Prevention and Control of the HIV Epidemic in Botswana: Surveillance, Modeling and Implementation of Interventions

Dr. Tendani Gaolathe visiting a Patient

 Participant List | Program

From June 12-15, 2008 participants convened in Gaborone, Botswana for the conference, “Prevention and Control of the HIV Epidemic in Botswana: Surveillance, Modeling and Implementation of Interventions.”

The conference brought together epidemiologists, virologists, biostatisticians, behavioral scientists, clinicians, community representatives, government officials and experts from the Botswana Ministry of Health, the World Health Organization, and the U.S. Centers for Disease Control. Representatives were from Botswana, South Africa, the U.S. and other countries. The conference was designed to stimulate discussion about HIV surveillance and prevention strategies. 54 participants attended. (See Participant List).

Sessions were led by experienced HIV/AIDS experts who are intimately involved in HIV research and surveillance initiatives or play key roles in establishing and/or advising national treatment and prevention programs. (See Program.) The meeting emphasized open discussion and comparative analysis.

SESSIONS COVERED THE FOLLOWING AREAS:

  • Status of International Programs: Surveillance and Prevention
  • Status of National Programs on Surveillance and Prevention in Botswana
  • Status of Potential Non-Vaccine Interventions for Reduction of Incidence
  • Methodological Challenges in Estimating and Tracking HIV Incidence Rates and Integration of Modeling for Prevention

Areas of Agreement

Botswana has been a global leader in HIV/AIDS policy and treatment. Now, as the Government puts an increasing focus on prevention, researchers and policy makers must work together to implement effective prevention programs. We need to rethink efforts on how to improve prevention methods, as well as improve efforts at measuring the impacts of prevention through surveillance in ways that are both timely and cost effective.

Areas of general agreement among participants were as follows:

• Male circumcision is effective in reducing transmission of HIV.

• Antiretroviral drugs are an effective means of both treatment and prevention of HIV.

• For prevention, ARVs are effective for mother- infant chemo-prophylaxis, PeP, PrEP, and treatment of index cases. Additional uses of ARVs for prevention purposes warrant further investigation.

• There must be open engaged communication between policy makers and researchers, between national and international agencies, especially in the discussions of which drug regimens are best for therapy in comparison with those that are best for transmission prevention using chemo-prophylaxis.

• The most effective prevention efforts combine a number of complementary interventions, rather than relying on a single intervention.

• Prevention programs should target those most at risk of becoming infected with HIV, especially teenagers and young adults.

• Better surveillance is needed for measuring incidence.

• Identification of acute infections represents an under-utilized tool in the fight against HIV.

• We should look at issues of pooling as a means to reduce surveillance costs of screening for recent infections.

• Modeling is critical to predict which prevention methods may be most effective.

• Models should help determine in real time which programs are succeeding and which are failing and how best to make midpoint corrections. It is important to validate or correct models by using actual surveillance data.

• Prevention programs should be country specific, taking into account local contexts and culture.

• We need better ways to study the influence of communities and community norms on individual behavior. We need to understand why people behave in certain ways.

• We need to understand the dynamics of sexual networks, which may help in understanding community dynamics. This would help in targeting interventions.

• At a population level, we need to determine which intervention methods will lead to behavior change that will help to decrease the rate of new infections.

• Policy makers should be a part of all discussions.


Participant List


Dr. Marina Anderson
Ministry of Health
Botswana

Dr. Aida Asmelash
Botswana-Harvard AIDS Institute Partnership
Botswana

Mr. Benjamin Binagwa
African Comprehensive HIV/AIDS Partnerships
Botswana

Dr. Deborah Birx
Global AIDS Program/CDC
United States

Dr. Sally Blower
UCLA
United States

Dr. Stephane Bodika
CDC/BOTUSA
Botswana

Mr. Lesego Busang
African Comprehensive HIV/AIDS Partnerships
Botswana

Dr. Hermann Bussmann
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Mary Maya Carlson
Harvard Medical School
United States

Dr. Esther Chigidi 
University of Botswana
Botswana

Dr. Bagele Chilisa
University of Botswana
Botswana

Dr. Hoosen Coovadia
Centre for the AIDS Programme of Research in S. Africa
South Africa

Dr. Margarett Davis
CDC/BOTUSA
Botswana

Dr. Victor De Gruttola
Harvard School of Public Health
United States

Dr. Diana Dickinson
Provate Practice
Botswana

Mr. Thabo Diphoko
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Felton James Earls
Harvard University
United States

Dr. Max Essex
Harvard AIDS Initiative
United States

Dr. Boga Fidzani
National AIDS Coordinating Agency
Botswana

Dr. Tendani Gaolathe
BHP-PEPFA
Botswana

Dr. Florindo de la Hoz Gomez
Ministry of Healt
Botswana

Rev. Rupert Hambira
Botswana-Harvard AIDS Institute Partnership
Botswana

Ms. Martha Henry
Harvard AIDS Initiative
United States

Dr. Phyllis Kanki
Harvard-PEPFAR
United States

Dr. Poloko Kebaabetswe
CDC/BOTUSA
Botswana

Dr. Stephen Lagakos
Harvard School of Public Health
United States

Dr. Rolang George Majelantle
University of Botswana
Botswana

Dr. Joseph Makhema
Botswana-Harvard AIDS Institute Partnership
Botswana

Mr. Leonard Manthe
African Comprehensive HIV/AIDS Partnerships
Botswana

Ms. Tlhalefo Maotwe
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Keikantse Matlhagela
Botswana-Harvard AIDS Institute Partnership
Botswana

Mr. Richard Matlhare
National AIDS Coordinating Agency
Botswana

Dr. Madisa Mine
Ministry of Health
Botswana

Dr. Koleka Mlisana
Centre for the AIDS Programme of Research in S. Africa
South Africa

Ms. Mpho Mmelesi
Ministry of Health
Botswana

Dr. Themba Moeti
African Comprehensive HIV/AIDS Partnership
Botswana

Dr. Howard Moffat
Ministry of Health
Botswana

Honorable Minister Lesego Motsumi
Ministry of Health
Botswana

Mr. Sikhulile Moyo
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Rosemary Musonda
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Godfrey Musuka
African Comprehensive HIV/AIDS Partnerships
Botswana

Ms. Marlene Nkete
National AIDS Coordinating Agency
Botswana

Mr. David Nkwe
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Vladimir Novitsky
Harvard School of Public Health
United States

Dr. Anthony Ogwu
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Saladin Osmanov
WHO-UNAIDS HIV Vaccine Inititative
Switzerland

Dr. Thomas Rehle
Human Science Research Council
South Africa

Dr. Thierry Roels
CDC/BOTUSA
Botswana

Ms. Raabya Rossenkhan
Botswana-Harvard AIDS Institute Partnership
Botswana

Ms. Michelle Schaan
Botswana-Harvard AIDS Institute Partnership
Botswana

Dr. Khumo Seipone
Ministry of Health
Botswana

Mr. Kelvin Sikwebele
African Comprehensive HIV/AIDS Partnerships
Botswana

Dr. Negussie Taffa
CDC/BOTUSA
Botswana

Mr. Gigi Thomas
University of Botswana
Botswana

Mr. Erik Widenfelt
Botswana-Harvard AIDS Institute Partnership
Botswana


Program


Thursday, June 12, 2008

5:30-7:30 PM  Check-in and Registration

6-7 PM Reception

7-9 PM Dinner with remarks by Honorable Minister Leego Motsumi and Max Essex

Friday, June 13, 2008

8-10 AM Session I: Status of International Programs: Surveillance and Prevention
Chairs: Max Essex and Themba Moeti

Presentations:
• CDC: Deborah Birx
• IMPAACT Network: Hoosen Coovadia
• World Health Organization: Saladin Osmanov
• Harvard PEPFAR: Phyllis Kanki

Discussants: Loeto Mazhani, Rosemary Musonda, Luke Nkinksi, Thomas Rehle

10 – 10:15 AM Break

10:15 – 11:30 AM Discussion of Session I

11:30-12:30 PM Session II: Status of National Programs on Surveillance and Prevention in Botswana
Chairs: Steve Lagakos and Newman Kahiya

Presentations:
• African Comprehensive HIV/AIDS Program (ACHAP): Themba Moeti
• National AIDS Coordinating Agency (NACA): Boga Fidzani
• Ministry of Health HIV/AIDS Prevention and Care: AIDS/STD Surveillance: Khumo Seipone

12:30 – 2 PM Lunch

2 – 3:30 PM Continuation of Session II: Status of National Programs on Surveillance and Prevention in Botswana

Presentations:
• BAIS Household Survey: Marlene Nkete
• BOTUSA: Margarett Davis
• Botswana–Harvard Partnership (BHP): Joseph Makehma

Discussants: Tendani Gaoloathe, Florindo de la Hoz Gomez, Leonard Manthe, Richard Matlhare, Howard Moffat, Thierry Roels

3:30 – 3:45 PM Break

3:45 – 5 PM Discussion fo Session II

7 PM Dinner

Saturday, June 14, 2008

8:30 – 10:30 AM Session III: Status of Potential Non-Vaccine Interventions for Reduction of Incidence
Chairs: Margarett Davis and Joseph Makhema

Presentations:
• Circumcision: Poloko Kebaabetswe
• Mother/infant chemoprophylaxis:
(i) Prenatal and perinatal: Aida Asmelash
(ii) Breastfeeding: Anthony Ogwu
• Behavior modification:
(i) Adolescents: Felton Earls
(ii) High Risk Adults: Kokeka Mlisana

10:30 – 10:45 AM Break

10:45 – 11:45 AM Continuation of Session III: Status of Potential Non-Vaccine Interventions for Reduction of Incidence

Presentations:
• Education: Bagele Chilisa
• Antiretrovirals use in adult chemoprophylaxis PREP: Poloko Kebaabetswe
• Relevance of drug resistance to HIV-1C for prophylaxis and HAART treatment: Max Essex
• Estimation of prevalence and incidence of drug-resistant variants in HIV-1C epidemic: Hermann Bussmann

12 – 12:30 PM Discussion of Session III

Discussants: Stefane Bodika, Lesego Busang, Sikhulile Moyo, Maya Carlson, Diana Dickinson, Kelvin Sikwibele

12:30 – 2 PM Lunch

2 – 3:30 PM Continuation of Session III Discussion

3:30 – 3:45 PM Break

3:45 – 5 PM Session IV: Methodological Challenges in Estimating and Tracking HIV Incidence Rates and Integration of Modeling for Prevention
Chairs: Leonard Manthe and Florindo de la Hoz Gomez

Presentations:
• Characterization and detection of acute infection: Vlad Novitsky
• Development and use of serological assays for detection of acute infection: Sikhulile Moyo
• Limitations and challenges of STAHRS and BED assays for incorporation of demographic and temporal information: Steve Lagakos
• Potential value of pooling studies and other approaches for estimating incidence: Victor DeGruttola

7 PM Dinner

Sunday, June 15, 2008

8:30 – 9:20 AM Continuation of Session IV: Methodological Challenges in Estimating and Tracking HIV Incidence Rates and Integration of Modeling for Prevention
Chairs: Leonard Manthe and Florindo de la Hoz Gomez

Presentations:
• Use of modeling most important determinants for prevention to prioritize future research: Sally Blower
• Second-generation HIV surveillance: Thomas Rehle

9:20 – 10 AM Discussion of Session IV

Discussants: Steve Lagakos, Rolang Majelantle, Godfrey Musuka, Negussie Taffa

10 – 10:15 AM Break

10:15 – 11 AM Continuation of Session IV Discussion

11 – 12:30 PM Session V: Summary: Future Directions

Discussion leaders: Deborah Birx, Hoosen Coovadia, Victor DeGruttola, Max Essex, Themba Moeti, Madisa Mine

Rapporteurs: Raabya Rosenkahn, Keikantse Matlhagela


ACHAP LogoThis conference was generously supported by The African Comprehensive HIV/AIDS Partnerships (ACHAP).