Background: Health care of older people living with HIV and on ARV treatment has
received very little attention in Botswana over the years. The 17.6% national HIV prevalence
for Botswana excludes the older people as the Botswana Index AIDS Survey (BIAS) is
focused on ages 10-64. This survey is meant to look at current national and district HIV
estimations, sexual and preventive trends for each target group, compare HIV rates, behavior,
knowledge, attitude, poverty and other factors related to HIV in order to come up with
strategies to mitigate and enhance uptake of programs for prevention and control of HIV in
Botswana. With little or no information on this group effective and targeted services are not
possible hence this study.
Objective: To explore perceived health services needs and services gaps for HIV positive
older people over 65 years by the older people attending ARV dispensing clinics and HCW
in Gaborone and Greater Gaborone, Botswana (2014-2015).
Methods: A cross-sectional survey was conducted among 20 older people on ARV treatment
and 15 Health Care Workers (nurses and pharmacy technicians) caring for them in Gaborone
and Greater Gaborone (2014-2015). An in-depth interview guide was used to explore
perceived health needs and services gaps of older people. Respondents were older people of
age ranges 65 to 87 years who have been on ARV treatment for an average of 7 years (4
months to 13 years).
Results: Older people in Botswana are happy with curative and non-curative services offered
as part of their care in ARV clinics. Curative services being ARV treatment, blood tests and
consultation are offered consistently to the appreciation of all older people. Counselling
services are not consistently done and older people advocate for its strengthening; targeted
health education in non-existent, there is limited interaction with medical doctors due to
language barrier, poor queue management results in older people waiting for long which is
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attributed to staff shortage, poor defaulter identification and follow up are also not
coordinated. The need for social support increases with their age and medical situation while
need for improved nutrition or food ration remains critical for their health and wellbeing
restoration. Above all pill burden due to comorbidities is in the increase therefore requiring
coordinated patient management to maximise positive outcomes and minimise impact on
older people.
Conclusion and Recommendations: Need for evidence based care initiatives can never be
over emphasised. Despite that older people report high cases of disclosure and adherence,
major needs and services gaps that need immediate response are inevitable basing on this
study. Their high illiteracy rates impact adherence to services, openness to discuss sensitive
issues, limits interaction with English speaking medical doctors and ultimately impact health
outcomes. More skilled HCWs should be placed in Botswana ARV clinics to offer
comprehensive and high quality services that meet the needs of older people. More
longitudinal researches are recommended to better understand the journey of older people
living with HIV in the mist of comorbidities. Coordination of services delivery among
various professionals remains instrumental if we hope to maximise adherence and benefits of
the services offered to older people.