Dr. Amon Marwiro highlights how Botswana is pioneering the integration of HIV services into primary health care, setting the stage for a more holistic and sustainable health system.
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Botswana, a country of 2.4 million in Southern Africa, has achieved a global milestone in the fight against HIV. As the first high-burden country to surpass the UNAIDS 95-95-95 target—four years ahead of schedule—the nation reached a remarkable 95-98-98 milestone by 2021. These achievements, driven by robust government investments, public-private partnerships, and two decades of international support from the U.S. Agency for International Development/President’s Emergency Plan for AIDS Relief (USAID/PEPFAR) and others, drastically reduced new HIV infections and nearly eliminated mother-to-child transmission, earning the World Health Organization’s prestigious “Silver Tier” status.
From crisis to leadership
In the early 2000s, Botswana faced the world’s highest HIV prevalence, with over 35% of adults affected. Former President Festus Mogae appealed to the United Nations for international support, warning that without intervention, Botswana could face national extinction. What followed was a unified response involving public-private partnerships, substantial government investments, and support from donors like USAID/PEPFAR and the Global Fund.
Over two decades, Botswana achieved remarkable progress: new HIV infections fell from 35,000 in the 1990s to 4,100 in 2022, and HIV-related deaths dropped from 19,000 to 3,300. Today, Botswana is recognized globally as a leader in HIV epidemic control.
“Epidemic control is not the end target. It is not a static milestone. One can fall back, losing all the gains made over the years,” warns Dr. Amon Marwiro, Jhpiego’s Country Director in Botswana and Chief of Party for USAID Project Connect.
Integrated care: the foundation of long-term success
Botswana is now designing the next phase of its HIV programming, focusing on integration as the linchpin of success. The country is transitioning from a vertical, HIV-specific program to a holistic, person-centered health system that strengthens and expands primary health care. This approach seeks to address not only HIV but also co-morbidities such as hypertension, diabetes, and mental health, ensuring equitable care for all.
“At the beginning of the epidemic, we had created a vertical HIV program as that was the need of the hour,” says Dr. Marwiro. “But now is the time to pivot. We need a holistic approach that considers the total health of the individual.”
Botswana recognizes there is more work to be done. “We still have some outstanding gaps and geographic disparities,” Dr. Marwiro adds. “We need to fully reach key populations—young children, adolescent girls and young women, and adult men. The challenge is maintaining the gains, innovating to close these gaps, and leveraging lessons learned from the HIV response to address newer challenges, such as the growing burden of non-communicable diseases. We must also share these lessons with countries approaching epidemic control.”
Project Connect: pioneering the future of integrated health care
Launched in July 2024 and funded by USAID/PEPFAR, Project Connect is at the core of Botswana’s integrated health strategy. The initiative focuses on three transformative priorities:
- Empowering the next generation: strengthening services for children, adolescents, and youth to leave no one behind
- Building capacity for community health: equipping community health care workers to deliver integrated care
- Strengthening civil society: supporting local organizations to advocate for and implement inclusive, sustainable health care
“At this critical juncture, we are on the race to the last mile,” says Dr. Marwiro. “Project Connect is about making strategic and meaningful connections, recognizing that different partners bring unique strengths. We connect local service providers with global evidence, implementing partners with sustainable resources, and communities with government and civil society organizations.”
By bridging these gaps, Project Connect extends care beyond clinical interventions, tackling challenges like stigma and bias while strengthening community support systems. A key innovation is the digitization of community health worker training, enabling health care workers to access cutting-edge knowledge and foster peer-learning communities. Jhpiego also uses data-driven strategies to refine care delivery and ensure resources reach those most in need.
The program’s holistic vision includes engaging the private sector and research institutions to broaden Botswana’s health ecosystem. “We’ve been working with local organizations for over 14 years, leveraging their deep understanding of community structures to ensure impactful and sustainable interventions,” says Dr. Marwiro.
Scaling an integrated approach
Botswana’s integration of HIV services into primary health care is still in its early stages, but it provides a replicable blueprint for countries working to close gaps in care and strengthen health systems. This approach is about more than maintaining epidemic control; it’s about reimagining health care to meet diverse needs and deliver equitable, sustainable solutions.
By addressing clinical needs alongside social determinants of health, Botswana is building a resilient system capable of adapting to emerging challenges. Through Project Connect and ongoing innovation, Botswana is moving from epidemic control to elimination, offering valuable lessons for the global health community.
Indrani Kashyap is Associate Director of Regional Communications for Jhpiego, based in Jhpiego’s office in India.