Botswana

Botswana, although a middle income country with a population of 1.86 million, is plagued by one of the most serious TB and HIV epidemics worldwide. It has one of the highest TB notification rates. In 2005 10,392 (all cases) have been notified which translates into a rate of 602 per 100,000 population. 93.4% were new, 6.6% re-treatment cases. But only 33.8% were sputum smear positive cases. In 44.7% of cases no smear was done. 12.1% are extra-pulmonary TB cases. The treatment success rates in new ss+ cases registered in 2004 were 71% with 11% death rate, 8% default rate, 9% transfer out rate and 1% treatment failure rate (overall 13% of patients were not evaluated). In 2006 only 8,519 (all cases) were notified (rate 453 per 100,000 population), 38% were new smear positive case.

Treatment success in new ss+ patients registered in 2005 was equally low at 70% (37%), failure, default and transfer out rates similar to the year before. However, the death rate decreased from 11 to 7%.  The decline in cases is rather related to the problems with data capturing at district level than caused by a real decline. There is a wide variation in performance between districts. 10 cases of MDR TB have been detected in 2005. 4,583 TB cases or 53% of TB cases were tested for HIV of whom 71% tested positive (2006).