The Minister of Health (MoH), Edwin Dikoloti announced that Botswana has approved the use of injectable anti-retroviral drugs to improve adherence to HIV treatment, becoming just the second country in Africa to do so. Taking a pill every day at a particular time is not only emotionally draining to people living with HIV but also an inconvenience to others. Many people have defaulted due to fear of discrimination and stigma, as well as other personal circumstances which make taking a pill every day inconvenient.

The injectable ARV can be taken once every two months, meaning just six injections, as opposed to the daily ARV pill. Although she does not have the disease, 29-year Ophadile Gofhamodimo from Jwaneng said from her interactions with HIV/AIDS patients, it is clear that taking ARV pills every day is very uncomfortable and a tiring routine to keep up with. “Many people are afraid to take their HIV treatment and I have a cousin who passed away because she was defaulting. “I feel that the injection will motivate people to adhere without defaulting. “It will also motivate people to test for HIV because no one will know that you are on treatment because the injection will be in your blood, unlike pills that you have to carry everywhere.

“With the injection, they will not be judged anymore,” says 19-year-old Masego Pelontle from Palapye. For her part, Sekgabo Seselamarumo from Maun welcomed the initiative with open arms saying injectable ARVs were a good intervention and ART development. The activist expects that people who have been defaulting will stop doing so.

“It will help a lot with people who have been relapsing and not taking their ARVs consistently,” she said. “It is just an injection and you take less than an hour to get it then can carry on in the most normal way with your life. “You don’t have to think of what time you should take your pill. “With it, people would not relapse. It doesn’t give people any reason to default medication.” For Seselamarumo, the injectable means young people will not need their parents to watch out for their intake of pills. Students will not miss class to get their pills refilled, as the injection is taken twice a month. “Taking the injection, you don’t have to tell anyone about your status. “You just take your injection and live more of a normal life with your friends and housemates.

“Injectables will give students a normal life and not interfere with their social life.

“It will improve people’s lifestyles.”

Bonosi Segadimo, another HIV activist, says many of the people she works with default as they hate being seen in long queues and holding ARV tablets in bottles that even make noise in public transport. Others find it difficult to take their meds in front of their partners more especially when they are not ready to disclose to them. This has resulted in many defaulting and lasting days or even weeks without taking their treatment.

“When you take your two months’ jab, things would be easier,” she said. “You can go wherever you want knowing that you have ARVs in your system. “This injectable will also help young girls who are prone to new infections because those old men will at least take the injection and not default therefore reducing reinfection and infecting innocent girls. “Many men are also afraid to disclose and that increases their viral load. Those in denial and who are afraid to test take their meds, those who are habitual defaulters, will also be motivated to take their meds.” For Keddy Makwati from Lobatse, the rollout has come at the right time. He, however, believes it could have been done “a long time ago to address the issue of defaulting”.

Health ministry chief public relations officer, Christopher Nyanga said the injectable programme is expected to be up and running in Botswana after June 2023. He added that it would be implemented side by side with the current HIV oral-based (tablet) medication, explaining that decisions on which areas to start the programme would be made in due course.

“This is a major advantage for patients, as they do not have to take medications every day like the oral formulations,” Nyanga said.

“This, therefore, helps improve treatment adherence, leading to high chances of viral load suppression and less chances of developing medicines resistance. It also helps reduce default rates. “All HIV-positive people in Botswana currently taking Antiretroviral Therapy medication and are stable on their first-line treatment, virally suppressed, and not having any opportunistic infections, will be eligible,” he said.

However, he pointed out that patients who were starting ARV treatment, would not be eligible adding that those who previously failed on any ARV treatment regimen would also not be eligible. Patients known to have an allergy to any of the two medications would also not be eligible. He added that it would improve treatment adherence, reduce chances of treatment failure, and reduce chances of developing medicine resistance.

“With improved chances of viral suppression, patients are also less likely to transmit the virus, hence less new infections for the country and less projected expenditure on ARV medicines and laboratories for the country.

“When all the logistics of implementation of the use of the injectable have been worked out, it is hoped that the medicines will be made available.”

Nyanga stressed that not all patients who qualify for the injectable would necessarily receive it, as some would get theirs through their medical aid.

Although HIV appeared to take a back seat to the COVID-19 pandemic in recent years, the virus continues to be a priority for the local healthcare sector. According to the preliminary results of the Botswana AIDS Impact Survey V (BAIS V) conducted in 2021, the HIV prevalence rate for adults aged 15 to 64 years is at 20.8%. Within this group, women have a higher prevalence rate of 26.2% compared to men at 15.2%.

At least 329,000 Batswana currently living with HIV are on life-saving treatment with 98% of them categorised as virally suppressed. In 2021, Botswana witnessed a steady decline in AIDS-related deaths from 6,460 to 4,600 per annum, although the prevalence rate amongst the adult population aged 15 to 64 years increased to 20.8% in 2021 from 18.5% in 2013.

Results from the BAIS V show that Botswana has exceeded UNAIDS 95-95-95 targets, which call for 95% of all people living with HIV to be aware of their status, 95% of those aware of their status to be on antiretroviral treatment (ART), and 95% of those on ART to achieve viral load suppression. With the injectable improving adherence, it is expected that Botswana will break even more targets going forward.

“It will relieve many people of the burden of carrying drugs around and improve confidentiality.

“You wake up and you know you don’t have to swallow the pills for the next 58 to 60 days and that’s good,” Kennedy Mupeli from Botswana Harvard AIDS Institute noted.