HIV and TB Overview: Eswatini

Background

CDC collaborates with the Ministry of Health (MOH) to improve the coverage and quality of HIV and TB treatment services in Eswatini. CDC supports Eswatini's National AIDS Program and the National TB Control Program to improve HIV testing and counseling services. In addition, CDC supports programs designed to prevent mother-to-child transmission of HIV and antiretroviral treatment (ART) programs for children and adults. CDC also assists the MOH to link and sustain people who test positive for HIV on effective treatment.

HIV and TB key data

HIV/AIDS

Eswatini has made remarkable progress towards the global targets for treatment and viral suppression, surpassing the 2025 UNAIDS 95-95-95 goal. As of 2021, 94 percent of adults 15 years and older living with HIV are aware of their HIV status. 97 percent of adults aware of their status are on ART, and 96 percent of people on ART are virally suppressed.

CDC PHIA data show that new HIV infections in Eswatini decreased from 6,000 in 2016-2017 to an estimated 4,000 in 2021. HIV remains a leading cause of mortality and morbidity in Eswatini, affecting nearly a quarter of the population 15 years and older. Approximately 2,700 HIV-related deaths occur annually in Eswatini.

Global Tuberculosis (TB)

Key activities and accomplishments

HIV program support

CDC, through PEPFAR, supports Eswatini in achieving and sustaining HIV epidemic control by providing high-quality services to people living with HIV. CDC's focus includes reducing new infections, decreasing HIV-related mortality, and increasing access to cervical cancer screening for women living with HIV.

CDC helps to strengthen Eswatini's laboratory and surveillance systems to address HIV, TB, and other public health threats. CDC collaborates with the government to develop policies, strategies, and procedures, ensuring quality management systems, and providing guidance and mentorship.

TB diagnosis, treatment and prevention

The Government of Eswatini declared TB a national emergency in 2011 and launched a rapid response across multiple sectors. With support from CDC, PEPFAR, and partners, Eswatini launched a rapid TB response effort across multiple sectors. This included TB screening, diagnostics, and integration of TB and HIV services, and the management of HIV/TB coinfection and drug-resistant TB. It also included the provision of TB preventive treatment (TPT).

Eswatini's TB program focuses on finding missing TB cases through improved screening, scaling-up short-term TPT, and the introduction of TB sequencing. Between 2015 and 2021, Eswatini saw a 46 percent reduction in TB incidence, a 62 percent decrease in TB case notifications. The country also saw a 55 percent decrease in TB-related deaths.

Strengthening laboratory capacity

CDC supports Eswatini's national laboratory programs to strengthen diagnostic systems for HIV, TB, and other diseases. This includes creating a robust specimen transport network and laboratory information system for the timely return of results. CDC also helps strengthen connections between health facilities and laboratories via the Eswatini Health Laboratory Service network. Additional CDC capacity building support for Eswatini's laboratory system includes:

• Staffing assistance
• Decentralizing tests
• Procurement of laboratory commodities
• Technical support for medical laboratory professional development
• Strategic planning
• Establishment of a national public health laboratory framework

With CDC's support, two national laboratories in Eswatini achieved international accreditation. CDC's investments improved access to viral load and early infant diagnosis testing. It also facilitated the introduction new methodologies for identifying advanced HIV disease and TB. With CDC's support, Eswatini's average monthly viral load tests increased from 3,000 in 2012 to over 20,000 in 2022.

Strategic information

CDC funds and supports Eswatini's MOH to generate, use, and share service delivery and surveillance data. These data are used to refine program activities and for making policy recommendations. Surveillance systems were also critical to the country's COVID-19 response, informing data dashboards, situation reports and sentinel surveillance sites.

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. This system produces data that are linked with each facility's HIV semi-annual and annual reviews. The data also provide timely performance feedback to health providers and program implementers at the site, regional, and national levels. These program review meetings, organized by the MOH and supported by CDC, drive improvements in service delivery.

Resources

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