{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:48:17Z","timestamp":1787874497290,"version":"build-2784847793"},"reference-count":49,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T00:00:00Z","timestamp":1698278400000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In December 2019, the Botswana government expanded free antiretroviral therapy (ART) to include non\u2010citizens. We evaluated the impact of this policy change on antenatal care (ANC), antiretroviral therapy coverage and adverse birth outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Tsepamo Surveillance study collects data at up to 18 delivery sites in Botswana. We compared outcomes in citizens and non\u2010citizens living with HIV before and after antiretroviral therapy expansion to non\u2010citizens. Adverse birth outcomes included preterm delivery (PTD) &lt;37 weeks, very preterm delivery (VPTD) &lt;32 weeks, small for gestational age (SGA) &lt;10th percentile, very small for gestational age (VSGA) &lt;3rd percentile, stillbirth and neonatal death. Log\u2010binomial regression models were constructed to generate risk ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From August 2014 to September 2021, 45,576 (96.5%) citizens and 1513 (3.2%) non\u2010citizens living with HIV delivered; 954 (62.9%) non\u2010citizen deliveries were before the antiretroviral therapy expansion, and 562 (37.1%) were after. Non\u2010citizen ANC attendance among pregnant people living with HIV increased from 79.2% pre\u2010expansion to 87.2% post\u2010expansion (<jats:italic>p<\/jats:italic>&lt;0.001), and became more similar to citizens (96.0% post\u2010expansion). Non\u2010citizens receiving any antenatal antiretroviral therapy increased from 65.5% pre\u2010expansion to 89.9% post\u2010expansion (<jats:italic>p<\/jats:italic> &lt; 0.001), also more similar to citizens (97.2% post\u2010expansion). Infants born to non\u2010citizens with singleton gestations in the pre\u2010expansion period had significantly greater risk of PTD (aRR = 1.28, 95% CI, 1.11, 1.46), VPTD (aRR = 1.89, 95% CI, 1.43, 2.44) and neonatal death (aRR = 1.69, 95% CI, 1.03, 2.60), but reduced SGA risk (aRR = 0.75; 95% CI, 0.62, 0.89) compared with citizens. Post\u2010expansion, greater declines in most adverse outcomes were observed in non\u2010citizens, with largely similar outcomes between non\u2010citizens and citizens. Non\u2010significant differences were observed for non\u2010citizenship in PTD (aRR = 0.84, 95% CI, 0.66, 1.06), VPTD (aRR = 0.57, 95% CI, 0.28, 1.01), SGA (aRR = 0.91, 95% CI, 0.72, 1.13), VSGA (aRR = 0.87, 95% CI, 0.58, 1.25), stillbirth (aRR = 0.71, 95% CI, 0.35, 1.27) and neonatal death (aRR = 1.35, 95% CI, 0.60, 2.62).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Following the expansion of free antiretroviral therapy to non\u2010citizens, gaps narrowed in ANC and antiretroviral therapy use in pregnancy between citizens and non\u2010citizens living with HIV. Disparities in adverse birth outcomes were no longer observed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26161","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T05:11:00Z","timestamp":1698383460000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The impact of free antiretroviral therapy for pregnant non\u2010citizens and their infants in Botswana"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2285-6056","authenticated-orcid":false,"given":"Christina","family":"Fennell","sequence":"first","affiliation":[{"name":"Department of Epidemiology Harvard T.H. 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Chan School of Public Health  Boston Massachusetts USA"},{"name":"Division of Infectious Diseases Beth Israel Deaconess Medical Center  Boston Massachusetts USA"},{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Modiegi","family":"Diseko","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4557-3075","authenticated-orcid":false,"given":"Gloria","family":"Mayondi","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Mabuta","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tumalano","family":"Sekoto","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tendani","family":"Gaolathe","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mompati","family":"Mmalane","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Lockman","sequence":"additional","affiliation":[{"name":"Botswana Harvard AIDS Institute Partnership  Gaborone Botswana"},{"name":"Division of Infectious Disease Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Department of Immunology and Infectious Diseases Harvard T.H. 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