Decentralised care and innovative treatments are helping people with HIV live longer, healthier lives.
The co-infection rates of HIV and tuberculosis (TB), including drug-resistant TB (DR-TB), are extremely concerning, and 10 per cent of people with TB are diagnosed with a drug-resistant form of the disease. Médecins Sans Frontières (MSF) began collaborating with the health ministry to address the HIV–TB epidemic in Shiselweni in 2007 and in Manzini in 2010.
MSF continued to support integrated HIV and TB care in Shiselweni region, with projects in Nhlangano, Hlatikulu and Matsanjeni. Since 2010, the programme has trained local workers and community members living with HIV, and has helped expand diagnosis and treatment of HIV and TB in this rural southern region. Patients are now able to access treatment and psychosocial support through 22 health clinics and three specialised facilities. A five-year evaluation on the decentralisation of care demonstrated that simplifying it and bringing it closer to home is sustainable, leads to increased access to ARVs and helps patients adhere to their drug regimens.
Central to the programme are the HIV-positive community members trained by MSF and the health ministry, Expert Clients, who carried out more than 3,200 health education sessions in 2014. Through these, some 137,100 people in Shiselweni were made aware of HIV-related issues. Door-to-door HIV testing has also been integrated into the programme, increasing the detection of HIV-positive people. Additionally, routine viral load measuring has been implemented to monitor health status, which allows for the identification of patients whose viral load is “undetectable”, meaning that the virus is under control and that the risk of transmission is markedly lower.
The first phase of the Treatment as Prevention strategy targeted pregnant women. It was implemented as a national strategy in 2014 after proving effective in a pilot project in Nhlangano. The second phase, Early Access to Antiretrovirals for All (EAAA), was launched in Nhlangano in October, providing all HIV-positive patients with antiretroviral (ARV) treatment whatever their clinical or immunological status.
The migrant workers and residents of Matsapha can be tested and treated for HIV and TB at MSF’s one-stop comprehensive family health clinic. Basic healthcare services, including maternity care, immunisations for children under five, family planning, home-based care services and medical and psychosocial treatment for victims of sexual violence are available.
Comprehensive care is also offered for people co-infected with HIV and TB at Mankayane hospital and community-based clinics. Whenever possible, patients with DR-TB are treated as outpatients, which helps minimise the isolation and discomfort of long hospital stays and increases adherence to treatment.
When standard first-line TB drugs do not work, the patient is said to have multidrug-resistant TB (MDR-TB). As the conventional treatment for this form of the disease takes a minimum of 20 months and has many painful side effects, MSF began an observational trial to study the effectiveness and safety of a nine-month MDR-TB regimen in Matsapha and Mankayane in 2014.
No. staff in 2014: 406 | Expenditure: €8.4 million | Year MSF first worked in the country: 2007 | msf.org/swaziland
Sphiwe – started on ARVs at Mashobeni clinic as part of the EEAA strategy
I am a rural health motivator (RHM); one of the people who have been trained by the Ministry of Health to conduct health promotion and home-based care at community level. As an RHM I talk about these things. Even at our support group we talk about it and encourage people to know their status and adhere to their medication. Being a part of these groups has helped me to accept my status and use my story to encourage other people in my community.