health, Education, and Labour and Home Affairs, in a range of activities designed to promote the prevention of sexual transmission of HIV through abstinence, faithfulness, partner reduction, and condom use.  These programs also address related issues such as alcohol abuse and gender equity. CDC Botswana supports the Ministry of Education in its effort to roll out a life skills curriculum and to train primary school teachers in its implementation.

Treatment

Working with the Ministry of Health, CDC Botswana assists the national Prevention of Mother-to-Child Transmission (PMTCT) program.  The focus of the program is to work towards elimination of vertical HIV transmission.

CDC Botswana provides support to the Ministry of Health care and support programs that includes palliative care, training on sexually transmitted infections, cervical cancer prevention and treatment, safe motherhood, and sexual reproductive health.

TB remains the leading cause of death among persons with HIV in Botswana. To increase routine HIV testing among tuberculosis patients and to support monitoring and evaluation systems, CDC Botswana assisted the Botswana National TB Program to develop a TB/HIV training curriculum for health care workers at the district and facility-levels.

CDC Botswana provides support to the Government of Botswana’s “Masa” (New Dawn) antiretroviral treatment program by providing technical assistance to the national central medical stores, developing and updating national treatment guidelines, and supporting a national training program.

For more information visit PEPFAR website.

The HIV Prevention Research (HPR) Division is a CDC-funded research program. The HPR Division conducted a microbicides study from 2002-2006, and began a clinical trial study in 2007 called the TDF2 Study, which was conducted in partnership with the Botswana Ministry of Health.

The TDF2 Study was a clinical trial designed to determine whether taking an antiretroviral drug before exposure to HIV could prevent HIV infection in 18-39 year old heterosexual adults. The strategy of providing daily oral antiretroviral drugs to uninfected individuals to prevent HIV is called pre-exposure prophylaxis, or PrEP.

TDF2 closed in March 2011 after reaching its goal of enrolling 1,200 participants. The study found that a once-daily tablet of TDF/FTC (known by its brand name Truvada) was effective in reducing the risk of HIV infection in the study population.

After releasing results in July 2011, the HPR Division requested and received approval from the Ministry of Health to proceed with plans to provide Truvada to all study participants in Botswana for one year through the Open-Label Extension of the TDF2 Study.

Visit CDC’s HPR website for more information.