Universal Testing and Treatment for HIV Infection in Botswana.

Abstract

To the Editor: Makhema et al. (July 18 issue)1 report the results of the Ya Tsie trial that was conducted in Botswana from 2013 to 2018. In this trial, which evaluated the effect of increasing treatment coverage on preventing human immunodeficiency virus (HIV) infection, the incidence of HIV infection was approximately 30% lower in the intervention group than in the standard-care group. The trial took place in 13 subdistricts: Barolong, Central Bobonong, Central Boteti, Central Mahalapye, Central Tutume, Kgatleng, Kweneng East, Kweneng West, Ngamiland West, Ngwaketse, North East, Serowe Palapye, and South East. We calculated annual migration rates among all 28 subdistricts in Botswana and found a high inflow and outflow of the population in many districts where the trial took place. This migration could have substantially decreased treatment coverage and hence reduced the effectiveness of the intervention. Therefore, increasing levels of treatment coverage throughout Botswana could have a much greater effect on reducing the incidence of HIV infection than indicated by the results of the Ya Tsie trial.