Evaluation of PrEP implementation strategies for the general population in Botswana - PROJECT SUMMARY While Botswana has attained the UNAIDS 95-95-95 target for HIV treatment and is the first country with severe HIV epidemic to reach the milestone of elimination of mother-to-child HIV transmission, the country failed to achieve the national target of zero new HIV infections by 2016 and is equally unlikely to achieve the UNAIDS target of zero HIV infection in Botswana by 2030. In 2021 alone, Botswana registered ~6,700 new HIV infections. The initial Botswana PrEP strategy focused on key populations (KP) including adolescent girls and young women (AGYW) with primarily HIV clinic based PrEP dispensing, and the general heterosexual population was not prioritized. In Botswana and the region, barriers to PrEP uptake or persistence include competing needs, mobility, poor knowledge about PrEP, limited social support for PrEP users, among others. New strategies to remove barriers related to PrEP knowledge, access, and uptake are urgently needed because there are individuals at substantial risk for HIV even in low incidence settings. Thus, in the proposed research, we will develop and test new strategies that target a younger, mobile, heterosexual and digitally connected population with high rates of sexual concurrency. Our proposed study will leverage a successful national ART program and infrastructure to first develop and pilot a PrEP implementation strategy for the general population. The program will be developed in collaboration with policy makers, healthcare providers, community leaders, information & communications service providers and adults between 18 and 49 years old in Botswana. It is intended to be delivered in- person and also using information and communications technology such as cellular, video or WhatsApp. Following the pilot, we will then use the new implementation strategy to conduct a type 3 hybrid multi- component cluster randomized trial to optimize evidence-based implementation (EBI) uptake and improvement of PrEP.
