Botswana National HIV/AIDS Treatment Guidelines: 2008 Version (PDF, 6.12 MB)

Botswana's national HIV treatment guidelines document was published in 2008. This document presents Botswana's national approach, which integrates the principles of ART for adults, pregnant women and children. Treatment criteria for adults include CD4 counts below 250 or clinical stage 3 or 4 of the disease, based on World Health Organization (WHO) criteria. Infants under one year old—regardless of clinical or immunologic status —and children over the age of one with CD4 counts at WHO clinical stage 3 or 4 are eligible for treatment.  Those with advanced or “severe” immune suppression, as defined by WHO's age-related CD4 percentage count, are also eligible for treatment. The first and second line regimen ART for adults, adolescents and children are based on the combination of three of the following drugs: ZVD, d4T, TDF, FTC or EFV. Botswana's guidelines also provide a third treatment option called “salvage” therapy consisting of both DRV and RAL (plus optimized background therapy) should second line treatment fail. The treatment criteria for pregnant women include CD4 counts below 250 or WHO clinical stage 3 or 4 and the treatment is a ZVD or d4T- based  regimen. When the CD4 counts are above 250, ZVD twice daily from 28th week and single dose NVP at the onset of labor are recommended. Newborns should receive single NVP at birth followed by AZT twice daily for 4 weeks. Post-exposure prophylaxis, comprehensive management of opportunistic infections and co-infection with TB and viral hepatitis are also included in this document.