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PLoS One. 2019 Aug 29;14(8):e0221629. doi: 10.1371/journal.pone.0221629. eCollection 2019.

Comparison of knowledge of HIV status and treatment coverage between non-citizens and citizens: Botswana Combination Prevention Project (BCPP).

Author information

1
Centers for Disease Control and Prevention, Gaborone, Botswana.
2
Public Health, Burnet Institute, Melbourne, Australia.
3
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
4
Northrop Grumman Corporation, Atlanta, Georgia, United States of America.
5
Division of Global HIV/AIDS and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
6
Botswana-UPenn Partnership, Gaborone, Botswana.
7
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
8
Botswana-Harvard Partnership, Gaborone, Botswana.
9
Harvard T.H Chan School of Public Health, Boston, Massachusetts, United States of America.
10
Tebelopele HIV Testing and Counselling Centre, Gaborone, Botswana.
11
Department of HIV/AIDS Prevention and Care, Botswana Ministry of Health, Gaborone, Botswana.

Abstract

INTRODUCTION:

Non-citizens often face barriers to HIV care and treatment. Quantifying knowledge of positive HIV status and antiretroviral therapy (ART) coverage among non-citizens in a high HIV-prevalence country like Botswana that is close to achieving UNAIDS "90-90-90" targets may expose important gaps in achieving universal HIV testing and treatment.

METHODS:

The Botswana Combination Prevention Project (BCPP) is a pair-matched cluster-randomized trial evaluating the impact of prevention interventions on HIV incidence in 30 rural or peri-urban communities. Community case finding and HIV testing were conducted in home and mobile venues in 15 intervention communities from October 2013-September 2017. In this secondary analysis, we compared HIV positivity, knowledge of positive HIV-status, and ART status among all citizens and non-citizens assessed at intake in the intervention communities.

RESULTS:

HIV status was assessed in 57,556 residents in the intervention communities; 4% (n = 2,463) were non-citizens. Five communities accounted for 81% of the total non-citizens assessed. A lower proportion of non-citizens were HIV-positive (15%; n = 369) compared to citizens (21%; n = 11,416) [p = 0.026]; however, a larger proportion of non-citizens did not know their HIV-positive status prior to BCPP testing (75%) as compared to citizens (15%) [p = 0.003]. Among residents with knowledge of their HIV-positive status before BCPP, 79% of the non-citizens (72/91) were on ART compared to 86% (8,267/9,652) of citizens (p = 0.137).

CONCLUSIONS:

Although non-citizens were less likely to know their HIV-positive status compared to citizens, there were no differences in treatment uptake among non-citizens and citizens who knew their status. Designing interventions for non-citizens that provide HIV testing and treatment services commensurate to that of citizens as well as targeting communities with the largest number of non-citizens may help close a meaningful gap in the HIV care cascade and ensure ethical treatment for all HIV-positive persons.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT01965470 (Botswana Combination Prevention Project).

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