EpiC Botswana Quarterly Report (October to December 2019)

The project focuses on key populations, including female sex workers (FSW) and men who have sex with men (MSM). In the first quarter of FY20, EpiC accelerated the provision of antiretroviral therapy (ART) to non-nationals following the passage of legislation to provide ART to all non-nationals. Targeted outreach activities for non-nationals improved the overall case-finding rate among FSW from 12% to 24% and from 7% to 13% among MSM. Francistown and Gaborone had the highest improvement in FSW case-finding compared to the last quarter of FY19, from 7% to 40% and from 12% to 43%, respectively. EpiC also received technical assistance for setting up the Going Online platform, which will help the program reach key populations who are difficult to reach through traditional outreach methods. The platform will be used to provide online and mobile services, contributing towards achieving 95-95-95 targets. The project achieved several key results in the first quarter of FY20. A total of 356 FSW and 277 MSM were tested, with all receiving their results. Newly diagnosed cases of HIV were identified among 84 FSW and 36 MSM, and 94 FSW and 35 MSM were initiated on treatment. Additionally, 7 FSW and 3 MSM were returned to treatment that had been lost to follow-up. The project also made progress in screening for tuberculosis (TB) among FSW and MSM, with 101 FSW and 38 MSM screened. Training was provided to 8 virtual outreach workers on the Going Online approaches, and 92 FSW and 76 MSM were initiated on pre-exposure prophylaxis (PrEP). A total of 209 FSW and 72 MSM had their viral load documented, and 56,862 condoms and 26,503 lubricants were distributed to key populations. The project's achievements against annual targets for MSM and FSW in Botswana for Q1 FY20 are summarized in Figure 1. The achievement stood at 28% for HIV testing and counseling (HTS_TST), 31% for HTS_TST_POS, 31% for treatment initiation (TX_NEW), 64% for treatment continuation (TX_CURR), 25% for PrEP initiation (PrEP_NEW), and 101% for PrEP continuation (PrEP_CURR). The project also made progress in case-finding among FSW and MSM. Figure 2 illustrates FSW case-finding by district for Q1 FY20, with the highest case-finding in Francistown at 39% and the lowest in Selibe-Phikwe at 7%. Figure 3 illustrates MSM case-finding by district for Q1 FY20, with the highest case-finding in Ngamiland at 32% and the lowest in Selibe-Phikwe at 4%. The project's PrEP cascade in Q1 FY20 is illustrated in Figure 4. Out of 489 KPs who tested negative for HIV, 219 were screened for PrEP, all were eligible, and were offered PrEP. However, only 159 (73%) were newly enrolled into PrEP. The project will develop standard operating procedures and information, education, and communication materials to strengthen PrEP literacy across all districts and improve PrEP uptake. The project also made progress in ART uptake among FSW and MSM. Figure 5 illustrates the variation in uptake for ART among FSW by district for FY20 Q1, with the highest uptake in Gaborone at 142% and the lowest in Selibe-Phikwe at 114%. Figure 6 illustrates the variation in uptake for ART among MSM by district for FY20 Q1, with the highest uptake in Selibe-Phikwe at 150% and the lowest in Chobe at 100%. The project's treatment performance against target for FSW across districts is shown in Figure 7, with Gaborone achieving the highest achievement against targets at 49%.