May 15, 2024

CDC in Eswatini

CDC Eswatini collaborates with the Government of the Kingdom of Eswatini (GoKE) and partners to address the HIV and tuberculosis (TB) epidemics, strengthen health systems, and enhance global health security.

Flag with horizontal bands of blue, yellow, and red from top to bottom.

Overview

Three CDC professionals stand outdoors on a dirt road. — CDC staff and a survey data collector oversee field data collection.

CDC has been working with the GoKE since 2004 and established an office in Eswatini in 2007.

With funding through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), CDC informs policymaking and program implementation by:

Designing evidence-based interventions.
Monitoring and evaluating program outcomes.
Conducting disease surveillance.
Using population-based survey data.

Global health security

Strategic focus

CDC's global health security investments strengthen public health systems. This work improves Eswatini's ability to prevent, detect, and respond to public health threats. Investments are being leveraged to support the government in establishing Eswatini’s National Public Health Institute, or “Eswatini CDC.”

Laboratory strengthening

CDC, through PEPFAR, supports Eswatini’s national laboratory programs to strengthen diagnostic systems for HIV, TB, and other diseases.

CDC strengthens connections between health facilities and laboratories in the Eswatini Health Laboratory Service network. CDC supports a robust specimen transport network and laboratory information system for the timely return of results. CDC also provides technical support for:

Strategic planning.
Optimizing diagnostic networks.
Assuring laboratory quality standards.
Training medical laboratory professionals.
Establishing a national public health laboratory.

These investments have:

Improved access to viral load monitoring and early infant diagnosis.
Helped introduce new ways to identify advanced HIV disease.
Increased diagnostic options for TB.
Supported the COVID-19 response.

Strategic information

Through PEPFAR, CDC invests in supporting the collection, use, and dissemination of service delivery and surveillance data. These investments inform program activities and policy recommendations such as:

Surveillance for recent HIV infections and dolutegravir resistance.
Strengthening mortality reporting to improve the quality of vital statistics data.
Population-based surveys to measure the impact of HIV and violence prevention and response interventions.

Surveillance data systems and infrastructure have been leveraged for the country’s COVID-19 response. This work included developing data dashboards, situation reports, and establishing sentinel surveillance sites. CDC also supported the Ministry of Health (MOH) to strengthen health workforce disease detection skills through the Field Epidemiology Training Program (FETP).

Four people stand and sit around a table under an outdoor tent. — CDC and partners collaborate to review service quality at a primary healthcare facility.

Continuous quality improvement

The Site Improvement Monitoring System assesses all high-volume CDC-supported facilities to enhance service quality, reduce HIV transmission, and increase impact. The data provide timely performance feedback to healthcare providers and program implementers at the site, regional, and national levels. Program review meetings, organized by the MOH and supported by CDC, drive improvements in service delivery.

Key achievements

International accreditation of two national reference laboratories in Eswatini.
Average monthly viral load tests increased from 3,000 in 2012 to over 20,000 in 2022.1
Recent infection surveillance is being conducted on over 80% of new HIV diagnoses.2

HIV

Strategic focus

Through PEPFAR, CDC is supporting Eswatini to end HIV as a public health threat by 2030. CDC works with the GoKE to develop effective policies, strategies, and procedures, implement quality management systems, and provide oversight and mentorship. These investments have contributed to remarkable progress towards the global targets for HIV treatment coverage and viral suppression. Eswatini has surpassed the 2025 UNAIDS 95-95-95 goal, increasing life expectancy from 45 in 2009 to 57 in 2021.3

Although new HIV infections have dropped, HIV remains a leading cause of illness and death. The disease affects nearly 25% of people 15 years and older and contributes to approximately 2,700 deaths annually.4 Women become infected at a rate nearly seven times that of men, with the highest incidence among women ages 15-34.5 Sexual violence is a known risk factor for HIV and remains a significant issue. One in twelve women ages 13-24 have experienced sexual violence in their lifetime.6

CDC's activities include:

Providing high-quality, person-centered services to people living with HIV.
Preventing new infections.
Decreasing HIV-related mortality.
Increasing access to cervical cancer screening for women living with HIV.
Strengthening laboratory and surveillance systems to address HIV, TB, and other public health threats.

A man touches a screen display with his finger. A person stands behind him and looks on. — US Ambassador Earl Miller learns how to use Lula Meds, an automatic refill dispenser.

Key achievements

The third Eswatini Population Based HIV Impact Assessment, locally known as SHIMS3 (2021), demonstrated that:

94% of adults 15 years and older living with HIV are aware of their HIV status.
97% of those aware of their status are on antiretroviral therapy (ART).
96% of people on ART have achieved viral suppression.

Eswatini has made significant progress since 2016-2017, when the HIV cascade was 87-89-91. The number of new HIV infections decreased from approximately 6,000 in 2016-2017 to 4,000 in 2021. The reported number of adults 15 years and older receiving ART was 205,152 (2023).

Keep Reading: HIV and TB Overview: Eswatini

TB

Strategic focus

In 2011, the GoKE declared TB a national emergency. With support from CDC, PEPFAR, and partners, Eswatini launched a rapid, multi-sectoral response to strengthen TB prevention, screening, diagnostics, and treatment.

Only 61% of people with TB receive treatment,7 and the rate of drug-resistant TB is increasing.8 CDC and PEPFAR are collaborating with the MOH to:

Improve TB screening and case finding.
Scale up short-term TB preventive and TB treatment regimens.
Introduce TB sequencing.

Eswatini is one of five countries participating in the TB Guidance for Adaptable Patient-Centered Service operational research study.9 The research aims to identify better ways to screen, diagnose, and prevent TB in children and adults. Funding is provided by CDC through Baylor College of Medicine.