The African Comprehensive HIV/AIDS Partnerships (ACHAP) was established in 2000 by the Government of Botswana, The Merck Company Foundation, Merck & Co., Inc. and the Bill & Melinda Gates Foundation, to enhance Botswana´s response to the HIV/AIDS epidemic through a comprehensive approach to prevention, care, treatment and support. The two foundations are each contributing USD 56.5 million over several years and Merck is donating its antiretroviral (ARV) medicines Crixivan® and Stocrin® to Botswana´s national ARV treatment program, Masa (dawn), for the partnership´s duration.

Masa is one of the largest government-sponsored HIV/AIDS treatment programs in Africa. With more than 92,000 people on treatment as of January 2008 and adherence rates comparable to the developed world, Botswana has, according to the WHO, the highest percentage of ARV coverage of any low- or middle-income country in the world. The program has achieved a measurable decline in adult mortality rate, especially in the districts where ARV therapy was first made available and where ARV coverage is most extensive.

The program has built 32 regional treatment centers, increased laboratory testing capacity to screen more than 20,000 patients per year; improved information systems to track patient adherence; provided more than 4,000 health care workers with clinical training by HIV and AIDS experts; supported 17 counseling centers for people living with HIV and AIDS, trained 450 counselors; and funded more than 100 community-based projects. The program pioneered routine HIV and AIDS testing, which greatly increased the number of people knowing their HIV status, getting on treatment and reducing stigma and discrimination.

ACHAP is also supporting the development of a national plan to scale up prevention under the leadership of the National AIDS Coordinating Agency. Its other prevention activities including condom distribution, behavioral change communication, sexually transmitted disease management and blood safety and youth prevention programs. ACHAP has also provided awareness and destigmatization education for nearly 21,000 school teachers. Prevention is starting to pay off: HIV antenatal prevalence has declined in most age groups since around 2001 and the number of HIV-positive infants born to HIV-positive mothers has declined from 40% to 4%.

In 2006, ACHAP expanded its support to target tuberculosis, as 65-85 % of TB patients in Botswana are HIV positive, and TB is the leading cause of death among adult AIDS patients.

The partnership´s strength lies in integrating government strategy with private-sector expertise, and its success demonstrates the value of public-private partnerships in the fight against HIV/AIDS – the lessons which are being applied elsewhere. Priorities for ACHAP beyond 2007 include improving prevention programs, ARV program support, expansion of HIV testing and strengthening post-test services.