Botswana was the first African country to introduce free antiretroviral treatment (ART) to people living with human immunodeficiency virus (HIV), but today it has the third highest HIV prevalence rate (20.3 per 100 population) in the world. This study investigates the availability and accessibility of ART facilities in Botswana and the utilization of ART services in districts with high HIV prevalence and low percentages of ART uptake. Availability and accessibility are measured using Botswana’s ART site model and road network analysis. Microdata on HIV status from the Botswana AIDS Impact Survey IV (BAIS IV) survey, and patient data on antiretroviral (ARV) utilization is examined at the health district level. The results show the spatial mean centers of hierarchically clustered ART facilities within ART sites are strategically located in areas of high population density. Many rural people across the country travel more than three hours to ART services. Within five rural health districts there are substantial ART facility patient deficits. Future planning should focus on increasing ART services and road infrastructure in rural areas, ART uptake for men, and ART adherence in relation to circular migration and social stigmas in rural destinations to ensure the success of the Treat All Program in Botswana.

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