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BWA | Dec 5, 2021

Botswana reaches key milestone in the elimination of mother-to-child HIV transmission

/ Our Today

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Kenielwe (in red) and her mother Cecilia (in Blue) walk around Lobatse town, in Botswana, where Kenielwe goes to high school. Now 17-years-old, Kenielwe was born HIV-free thanks to the medication her took when she was pregnant. (Photo: World Health Organization)

Botswana has become the first high-burden country to be certified for achieving an important milestone on the path to eliminating mother-to-child transmission of HIV by the World Health Organization (WHO).

High-burden HIV countries are defined as those with more than two per cent of pregnant women living with the virus. In a press release, UNAIDS says Botswana has achieved the “silver tier” status, which moves it closer to eliminating mother-to-child HIV transmission.

The WHO awards this certification to countries that have brought the mother-to-child HIV transmission rate to under five per cent; provided antenatal care and antiretroviral treatment to more than 90 per cent of pregnant women and achieved an HIV case rate of fewer than 500 per 100,000 live births.

For his part, WHO Regional Director for Africa, Dr Matshidiso Moeti asserted, “This is a huge accomplishment for a country that has one of the most severe HIV epidemics in the world – Botswana demonstrates that an AIDS-free generation is possible. This groundbreaking milestone is a big step forward in ending AIDS on the continent and shows how visionary political leadership aligned with public health priorities can save lives. I look forward to other African countries also reaching this goal.”

National response spanning two decades

Fifteen countries across the globe have been certified for eliminating mother-to-child HIV transmission. However, none of them had an epidemic as large as Botswana. The country’s feat to date on its journey to elimination is the result of a national response strategy spanning two decades.

In 1999 and facing an HIV prevalence rate as high as 30 per cent, Botswana initiated an aggressive programme to prevent mother-to-child transmission. “Botswana’s pathfinding accomplishment demonstrates the remarkable progress that can be achieved when the needs of mothers living with HIV and their children are prioritized,” explained Winnie Byanyima, UNAIDS Executive Director.

According to her, “Children are among the groups left furthest behind in the HIV response. Addressing this inequality and preventing new HIV infections in children is critical if we are to end AIDS. Political commitment, strong leadership and the hard work of dedicated health care workers and communities in Botswana have delivered impressive results.”

Women living with HIV who do not receive antiretroviral (ARV) medicine have a 15–45 per cent chance of transmitting the virus to their children during pregnancy, labour, delivery or breastfeeding. That risk drops to less than five per cent if treatment is given to both mothers and children throughout the stages when transmission can occur. Botswana quickly achieved national ARV coverage before going on to implement increasingly effective regimens, following WHO guidance.

In 2013, Botswana became one of the first countries in the world to implement the so-called ‘Option B+’, a plan for treating all pregnant and breastfeeding women living with HIV with a highly effective lifelong triple antiretroviral treatment regimen at the time of diagnosis.

Pictured is Dora, a poultry farmer who is living with HIV in Serowe village, Botswana. After sticking with her medication, the Botswanan was happy to learn her baby was born HIV-free. (Photo: World Health Organization)

The global validation criteria and processes date to 2015, when UNAIDS, UNICEF, WHO and other partners created the Global Validation Advisory Committee to standardise the measurement of achievements for eliminating mother-to-child transmission of HIV and syphilis.

In 2017 and in recognition of the achievements made by countries with a high burden of HIV that were demonstrating significant and sustained reductions in the mother-to-child transmission rate, new Path to Elimination criteria were introduced. The elimination agenda has broadened to a “triple elimination” of mother-to-child transmission of HIV, syphilis and hepatitis B.

Botswana is now updating its guidance regarding syphilis and will expand its elimination objectives moving forward. Mohamed Fall, UNICEF Regional Director for Eastern and Southern Africa, argued that the country’s progress could serve as an example for others.

He added, “We applaud Botswana for this remarkable achievement, which serves as inspiration to other countries in Eastern and Southern Africa. The progress on prevention of mother to child transmission of HIV in this region is truly a public health success, with more than 1.7 million new infections in children averted since 2010.”

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