Prevalence of transmitted HIV drug resistance in Botswana: Lessons learned from the HIVDR-threshold survey conducted among women presenting for routine antenatal care as part of the 2007 national sentinel survey

Hermann Bussmann, Florindo De La Hoz Gomez, Thierry H. Roels, C. William Wester, Stephane M. Bodika, Sikhulile Moyo, Negussie Taffa, Marina G. Anderson, Madisa Mine, Ebi Celestin Bile, Chunfu Yang, Kereng Mphoyakgosi, Erica Ann Lehotzky, Busisiwe Mlotshwa, Mpho Mmelesi, Khumo Seipone, Moeketsi J. Makhema, Richard Marlink, Vladimir Novitsky, M. Essex

Publication Date: 04/01/2011

The emergence and spread of transmitted drug resistance (TDR) poses a major threat to the success of the rapidly expanding antiretroviral treatment (ART) programs in resource-limited countries. The World Health Organization recommends the use of the HIV Drug Resistance Threshold Survey (HIVDR-TS) as an affordable means to monitor the presence of TDR in these settings. We report our experiences and results of the 2007 HIVDR-TS in Botswana, a country with one of the longest-existing national public ART programs in Africa. The HIVDR-TS and HIV-1 incidence testing were performed in the two largest national sites as part of the 2007 antenatal Botswana Sentinel Survey. The HIVDR-TS showed no significant drug resistance mutations (TDR less than 5%) in one site. TDR prevalence, however, could not be ascertained at the second site due to low sample size. The agreement between HIVDR-TS eligibility criteria and laboratory-based methodologies (i.e., BED-CEIA and LS-EIA) in identifying recently HIV-1 infected adults was poor. Five years following the establishment of Botswana’s public ART program, the prevalence of TDR remains low. The HIVDR-TS methodology has limitations for low-density populations as in Botswana, where the majority of antenatal sites are too small to recruit sufficient numbers of patients. In addition, the eligibility criteria (age <25 years and parity (first pregnancy)) of the HIVDR-TS performed poorly in identifying recent HIV-1 infections in Botswana. An alternative sampling strategy should be considered for the surveillance of HIVDR in Botswana and similar geographic settings.