Comparison of knowledge of HIV status and treatment coverage between non-citizens and citizens: Botswana Combination Prevention Project (BCPP).
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Author list: Marukutira T, Block L, Alwano MG, Behel S, Jarvis JN, Chakalisa U, Powis K, Novitsky V, Bapati W, Wang H, Ussery F, Lebelonyane R, Mills LA, Moore J, Bachanas P
Publisher: Public Library of Science
Publication year: 2019
Journal: PLoS ONE (1932-6203)
Journal acronym: PLoS One
Volume number: 14
Issue number: 8
ISSN: 1932-6203
eISSN: 1932-6203
Languages: English-Great Britain (EN-GB)
Abstract
INTRODUCTION\nMETHODS\nRESULTS\nCONCLUSIONS\nTRIAL REGISTRATION\nNon-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.\nThe 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.\nHIV 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).\nAlthough 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.\nClinicalTrials.gov: NCT01965470 (Botswana Combination Prevention Project).
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