Why are we there?
- Endemic/epidemic disease
Preventing transmission of the virus from mother to child: a video story
Stopping the spread of HIV/AIDS from mothers to their children is an essential step in curbing the disease’s epidemic in Swaziland. Read more.
This is an excerpt from MSF's 2014 International Activity Report:
Decentralized 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 percent of people with TB are diagnosed with a drug-resistant form of the disease. Doctors Without Borders/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 this year, with projects in Nhlangano, Hlatikulu, and Matsanjeni. Since 2010, the program 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 specialized facilities. A five-year evaluation on the decentralization of care demonstrated that simplifying it and bringing it closer to home is sustainable, leads to increased access to antiretrovirals (ARVs), and helps patients adhere to their drug regimens.
Central to the program 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 program, 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 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 health care services, including maternity care, immunizations 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 minimize 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.
At the end of 2012, MSF had 307 staff in Swaziland. MSF has been working in the country since 2007
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 has 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.”