Key medical figures:
• 20,100 patients on first-line ARV treatment
• 1,900 patients under treatment for TB
The decentralisation of medical services in Swaziland is helping people with HIV, tuberculosis (TB) and multidrug-resistant TB (MDRTB) get the care they need.
Swaziland has high rates of HIV–TB co-infection and the number of people with drug-resistant forms of TB (DR-TB) is rising. Médecins Sans Frontières (MSF), in collaboration with the Ministry of Health, has been integrating HIV and TB services atbasic health clinics and in the community. Further strategies have included advocating for the introduction of horter, more tolerable treatment regimens for DR-TB and the promotion and implementation of outpatient DR-TB care.
One-stop, comprehensive care for HIV and TB is provided in Matsapha, Manzini region, an industrial town that attracts migrant workers. The clinic here offers HIV counselling and testing, diagnosis and treatment of TB, and sexual and reproductive healthcare services, including ante- and postnatal care. The clinic provides victims of violence with medical and psychosocial care, and consultations and treatment for common illnesses, as well as immunisations for children, are also available.
In Mankayane, MSF works closely with the Ministry of Health’s HIV and TB department to improve diagnosis and treatment of patients suffering from HIV–DR-TB co-infection. Antiretroviral (ARV) treatment has been integrated with that for TB and DR-TB. In 2013, the MSF team continued to improve infection control and provided psychosocial support for patients in Mankayane hospital and in communitybased clinics. They also trained staff at the TB National Reference Laboratory in Mbabane, where MSF assists with TB cultures and drug-sensitivity testing.
Patient-centred HIV and TB care in Shiselweni
After five years of increasing the number of HIV and TB services, Shiselweni, formerly the most disadvantaged region for healthcare, now has multiple HIV and TB service points. MSF provides treatment and psychosocial support for HIV and TB patients in 22 basic health clinics and three specialist facilities. Teams also work on infection control and improving adherence to treatment.
In 2013, there was a strong focus on improving access to DR-TB diagnosis and care. Locating laboratories at points of care was an important component, and rapid diagnostic technology (GeneXpert) was distributed throughout the region; 20 primary clinics now have their own mini-labs. Furthermore, patients who cannot come to their nearest facility for daily injections during the intensive treatment phase are now visited by community treatment supporters (CTS). This is a new approach and an analysis of the effectiveness of the CTS programme is currently underway.
A ‘test early and treat early’ effort began last year as a preventive measure against the transmission of HIV. It ultimately aims to put everyone testing positive for HIV on ARV treatment, regardless of how far the virus has progressed. The first phase, which started in January 2013, involved putting all HIV-positive women on treatment, and this work continues, along with routine viral load testing.
A voluntary door-to-door HIV-testing campaign was also conducted in August, which resulted in 6,452 people being screened. International Activity Report 2013 swaziland
No. staff end 2013: 439 | Year MSF first worked in the country: 2007