Botswana was the first African country to introduce free antiretroviral treatment (ART) to people living with human immunodeficiency virus (HIV), but today it has the third highest HIV prevalence rate (20.3 per 100 population) in the world. This study investigates the availability and accessibility of ART facilities in Botswana and the utilization of ART services in districts with high HIV prevalence and low percentages of ART uptake. Availability and accessibility are measured using Botswana’s ART site model and road network analysis. Microdata on HIV status from the Botswana AIDS Impact Survey IV (BAIS IV) survey, and patient data on antiretroviral (ARV) utilization is examined at the health district level. The results show the spatial mean centers of hierarchically clustered ART facilities within ART sites are strategically located in areas of high population density. Many rural people across the country travel more than three hours to ART services. Within five rural health districts there are substantial ART facility patient deficits. Future planning should focus on increasing ART services and road infrastructure in rural areas, ART uptake for men, and ART adherence in relation to circular migration and social stigmas in rural destinations to ensure the success of the Treat All Program in Botswana.

中文翻译：

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优化博茨瓦纳农村地区抗逆转录病毒药物的使用：推进世界卫生组织的“所有人治疗”计划

博茨瓦纳是第一个向人类免疫缺陷病毒 (HIV) 感染者提供免费抗逆转录病毒治疗 (ART) 的非洲国家，但如今它的艾滋病毒流行率位居世界第三（每 100 人中有 20.3 人）。本研究调查了博茨瓦纳 ART 设施的可用性和可及性，以及 HIV 流行率高和 ART 摄取率低的地区的 ART 服务利用情况。可用性和可达性是使用博茨瓦纳的 ART 站点模型和道路网络分析来衡量的。博茨瓦纳艾滋病影响调查 IV (BAIS IV) 调查中有关 HIV 状况的微观数据以及有关抗逆转录病毒 (ARV) 使用的患者数据在卫生区一级进行检查。结果表明，ART 站点内分层聚集的 ART 设施的空间平均中心战略性地位于人口密度高的地区。全国许多农村人需要三个多小时才能获得 ART 服务。在五个农村卫生区内，ART 设施患者严重短缺。未来的规划应侧重于增加农村地区的 ART 服务和道路基础设施、男性接受 ART 以及与农村目的地的循环移徙和社会污名相关的 ART 依从性，以确保博茨瓦纳的“所有人治疗”计划取得成功。