Inter-ministerial National Structural Interventions Trial

In Botswana around 23.4% of adults aged 15-49 are living with HIV, the second highest HIV prevalence among adults worldwide after Swaziland. Despite current prevention efforts, the annual incidence of HIV among the adult population aged 15-49 years remains at around 1.5%: some 15,000 new infections every year. Young women in Botswana have much higher HIV rates than any other group. Those who suffer intimate partner violence, have high or lower incomes than their partners, have less education, and who are very poor have five times the HIV risk of young women who have none of these four factors.

Although structural factors are recognised as increasing the risk of HIV, there are few controlled trials of structural interventions that measure the impact on HIV infection. The Inter-ministerial National Structural Intervention Trial (INSTRUCT) is an HIV prevention initiative in Botswana that tests the impact of a combined package of structural and behavioural interventions focused on young women and the choice disabled. The nationwide study, led by CIET and Botswana’s National AIDS Coordinating Agency (NACA), is a cluster randomised controlled trial (trial registered as ISRCTN54878784) measuring the impact of interventions on HIV infection among young women. The INSTRUCT interventions are based on CIET’s recent Choice Disability trial in Botswana, Namibia and Swaziland, with the addition of a re-gearing of government structural support programmes towards those most vulnerable for HIV.