Country Background
Botswana was the first African country to aim to provide HIV/AIDS treatment to all its needy citizens.   Yet even with the universal treatment access, the country continues to suffer greatly from AIDS.  The HIV/AIDS epidemic has reached a disturbing proportion of approximately 30% of the population in Botswana, and the HIV/AIDS prevalence is highest among women, especially pregnant women.  DNA PCR dry blood tests are the most commonly used technique in Botswana for HIV/AIDS diagnosis and more than 90% of infants are tested.

  GHI in Botswana

GHI in Botswana
GHI sent the Kellogg field team to Botswana in summer 2008 to conduct field research focusing on infant diagnosis.  The purpose of the market research wais to study the size and growth of the infant diagnosis market in Botswana, understand the interest, and pinpoint the unmet needs for HIV/ADIS testing, especially for infant diagnosis.  GHI teams interviewed extensively with the key stakeholders and collected valuable market information.  Different diagnosis technology concepts were also tested to identify the most desired product attributes for infant diagnosis in Botswana.

GHI future work in Botswana 
GHI will indentify the best location for an initial pilot program for infant diagnosis in Africa, and the field study results from Botswana will be evaluated and compared with other Africa countries.  GHI will continue to form and maintain relationships with local stakeholders and international NGOS working in Botswana, and develop potential partnerships to introduce the new Infant diagnosis to the area in the future. 

Preliminary Findings from Botswana
In 2008 Erin Linville, Jordan Linville, Peter Klein and Travis Jarrell visited various parts of Namibia and Botswana to conduct their research.  In 2006, both countries introduced DNA PCR dried blood spot (DBS) testing for infants where blood samples are collected at remote testing sites and sent to central laboratories for testing.  These testing networks now reach nearly all HIV exposed infants in Botswana.

Concept Testing
GHI’s proposal for a POC infant diagnostic device was met with moderate enthusiasm in both countries.  Recognized benefits included improved turnaround time of anywhere from 4-8 weeks (on average), accelerated treatment, and a probable reduction in long-term costs.  However, these benefits were deemed as less impactful than benefits that could be realized through investment in other problem areas (i.e. malaria, tuberculosis, education and infrastructure).  Furthermore, the increasing effectiveness of the PMTCT program (Prevention of Mother to Child Transmission) will make the need for short turnaround time less pronounced. 

Among those who work directly with mothers and infants, there were varying levels of excitement regarding the proposed devices.  In Botswana, DBS testing is run by the Ministry of Health. While testing is widely available at every healthcare facility throughout the country, turnaround times range from 2 weeks to 4 months.  In July 2008, a second central lab in Francistown had opened and turnaround times were expected to decrease to 3 weeks.  The primary benefit of POC testing in Botswana is the ability to prescribe ARVs one month earlier (on average) for HIV-positive infants.

In conclusion, this group found that the POC infant test would be less impactful in Namibia and Botswana than in countries where no DNA PCR testing is available.  However, the countries’ developed infrastructure suggests that a pilot test would be an implementation “best case scenario,” and this could be a positive for a pilot.  Key recommendations from this group are:

  1. Maintain regular contact with the stakeholders they met
  2. Work with international partners across countries
  3. Identify the best pilot site/county for the POC testing device