Publications (2)3.23 Total impact
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ABSTRACT: Use of an innovative governance structure to successfully leverage private, public partnerships in the fi ght against HIV/AIDS in Botswana: The Madikwe Forum L. Busang1, K. Sikwibele1, L.R.G. Manthe1, C. Blumton1, T.L. Moeti1, B.C. Molomo2, G. Musuka1 1 ACHAP, 2 NACA Issue: National Coordinating Agencies (NCAs) have been established in many developing countries to strengthen the fi ght against HIV and AIDS. However, these institutions have long been victims of government bureaucratic procedures and systems in implementing HIV and AIDS interventions. Since 2001, the African Comprehensive HIV/AIDS Programme (ACHAP) has been providing support to Botswana’s National AIDS Coordinating Agency (NACA). Recognizing these challenges, the government and ACHAP established the Madikwe Forum to guide implementation of the overall ACHAP strategy in light of existing government policies and recommend changes in order to remove bottlenecks and bureaucratic challenges to implementation. Description: ACHAP is a public/private sector initiative between the Bill & Melinda Gates Foundation and Merck Foundation/Merck & Co., Inc., working in partnership with the Government of Botswana (GoB). In 2004, the Madikwe Forum was established to foster transparency and facilitate ACHAP’s contribution to the national HIV and AIDS strategic goals and to ensure the removal of project implementation bottlenecks. It consists of high-level representatives from Government, NACA, ACHAP Board of Directors (BOD) and ACHAP. The Forum meets frequently to review, assess and act on implementation issues arising out of ACHAP’s support to the national HIV and AIDS response of the GOB. Lessons Learned: The Madikwe Forum has presented an opportunity to tap into public sector experience and knowledge of government systems to enhance support to the GoB by building consultative partnerships based on a clearly defi ned governance structure with interaction at policy and implementation levels. Recommendations: A public/private sector HIV/AIDS response initiative faced with bureaucratic policy and implementation challenges should consider setting up a governance structure similar to that of the Madikwe Forum. Such a forum creates an opportunity for members to bridge policy, planning and implementation differences, develop common understanding of issues and enhance the impact of HIV/AIDS response programmes.
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ABSTRACT: This study uses surveillance, survey and program data to estimate past trends and current levels of HIV in Botswana and the effects of treatment and prevention programs. Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007. Using the prevalence trend we estimated the number of new adult infections, the transmission from mothers to children, the need for treatment and the effects of antiretroviral therapy (ART) and adult and child deaths. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. National prevalence is estimated at 26% (25-27%) in 2007. About 330,000 (318,000-335,000) people are infected with HIV including 20,000 children. The number of new adult infections has been stable for several years at about 20,000 annually (12,000-26,000). The number of new child infections has declined from 4600 in 1999 to about 890 (810-980) today due to nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The annual number of adult deaths has declined from a peak of over 15,500 in 2003 to under 7400 (5000-11,000) today due to coverage of ART that reaches over 80% in need. The need for ART will increase by 60% by 2016. Botswana's PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed.