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MSF in Swaziland, 2009
Field Staff: 113
Reason for Intervention:
All articles on Swaziland »
Swaziland has the world’s most severe HIV/AIDS epidemic. A report from 2006/2007* estimated the prevalence of the disease among adults to be 25.9 per cent.
Tuberculosis (TB) in HIV-infected people is the number one cause of death, and more and more patients who are being treated by the joint MSF and Ministry of Health teams are being diagnosed with drug-resistant forms (DR-TB). Since November 2007, MSF has been working in close collaboration with the Ministry of Health to respond to this epidemic by providing diagnosis and treatment for HIV/TB infected patients via rural clinics.
Currently, MSF is working in the south of the country in the rural Shiselweni region, where a fifth of the country’s population live, mostly in villages or on remote farms. They often have to travel for hours to get to the closest health facility. MSF’s aim is to reduce the number of deaths from TB and HIV/AIDS by providing diagnosis, treatment, and care as close as possible to where the patients live through small rural clinics, and also to bring some aspects of care into the communities themselves. In 2009, MSF supported one hospital, two health centers and 18 clinics in the area. By the end of 2009, more than 8,000 HIV/AIDS patients were receiving antiretroviral therapy and 3,381 patients were receiving treatment for TB.
One important component of MSF’s program is to help patients to adhere to their treatment, using guidance and counseling from ‘expert patients’ to teach others how to manage it. This is especially relevant today, since more and more TB patients in Swaziland are failing to respond to standard drugs. Those with DR-TB have to commit to an especially long, painful, expensive and difficult treatment regimen. In 2009, MSF teams provided intensive support to 96 patients infected with DR-TB.
A lack of qualified medical staff is another challenge facing the country’s health system. In order to overcome this obstacle, MSF advised the authorities to implement a ‘task shifting’ policy that would allow nurses to take over some of the medical tasks currently performed only by doctors. This policy change was one of the recommendations of an International Consultative Workshop on the DR-TB and HIV/AIDS crisis in the Southern African region, co-organized by MSF and the Swaziland Ministry of Health in October 2009.
Nonkululeko Mamba, a 25-year-old woman is HIV-positive and suffering from DR-TB.
‘I take a minimum of 15 pills each day just to fight against DR-TB. These drugs are of different sizes. Some are the size of wheat grains or even bigger than that, the size of a big bean. It is difficult, but I don’t have a choice because I want to live a normal life. After many months, I finally got used to taking a lot of drugs. But it would be better if all the drugs could be combined into one. It would be easier and less of a burden.’
MSF has worked in Swaziland since 2007.
* USAID Demographic and Health Survey