MILESTONE Botswana breaks another HIV response
Record
Botswana is the first country in the SADC region to roll out Operation Triple Zero (OTZ), an initiative aimed at ending HIV/ AIDS and improving advocacy. This is a customised adolescentfocused service delivery model, which stands for “Zero viral load, Zero missed appointments, and Zero missed drugs.
It was made possible by UNICEF in partnership with the Ministry of Health, NAHPA, Centre for Disease Control (CDC) and implementing partners, Sentebale and Baylor Botswana.
It will provide a platform for young people living with HIV to interact with peers facing similar challenges, which has helped to relieve anxiety and uncertainty among enrolees. The programme also prioritises timely antiretroviral refills and encourages viral load sample collection during OTZ club meetings to support continuity in care.
In Botswana, adolescents ages (10 to 19) and young persons (ages 15 to 24) living with HIV are among the most vulnerable yet underserved populations in the HIV response compared to adult populations. This was highlighted by Deputy Chief of Mission at UNICEF, Amanda Jacobsen. She said they are hopeful that the Operation Triple Zero initiative would amend this concern as this group lags behind across the entire HIV treatment cascade.
Jacobsen emphasised that Adolescents and Young People (AYP) living with HIV are faced with challenges related to growing up with HIV infection, including stigma and discrimination, clinical complications, side effects of treatment, problems with long-term adherence to treatment, stress, anxiety and other mental health issues, while faced with the developmental tasks of this phase of life. “Disclosure of HIV diagnosis to others, including sexual partners, sexual and reproductive health decisions, academic performance with potentially long-term effects on employability, income and wellbeing are challenges this cohort of young people face,” she added.
e young people attended the launch in large numbers to learn about the initiative, and also air their views. ey have excitedly welcomed this initiative and appreciated being made part of its inception, hence the adopted children’s notion ‘nothing for us, without us’. Other challenges faced by this population include transitioning from health services provided in pediatric HIV care settings to adult HIV care systems, the lack of adolescent-friendly health services and assuming increased responsibility for their own care. HIV activist, Tlotlo Moilwa who was the Master of Ceremonies on the day, emphasised that they are hopeful that this will help curb discrimination against people living with HIV, as the initiative aims at encouraging young people to disclose their status and achieve the mandate of the programme.
She decried that discrimination is still rife in Botswana, which hinders many especially young people to accept their status and take their treatment accordingly.
According to Botswana AIDS Impact Survey (BAIS V), 84·5 percent of young people aged 15 to 24 years living with HIV were aware of their status, 98·5 percent of those aware were on ART, and 91·6 percent of those on ART had viral load suppression. Jacobsen also reiterated that the plan of this programme is to increase the number of adolescents who get their treatment well with no missed appointments, and perhaps become virally suppressed. “We believe that this approach will lead to an increase in the number of adolescents who are comfortable disclosing their HIV status, and who
successfully enrol in and continue ART care and take full ownership of their health care,” she said. e ceremony marked yet another great episode in the remarkable journey towards HIV epidemic control in Botswana. It is part of the US President’s Emergency Plan for AIDS Relief (PEPFAR). e CDC Botswana continues to provide technical and financial assistance to Botswana through the Ministry of Health (MOH) and its partners to effectively scale up paediatric and adolescent HIV care and treatment services across health centres and hospitals in the country.
Jacobsen added that in the fiscal year 2023-2024, a total amount of $467, 000 was provided to UNICEF to support this initiative. UNICEF Representative, Dr Joan Matji said that the programme comes at a critical time when adolescents are falling behind regarding the 95-95-95 targets, and they must not be left behind.
“We have reasons to be proud of Botswana’s progress in its HIV response. From being one of the countries with the highest burdens of HIV in the world, Botswana has achieved and, in some targets, surpassed the UNAIDS 95-95-95 targets. Moreover, we have received the silver tier status for PMTCT,” she said.
“UNICEF is grateful to have young people that are ready to champion their needs to ensure their voices are amplified and heard at all levels. Young people are the cornerstone of the country’s present and future. It is therefore our hope to continue to see them engage and communicate their needs to decision makers,” she added. She said their research has proven that in Motokwe village, many children under five years of age miss vaccinations and adolescents miss their medical monthly check-ups and medication.
e programme is expected to help in clinical follow-ups with the youth who do not adhere to treatment to help the situation and gradually have most of the youth being actively involved with their health. is will also work positively for Botswana’s commitment to achieving the UNAIDS 95-95-95 goals across all age categories. e introduction of the OTZ approach will assist to reach AYP living with HIV with a package of care that includes youth-friendly HIV services, connectedness, positive living messages, caregiver education on supportive parenting and strategies to improve health by targeting zero missed appointments, zero missed medications and zero viral load for adolescents and young persons.