The Princess Marina Hospital in Gaborone, Botswana, had an outbreak of COVID-19 from early August 2020. The aim of this paper was to describe the outbreak investigation. The investigation’s specific objectives were to describe the COVID-19 cases in terms of person, place, and time (PPT) and to determine measures to prevent further transmission of the infection. The data reported herein were collected over a 3-month period from beginning of August to end of October 2020. The investigation included all COVID-19 cases i.e. both patients and healthcare workers. It followed the steps of an outbreak investigation. These included assembling an investigation team comprising both the hospital and DHMT staff. All the wards reported their confirmed cases to the infection control team who in turn prepared line lists and case reports. Epicurves were produced from date of positive result. A total of 193 cases were reported, of which 110 (57.0%) were patients and 83 (43.0%) were healthcare workers. The median age was 35 years. Females accounted for 154 (79.8%) participants. Most of the wards were affected. The wards with the highest numbers of cases were female medical ward (39), emergency department (24), gynecology ward (17), and pediatric medical ward (10). Control measures included restricting movement into the hospital as well as clinical screening at all entry points. Furthermore, all patients were tested before admission into the wards. Surveillance of COVID-19 cases was continued beyond the 3 months reported in this paper. COVID-19 can spread rapidly in hospital settings affecting both patients and healthcare workers. Outbreak investigations including describing cases in terms of person, place, and time are critical if the most effective and efficient control measures are to be implemented.

COVID-19 was declared a Public Health Emergency of International Concern (PHEIC) in January 2020 and a pandemic in March 2020. Botswana reported its first case on 30 th March 2020 and as of 31 st January 2021 had 21,293 cases and 46 deaths. The University of Botswana Public Health Medicine Unit has made significant contributions to the national preparedness and response to COVID-19. The program alumni and Public Health Medicine residents have and continue to provide key technical support to the Ministry of Health and Wellness across the major pillars of COVID-19. This includes key roles in national and subnational coordination and planning, surveillance, case investigations and rapid response teams, points of entry, travel and transportation, infection prevention and control and case management. The unit is thus supporting the country in achieving the World Health Organization (WHO) primary objective of limiting human-to-human transmission, optimal care of the affected and maintaining essential services during the outbreak. The Public Health Medicine Unit has played a key role in capacity building including early rapid COVID-19 training of healthcare workers across the country. Furthermore faculty members and residents are involved in several COVID-19 research projects and collaborations.

Introduction key populations and transgender people in particular are at a high risk of HIV infection. However, very little is known about risk behaviors of transgender people in Botswana. The aim of this study was to determine the prevalence of high-risk behaviors for HIV and sexually transmitted infections (STIs) among transgender people in Botswana. Methods data from the Botswana 2017 Biological and Behavioral Surveillance Survey of HIV/STIs among select key populations (BBSS-2) was used. The cross sectional survey documented behavioral risk factors for these infections. This paper only focused on the analysis of the transgender data. Descriptive analysis was done with IBM Statistical Software for the Social Sciences (SPSS) version 24. Results there were 56 transgender people identified of which 12 (21.4%) were transgender women. The median age was 24 (interquartile range (IQR) 22-28). Among transgender women, 2 (16.7%) reported concurrent sexual partners and 9 (75%) reported condom use at last intercourse. However, only 7 (58.3%) reported consistent lubricant use. About 45% of the respondents did not know the HIV status of their last male partner. Only one of the transgender women reported intercourse with at least 1 female in the last month. About a third reported that they had STI symptoms in the past year. Alcohol use was reported in 50% of respondents while 83% had disclosed gender identity and had been accepted by their families. However, 25% reported discrimination by a healthcare worker. Conclusion the high-risk behaviors were frequent among transgender women. This study underlines the need for sustained efforts to reach this key population.

Introduction Coronavirus disease 2019 (COVID-19) has been associated with mental health outcomes and healthcare workers (HCWs) are at the highest risk. The aim of this study was to determine the prevalence and predictors of depression, anxiety and stress, among frontline HCWs at COVID-19 isolation and treatment sites in Gaborone, Botswana. Methods This was a cross-sectional study using self-administered questionnaires at the six (6) isolation facilities. The 42-item Depression, Anxiety and Stress Scale (DASS-42) was used to assess for the outcomes. The proportions are presented with 95% confidence intervals (95% CI). Logistic regression analysis identified predictors of the outcomes. A p value of <0.05 was considered significant. Results A total of 447 participants with a median age of 30 years responded. Depression, anxiety and stress were detected in 94 (21.0% (95% CI 17.3–25.1%)), 126 (28.2% (CI 24.1–32.6%)) and 71 (15.9% (12.6–19.6%)) of the participants respectively. Depression was associated with smoking (AOR 2.39 (95% CI 1.23–4.67)), working at the largest COVID-19 isolation centre, Sir Ketumile Masire Teaching Hospital (SKMTH) (AOR 0.25 (95% CI 0.15–0.43)) and experience of stigma (AOR 1.68 (95% CI 1.01–2.81)). Tertiary education (AOR 1.82 (95% CI 1.07–3.07)), SKMTH (AOR 0.49 (95% CI 0.31–0.77)), household members with chronic lung or heart disease (AOR 2.05 (95% CI 1.20–3.50)) and losing relatives or friends to COVID-19 (AOR 1.72 (95% CI 1.10–2.70)) were predictors of anxiety. Finally, predictors of stress were smoking (AOR 3.20 (95% CI 1.42–7.39)), household members with chronic heart or lung disease (AOR 2.44 (95% CI 1.27–4.69)), losing relatives or friends to COVID-19 (AOR 1.90 (1.05–3.43)) and working at SKMTH (AOR 0.24 (0.12–0.49)). Conclusion Depression, anxiety and stress are common among frontline HCWs working in the COVID-19 isolation sites in Gaborone. There is an urgent need to address the mental health outcomes associated with COVID-19 including addressing the risk factors identified in this study.