BRIEF RESEARCH REPORT article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1582940
This article is part of the Research TopicChallenges in reaching the UNAIDS 95-95-95 targets in Sub-Saharan Africa: Status, innovations, and pathways forwardView all 12 articles
High Prevalence of Undisclosed Antiretroviral Drug Use Among Individuals Initiating HIV Treatment in Gaborone, Botswana
Provisionally accepted
Natasha Onalenna Moraka1
Sikhulile Moyo1
Terence Mohammed1Kesaobaka Molebatsi1
Joachim Lubbe Wiesner2Patrick Thatoyaone Mokgethi1Irene Gobe3Salang Tebo Moutswi1Laone Rabatoko1Queen Leteemane1Vanessa Strachan-Amaro1
Phenyo Sabone1
Margaret Mokomane3
Simani Gaseitsiwe1*- 1Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- 2University of Cape Town, Cape Town, South Africa
- 3University of Botswana, Gaborone, Botswana
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Antiretroviral therapy (ART) uptake is critical for evaluating the effectiveness of HIV epidemic control. We evaluated the extent of undisclosed ARV drug use among individuals newly diagnosed and initiating ART in greater Gaborone, Botswana.Plasma samples from an ongoing longitudinal cohort study were screened for antiretroviral drug (ARV) traces using the liquid chromatography with tandem mass spectrometry assay. The ARV drug screening panel used detects 4 ARV drugs: Integrase Strand Transfer Inhibitor [INSTI] -dolutegravir (DTG), two non-nucleoside reverse transcriptase inhibitors [NNRTIs] -Efavirenz (EFV), Nevirapine (NVP), and a protease inhibitor [Pl] -Lopinavir. We estimated adjusted prevalence ratios (aPR) for factors associated with undisclosed ART use using modified Poisson regression.We enrolled 192 participants, between October 2023 and January 2024, and a total of 120 (63.4%) were screened for plasma ARV drug traces. Participants were of median age 32 (IQR 26, 39), mostly female (66.7%) and of Botswana nationality (75.0%). Among those screened for ARV drug traces 36 (30.0%; 95%CI:30 -39) participants had at least one of the ARVs in the panel detected. One participant (0.8%) was positive for EFV, and 35 (29%) had DTG traces at baseline. Undisclosed ART use was associated with lower viral load (aPR=0.84; 95%CI: 0.70 -1.00) and being of non-Motswana nationality (aPR 2.6; 95% CI 1.5 -4.5).We report a relatively high proportion of individuals with undisclosed drug use in their baseline plasma. Our results suggest the need to implement pre-drug screening for routine HIV incidence surveillance, including pre-treatment drug resistance evaluations before ART initiation.
Keywords: Antiretroviral drugs (ARVs), Antiretroviral therapy (ART), Human immunodeficiency virus (HIV), Botswana, Newly HIV diagnosed individuals, Undisclosed ARV drug use
Received: 25 Feb 2025; Accepted: 23 May 2025.
Copyright: © 2025 Onalenna Moraka, Moyo, Mohammed, Molebatsi, Wiesner, Mokgethi, Gobe, Moutswi, Rabatoko, Leteemane, Strachan-Amaro, Sabone, Mokomane and Gaseitsiwe. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Simani Gaseitsiwe, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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