PLoS ONE (Jan 2019)

Comparison of knowledge of HIV status and treatment coverage between non-citizens and citizens: Botswana Combination Prevention Project (BCPP).

  • Tafireyi Marukutira,
  • Lisa Block,
  • Mary Grace Alwano,
  • Stephanie Behel,
  • Joseph N Jarvis,
  • Unoda Chakalisa,
  • Kate Powis,
  • Vladimir Novitsky,
  • William Bapati,
  • Huisheng Wang,
  • Faith Ussery,
  • Refeletswe Lebelonyane,
  • Lisa A Mills,
  • Janet Moore,
  • Pamela Bachanas

DOI
https://doi.org/10.1371/journal.pone.0221629
Journal volume & issue
Vol. 14, no. 8
p. e0221629

Abstract

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IntroductionNon-citizens often face barriers to HIV care and treatment. Quantifying knowledge of positive HIV status and antiretroviral therapy (ART) coverage among non-citizens in a high HIV-prevalence country like Botswana that is close to achieving UNAIDS "90-90-90" targets may expose important gaps in achieving universal HIV testing and treatment.MethodsThe Botswana Combination Prevention Project (BCPP) is a pair-matched cluster-randomized trial evaluating the impact of prevention interventions on HIV incidence in 30 rural or peri-urban communities. Community case finding and HIV testing were conducted in home and mobile venues in 15 intervention communities from October 2013-September 2017. In this secondary analysis, we compared HIV positivity, knowledge of positive HIV-status, and ART status among all citizens and non-citizens assessed at intake in the intervention communities.ResultsHIV status was assessed in 57,556 residents in the intervention communities; 4% (n = 2,463) were non-citizens. Five communities accounted for 81% of the total non-citizens assessed. A lower proportion of non-citizens were HIV-positive (15%; n = 369) compared to citizens (21%; n = 11,416) [p = 0.026]; however, a larger proportion of non-citizens did not know their HIV-positive status prior to BCPP testing (75%) as compared to citizens (15%) [p = 0.003]. Among residents with knowledge of their HIV-positive status before BCPP, 79% of the non-citizens (72/91) were on ART compared to 86% (8,267/9,652) of citizens (p = 0.137).ConclusionsAlthough non-citizens were less likely to know their HIV-positive status compared to citizens, there were no differences in treatment uptake among non-citizens and citizens who knew their status. Designing interventions for non-citizens that provide HIV testing and treatment services commensurate to that of citizens as well as targeting communities with the largest number of non-citizens may help close a meaningful gap in the HIV care cascade and ensure ethical treatment for all HIV-positive persons.Trial registrationClinicalTrials.gov: NCT01965470 (Botswana Combination Prevention Project).