Botswana: Botswana Rolls Out Treatment in Remote Areas (August 2007)

In remote places like Bokspits, Botswana, a growing number of people are accessing antiretroviral therapy (ART) thanks to support from the U.S. President's Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR). The Kgalahadi District in Botswana was one of the first to roll out treatment to several rural clinics, enabling patients to receive medications where they live instead of traveling long distances.

Out of the 950 people currently on ART in the district, about half reside in remote villages (namely Bokspits, Middelspits and Werda) outside of Tsabong, the district headquarters where antiretroviral drugs (ARVs) are dispensed from the primary hospital. Many people in these areas are unemployed with little or no income and no transportation making it difficult to receive treatment. Recognizing this, district officials pushed for the rollout of treatment to satellite clinics.

The Kgalagadi District began rolling out ART in the village of Middelspits in August 2006. In April 2007, they expanded the program to Werda. A mobile caravan allows the doctors at the two clinics to take treatment to Bokspits and other remote places at least once a month. This expansion has enabled patients enrolled at the primary hospital in Tsabong to be transferred to closer clinics.

Nurses and lay counselors at the clinics and surrounding health posts say the rollout has already made an impact in their communities.

"Word is getting out that ARVs are now available here, so we have seen people come in big numbers to test for HIV," Lenah Metswi, a lay counselor at Middelspits Clinic, said. "I think there is less hesitancy now knowing that they can get this service at home without having to travel so far."

Botswana has been at the forefront of the response, to the HIV/AIDS pandemic. In 2002, it was one of the first countries in Africa to provide its citizens free HIV/AIDS treatment. Now more than 90 percent (approximately 82,500) of those estimated to need treatment are receiving it. The U.S. Government, through PEPFAR, is supporting Botswana's treatment efforts with more than $18.5 million in Fiscal Year (FY) 2006 and $25.1 million in FY 2007.

Sophia Busang lives in the tiny village of Bokspits, located in the southernmost tip of Botswana. Once the winner of a local beauty pageant, Sophia's life changed dramatically when she learned she was HIV positive. The disease stripped her health and confidence, but with the help of life-saving ARV's, Sophia once again walks with the poise of a former beauty queen.

"I used to walk like this," she says, demonstrating her illness by crouching low, holding her stomach and moaning. Then, with a wide and toothy grin, she suddenly stands upright. "Now (with ARVs), I am like this again," she says, marching in big steps with her head held high.

Sophia's story is one of many surfacing in far-off places like Bokspits, one of the most remote villages in the Kalahari where a growing number of people are benefiting from the ART program.

Dr. Mwala, a clinic doctor, attributes the successes of the ART rollout to the motivated workers who support the clinics and health posts at the grassroots level. "Their level of commitment and record keeping is remarkable," Mwala said. "Without them this rollout couldn't have happened."

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