African Comprehensive HIV/AIDS Partnerships (ACHAP)

Partnership objective

Support and enhance Botswana's response to the HIV/AIDS epidemic through a comprehensive approach to prevention, care, treatment and support and impact mitigation.

A family welfare educator and a community-based health worker discuss HIV/AIDS prevention to a family in the home setting. A family welfare educator and a community-based health worker discuss HIV/AIDS prevention to a family in the home setting. Copyright MSD

What are the health needs and challenges?

When ACHAP was established in 2000, more than one in four adults in Botswana was infected with HIV– then the highest HIV prevalence rate in the world. HIV prevalence exceeded 30 percent among men and women in the 25-40 year age group. More than one-third of children born to HIV-positive women became infected with the disease. The number of AIDS orphans quadrupled in five years. Fewer than five percent of those in need of anti-retroviral (ARV) therapy were receiving it. Health facilities were overburdened: About 60 percent of hospital beds were occupied by patients who were HIV infected and in need of care. There was a severe shortage of health workers and physicians, particularly those trained in the area of HIV/AIDS. Life expectancy at birth had declined by 13 years and between 1991 and 2003, morbidity increased four-fold among 25-44 year olds. At this rate, the total population of the country was expected to be reduced by 18 percent, while the Gross Domestic Product was projected to decline 4.5 percent annually, resulting in an economy 30 percent smaller than it would have been without AIDS.

Description of partnership activities and how they address needs and challenges

In 2000, MSD* and the Merck Foundation, the government of Botswana, and the Bill & Melinda Gates Foundation established the African Comprehensive HIV/AIDS Partnerships (ACHAP).

The project involved Non-Governmental Organizations (NGO) and Community Based Organizations (CBO) Community and Intergovernmental Organizations (IGO) i.e. UNAIDS, WHO, World Bank etc.

ACHAP's mission is to support and enhance Botswana's response to the HIV/AIDS epidemic through a comprehensive approach that includes HIV/AIDS prevention, treatment, care and support, and impact mitigation. At its inception, The Merck Foundation and the Gates Foundation established ACHAP with a commitment of USD 106.5 million to the partnership, and MSD agreed to donate its antiretroviral (ARV) medicines—STOCRIN® (efavirenz) and CRIXIVAN® (indinavir sulfate)—to Botswana's national antiretroviral (ARV) treatment program for the partnership's duration. In November 2008, MSD expanded its donations to include ATRIPLA® (efavirenz 600 mg/emtricitabine 200 mg, tenofovir disoproxil fumarate 300 mg) and ISENTRESS® (raltegravir).

Initially, ACHAP’s comprehensive approach included the prevention and treatment of HIV/AIDS, care and support for those infected and mitigation of the disease’s effect on the community. In 2010, The Merck Foundation committed an additional $30 million over five years (2010–2014) to support Phase II of ACHAP. This additional funding enabled ACHAP to build on its progress by:

  • Positioning ACHAP as a successful country-led, public-private partnership model, now and in the future, through focused and sustained stakeholder relations and engagement;
  • Systematically transitioning the support of the antiretroviral (ARV) treatment program to the government of Botswana;
  • Supporting the scale up of safe male circumcision among HIV-negative males aged 15–29 years;
  • Strengthening the National Tuberculosis (TB) Programme in order to improve access to and utilization of integrated TB and HIV services by 2014;
  • Improving the generation, utilization and sharing of strategic information and knowledge from HIV/AIDS and TB programs in Botswana in order to inform and improve programs in Botswana and the region by 2014.

From the beginning, MSD and the Gates Foundation have sought to create a program that would leverage private-sector management expertise to resolve social and public health issues. They also hoped to create a model of care, which, if successful, could inform and encourage others in government, international organizations, foundations and the private sector working to address HIV/AIDS in other countries or regions.

Lessons learned

MSD's in Botswana has taught valuable lessons about implementing an appropriate response to HIV/AIDS:

  • A successful national response to HIV/AIDS requires a sound policy designed to enable stakeholders to drive and guide the right course of action;
  • Local, national and international partners must integrate and align all efforts with the national blueprint;
  • Success depends on building local capacity and gaining agreement on a common strategy at all levels;
  • It is possible to implement effective ARV therapy in the public health sector, even in a resource-limited setting;
  • A sustainable solution must address both treatment and prevention;
  • ACHAP is considered an important model for addressing the African HIV epidemic, and the lessons learned can help to inform positive action in other countries in the region;
  • Working collaboratively and in a complementary fashion with other development partners enables the expansion and strengthening of key programs.

ACHAP is considered an important model to address the African HIV epidemic and lessons learned can be leveraged to inform positive action in other countries in the region and internationally. Working collaboratively and in a complimentary fashion with other development partners has enabled the expansion and strengthening of key programs and avoided duplication of efforts.

Summary of impact and forward looking information

ACHAP has helped reduce both the number of deaths and the spread of HIV/AIDS throughout Botswana. A sampling of its achievements:

  • People on treatmnt increased from around 93,000 in 2007 to 229,055 by the end of December 2013;
  • Halved the mortality rate in adults, saving over 50,000 lives between 2002 and  2007;
  • Dramatically reduced mother-to-child transmission and reduced new infections among children by at least 80 percent (from around 40 percent zero--conversion to less than 5 percent);
  • Developed sustainable treatment by supporting the recruitment of over 200 positions, on civil service terms, to help staff the treatment program and its rollout to the clinics over the project period;
  • Increased laboratory capacity so that more than 130,000 patients could be supported in their treatment in the public sector;
  • Supported the development of the first National Strategic Framework for HIV/AIDS (2003–2009) and the second National Strategic Framework (2010–2016).


*MSD is known as Merck in the U.S. and Canada


Voices from the Field

Partnership information

Company(ies) MSD

Partner(s) Bill and Melinda Gates Foundation, Botswana Harvard Partnership, Botswana Ministry of Finance and Development Planning, Botswana Ministry of Health, Botswana Ministry of Labour and Home Affairs, Botswana Ministry of Youth, Sport and Culture, Botswana National AIDS Coordinating Agency, Central Medical Stores (CMS), Harvard School of Public Health, UNAIDS, University of Botswana, US President´s Emergency Plan for AIDS Relief (PEPFAR), World Bank, World Health Organization (WHO)

Type of Partner(s) Academia / Hospitals, Government, IGOs, NGOs

Therapeutic Focus Infectious Diseases

Disease(s) HIV/AIDS

Program Type(s) Availability of Treatment - Product Donations, Health System Infrastructure - Outreach & Medical Services, Health System Infrastructure - Training, Prevention Programs - Awareness & Outreach

Targeted Population(s) Children, Elderly, Marginalised / Indigenous People, Men, Mothers, People with low income, Women, Youth

Region(s) Sub-Saharan Africa

Number of Countries 1

Country(ies) Botswana

Start Date 2000

More information ACHAP Website

Completed date 2014