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Declining HIV Prevalence among young women in Botswana: Results from the 2009 ANC Sentinel Surveillance survey Authors: Yadav Bindeshwar P Anderson Marina G Mine Madisa Moyo Sikhulile Seipone Khumo Presenter Dr M Anderson MD MPH

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Background Botswana is one of the countries hardest hit by HIV in the world. It is experiencing generalized epidemic with high levels of HIV prevalence. Ante-natal sentinel surveillance has been conducted in the country since 1992. Ante-natal sentinel surveillance aims to estimate HIV point prevalence among pregnant women aged 15-49 years.

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3 To determine prevalence of HIV infection among pregnant women of 15-49 years old. To monitor trends of HIV infection among pregnant women of 15-49 years old. To use left over blood for routine tests during ANC visits to determine HIV prevalence, and HIV incidence.

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Methodology (2009 Surveillance) Survey Design The antenatal HIV surveillance survey is an anonymous, unlinked, cross-sectional survey. Study population Pregnant women aged 15 to 49 years presenting for the first time for antenatal clinic, for their current pregnancy Sentinel Sites (n = 262 facilities) In each district, the primary or general hospital served as the primary sentinel site. It was complemented by several health facilities as satellite sites to achieve the targeted sample size. Study Period 13 July 2009 9 October 2009

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Botswana Sentinel Surveillance 2009 Sample Flow for all sites Purple top (EDTA) tube (Name and Barcode) Haemoglobin, rhesus factor and blood group tests Left to settle upright at room temp OR spun at 3000 rpm for 3 min before separation. Syphilis test is done, results sent back to district facility. Results also documented on the syphilis form, adjacent to individual bar-code, and sent to the NHL. Make 3 x DBS Cards Red Top (PLAIN or CAT) (Name and Barcode) Label each DBS card with 1- Barcode Dry, Package and send to National Health Laboratory for HIV testing

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Forms Data Flow Forms received 7631 Total rejected 292 (3.8%) Not participating Facility Age out of range Date out of Time frame Form not readable or incomplete Not participating Facility Age out of range Date out of Time frame Form not readable or incomplete Laboratory Results received Information Bank Database Complete Forms Finally 7339 valid Forms available for analysis

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Data Analysis Data was analyzed using Microsoft Excel and Epi Info version 3.5.1 statistical software

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Age group of the participants VariableNo.Percent Age group. N=7339 15-19100613.7 20-24228831.2 25-29203827.8 30-34119216.2 35-396048.2 40-441912.6 45-49200.3

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Trend in HIV Prevalence among young women 15-19 years and 20-24 years pregnant women in Botswana (1992-2009) Highest prevalence in 1995 in 15-19 yrs age group, and in 1998 in 20-24 years age group

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YearAge group HIV Positive TotalHIV Prevalence P value 200715-19 years 190110417.2%0.011 200915-19 years 133100613.2% 200720-24 years 703252128.1%0.003 200920-24 years 552228824.1% Comparison of 2007 and 2009 HIV prevalence among young pregnant women in Botswana

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49.7% 50.4% HIV Prevalence among older age group pregnant women in Botswana (1992-2009) In age group the highest prevalence was estimated in 2000, and it is declining since 2003

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The highest HIV prevalence is (50.7%) among 35-39 years old pregnant women in sentinel surveillance 2009

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References: 2009 Botswana Second Generation HIV/AIDS Sentinel Surveillance Result 2007 Botswana Second Generation HIV/AIDS Sentinel Surveillance Technical Report 2005 Botswana Second Generation HIV/AIDS Surveillance Technical Report SENTINEL SURVEILLANCE REPORT 1999 AIDS / STD UNIT, Ministry of Health, Botswana

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16 Age group 20 24 1994 P = 31.5% 1999 2004 2009 The age group 20 24 in 1994...

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17 1994 P = 31.5% 1999 P = 43.3% 2004 2009 Age group 25 29 New Infections The age group 20 24 in 1994 becomes the age group 25 29 in 1999

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18 1994 P = 31.5% 1999 P = 43.3% 2004 (2005 P=49.2%) 2009 Age group 30 - 34 New infectons The age group 25 29 in 1999 becomes the age group 30 34 in 2004

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19 1994 P = 31.5% 1999 P = 43.3% 2004 2005 P=49.2% 2009 P = 50.7% Age group 35 - 39 New infections The age group 30 34 in 2004 becomes the age group 35 - 39 in 2009

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20 1994 P = 31.5% 1999 P = 43.3% 2004 (2005.P=49.2%) 2009 P 50.7% Age group 20 24 Age group 25 - 29 New Infections Age group 30 - 34 New infections Age group 35 - 39 New infections It follows that highest prevalence among age group 35-39 in 2009 is could be due to long survival because of wide ART coverage in the country, and less likely due to new infections.

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Discussion Data indicates a significant decline in HIV prevalence among young pregnant women over time Declining HIV prevalence among young pregnant women in Lusaka, (Elizabeth et al. WHO Bulletin 2008) New HIV infections have been reduced by 17% over the past eight years (UNAIDS / WHO : AIDS update 2009) In the oldest age groups the HIV seroprevalence has increased as highly active antiretroviral therapy becomes more widespread potentially fewer people dying from AIDS..

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CONCLUSIONS As Botswana works hard to curb the HIV epidemics, these results from the youngest age groups are encouraging, given the highest political priority and efforts to achieve a new HIV infection free Botswana by 2016.

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Recommendations HIV prevention efforts should continue to be promoted widely, and even strengthened. Promotion of strong preventive strategies for youth of all socioeconomic classes.

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Thanks Thank you