1. Home
  2. Research

Research

Cervical Cancer Prevention

HPV Study logo with Re Ntsha Peo symbol inside

Re Ntsha Peo

Longitudinal HPV Screening Cohort in Women with HIV

Re Nstha Peo is a longitudinal HPV screening study that enrolled a cohort of 3000 women (both with and without HIV) from February 2021 to July 2022. Re Nstha Peo is a Setswana phrase that means “uprooting the seed,” signifying the study’s objective to uproot the seed of cervical cancer before it takes root and grows in Botswana.

  • Evaluation of triage strategies for primary HPV testing: 

    This study explored the effectiveness of triage strategies VIA, colposcopy and 8-type HPV genotype restriction following primary HPV screening in women with and without HIV. Although overall diagnostic accuracy of 8-type HPV genotype restriction was lower than visual triage alternatives,  8-type HPV genotype restriction was the most sensitive triage strategy and a promising component of effective triage for positive HPV results. 

  • Implementation of HPV self-collection: 
  • hrHPV self-testing was determined to be acceptable and feasible. 90% of patients completed an interval triage visit when indicated. Providing results over the phone was associated with high screening completion and required few calls to participants.
     

  • Optimal intervals for HPV screening in women with HIV:  

    Interval surveillance and rescreening in this cohort was conducted among women living with HIV from March 2023 to December 2025, at intervals determined by baseline screening and diagnostic results. The primary objective is to evaluate 1-3 year outcomes in an HPV based screening programme. With low overall CIN2+ incidence, the findings support 2-3 year HPV rescreening intervals in women living with HIV  engaged in an established primary HPV screening program. 

HOPE-II Study: Efficacy of Human Papillomavirus (HPV) Vaccination to Prevent Infection Among Women Living with HIV: A Prospective, Individual, Double-Blind, Randomized Controlled Study

HOPE-II study is a Phase IIIB/IV international multisite trial evaluating single-dose 9-valent HPV vaccination in women living with HIV. It is led by Ruanne Barnabas at Massachusetts General Hospital and implemented in Botswana, Rwanda, and South Africa. Its primary objective is to test the efficacy of single-dose 9-valent HPV vaccination to prevent incident persistent HPV 16/18/31/33/45/52/58 infection among women living with HIV who were previously vaccinated against HPV16/18. Enrollment of 258 participants in Botswana is complete and follow-up visits are ongoing. Retention at 3- 6- and 12- month visits has been >98%.

  • Individual-level HPV vaccination verification in Botswana: lessons learned from implementation of the HOPE II trial

    We sought HPV vaccination records for 80 potential participants for HOPE II across 80 schools and 68 clinics. Only 15 participants (18.8%) had verifiable records: 2 (2.5%) retained vaccination cards, 4 (5.0%) had documentation in school records, and 9 (11.3%) had entries in MoH registers. Most school records were incomplete or missing, and several sites reported loss or disposal of records due to relocation, fire damage, or storage constraints. These findings highlight critical gaps in HPV vaccination documentation, which could be mitigated by strengthening electronic immunization registries, standardizing record transfer, and improving data integration.

HOPE II logo with a green leaf and a woman's head and the text: EFFICACY OF HUMAN PAPILLOMAVIRUS VACCINATION TO PREVENT INFECTION AMONG WOMEN LIVING WITH HIV

Obstetrics Research

In 2021, we established an ongoing surveillance study of maternal outcomes at Princess Marina Hospital in Gaborone, the largest tertiary referral hospital in Botswana. The aim of surveillance is to identify severe maternal morbidities that could be intervened on to prevent maternal deaths. In 2026, we expanded surveillance to 4 additional sites to allow monitoring at the district-level.

Adverse Maternal Outcomes Among People with HIV Using Antiretroviral Therapy in Botswana

  • This retrospective cohort study aims to evaluate maternal mortalities and obstetric morbidities by HIV status in a large cohort with high HIV prevalence in Botswana after implementation of a treat-all policy. There was little difference in adverse maternal obstetric outcomes between people with and without HIV in the treat-all era with integrase strand inhibitors (INSTIs, primarily dolutegravir); notable exceptions included slightly reduced risk of preeclampsia and, though rare, increased risk of uterine rupture in those with HIV.

Pre-Eclampsia Rates in Women With and Without HIV in Modern ART Era in Botswana

  • This study compares the prevalence, severity, and neonatal outcomes of pre-eclampsia in women living with HIV (WLWH) and women without HIV in Botswana. WLWH were found to have a slightly lower risk of pre-eclampsia than HIV-negative peers. In particular, WLWH initiating ART preconception and achieving undetectable viral loads had a reduced risk of pre-eclampsia. HIV status was not associated with worse neonatal outcomes in the setting of pre-eclampsia.

Severe maternal morbidity at the largest tertiary referral hospital in Botswana: Data from a longitudinal surveillance cohort

  • In this study, we analyzed severe maternal morbidity (SMM) at the largest tertiary referral hospital in Botswana and found that hypertensive disorders and obstetric hemorrhage are the leading causes of SMM. Secondarily, we evaluated the applicability of World Health Organization (WHO), Sub-Saharan African (SSA)-adapted criteria and Namibia maternal near-miss (MNM) criteria in capturing SMM in the Botswana clinical context. The SSA-adapted criteria identified a greater number of SMM cases than the standard WHO criteria, making it a more sensitive approach for surveillance in Botswana’s resource-limited setting, though our findings support the adaptation of MNM criteria to the local healthcare context to strengthen early warning systems and reduce maternal mortality.