Estimated HIV Trends and Program Effects in Botswana John Stover1*, Boga Fidzani2,3, Batho Chris Molomo2, Themba Moeti3, Godfrey Musuka3 1 Futures Institute, Glastonbury, Connecticut, United States of America, 2 National AIDS Coordinating Agency, Gaborone, Botswana, 3 African Comprehensive HIV/AIDS Partnership, Gaborone, Botswana Abstract Background: This study uses surveillance, survey and program data to estimate past trends and current levels of HIV in Botswana and the effects of treatment and prevention programs. Methods/Principal Findings: Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007. Using the prevalence trend we estimated the number of new adult infections, the transmission from mothers to children, the need for treatment and the effects of antiretroviral therapy (ART) and adult and child deaths. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. National prevalence is estimated at 26% (25–27%) in 2007. About 330,000 (318,000–335,000) people are infected with HIV including 20,000 children. The number of new adult infections has been stable for several years at about 20,000 annually (12,000–26,000). The number of new child infections has declined from 4600 in 1999 to about 890 (810–980) today due to nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The annual number of adult deaths has declined from a peak of over 15,500 in 2003 to under 7400 (5000–11,000) today due to coverage of ART that reaches over 80% in need. The need for ART will increase by 60% by 2016. Conclusions: Botswana’s PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed. Citation: Stover J, Fidzani B, Molomo BC, Moeti T, Musuka G (2008) Estimated HIV Trends and Program Effects in Botswana. PLoS ONE 3(11): e3729. doi:10.1371/ journal.pone.0003729 Editor: Douglas F. Nixon, University of California San Francisco, United States of America Received July 28, 2008; Accepted October 25, 2008; Published November 14, 2008 Copyright: 2008 Stover et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was funded by the Bill and Melinda Gates Foundation through the African Comprehensive HIV/AIDS Partnership. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: JStover@FuturesInstitute.org Introduction Botswana has one of the highest levels of HIV in the world. UNAIDS estimated that adult prevalence was about 24% in 2005, higher than any other country except Swaziland [1]. The epidemic has imposed a terrible burden due to lives lost, reduced quality of life and a large number of orphans. Since 2003 Botswana and its development partners have launched strong efforts to prevent the transmission of HIV from mothers to their children and to provide advanced treatment to those who need it. Information on epidemic trends is available from sentinel surveillance conducted annually at antenatal clinics around the country. Program statistics describe the expansion of the PMTCT and treatment programs [2]. Comprehensive assessments of the demographic impact of the epidemic were conducted for Botswana in 2000 [3] and 2006 [4]. This report expands and updates those analyses using the latest surveillance and program data as well as updated models developed by UNAIDS. It describes the use of these data to estimate national prevalence in Botswana and to assess the implications of that estimate for other indicators of interest, such as the number of people infected, the annual number of new infections, the number of people in need of ART, and the impact of the PMTCT and treatment programs. Methods The HIV surveillance program conducts annual HIV surveys among women aged 15–49 years attending ante-natal clinics. Surveillance has been conducted annually since 1992 and now includes 24 sites [5]. Since these surveys measure HIV prevalence in pregnant women they do not represent prevalence in all adults, including both men and women. However, since ANC surveil- lance is conducted annually it does provide information on trends in prevalence that should be representative of those in the general adult population. The Botswana AIDS Impact Survey II (BAIS II) conducted in 2004 measured the prevalence of HIV infection in the population aged 18 months and above [6]. Although only 61% of those interviewed in this survey agreed to provide a blood sample for HIV testing, the results of this survey are thought to provide a reasonably accurate measure of HIV prevalence in 2004. The UNAIDS Reference Group on Estimates, Models and Projections has developed several tools to estimate national prevalence. One of these tools, the Estimation and Projection Package (EPP), is used in most countries in sub-Saharan Africa to estimate prevalence trends from surveillance and survey data in countries with generalized epidemics [7]. EPP works by fitting a simple epidemic model to surveillance data from multiple sites PLoS ONE | www.plosone.org 1 November 2008 | Volume 3 | Issue 11 | e3729