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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

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



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.


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.


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).


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: NCT01965470 (Botswana Combination Prevention Project).

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