Preface
Eswatini has made significant strides towards achieving the UNAIDS 95-95-95 targets set for 2025. This is evidenced by preliminary data from SHIMS3, which reported that 94% of adults 15 years and older living with HIV are aware of their status, 97% of those aware of their status are on antiretroviral therapy (ART), and 96% of those on ART have achieved viral suppression. However, further analysis of HIV data shows that there are sub-population differences. To close these gaps, the country needs to scale up provision of prevention services among those at risk, and ensure timely treatment for those lagging sub-populations. It is therefore important to prioritise key populations, males, especially young men as well as adolescents and young children to be retained in care, if the country is to maintain the gains attained so far. A significant proportion of deaths among PLHIV are from non-AIDS-related causes, hence the need to provide integrated services. These guidelines address innovations like HIV self-testing (HIVST), Pre-Exposure Prophylaxis (PrEP) for HIV prevention, package of care for clients with advanced immunodeficiency and the introduction of newer drugs formulations and new differentiated service delivery (DSD) models. With the introduction of new drugs, emphasis has also been made on strengthening pharmacovigilance.
The emergence of the COVID-19 pandemic has also emphasised the need for integrated services and ensuring patient-centred care. HIV service delivery has been decentralised in to the community and psychosocial interventions have been introduced as a means to retain patients in care particularly in adolescents and in those re-engaging into care. The country has been and continues to integrate other services into the HIV program. Of note, sexual and reproductive health services have been successfully integrated into most health facilities with contraception and cervical cancer screening being offered within ART clinics. To increase the uptake of HIV services among the male population, voluntary male circumcision is also offered in selected health facilities, some of which have opened male-centred clinics. Integration of non-communicable diseases (NCDs) management especially diabetes mellitus and hypertension screening and treatment are currently ongoing within the country. Due to the effect of HIV on the outcome of COVID-19 coinfection, vaccination is also being encouraged and promoted among all PLHIV.
As the global economic climate changes coupled with the country’s steps towards achieving epidemic control, it is very important to ensure that the gains attained so far are maintained and sustained. This requires a clear understanding of donor-funded programs and intervention components that are critical for the country to achieve and sustain epidemic control and how these components can be transitioned to the government if not already within government structures. Additionally, healthcare workers across all cadres should maintain to date understanding of these innovative approaches, incorporating them into daily practice.
These guidelines provide the standards and recommendations for the Government of the Kingdom of Eswatini’s vision of ending AIDS as a
public health threat. To achieve this vision, we need a continued concerted effort from all stakeholders at all levels of service delivery to
translate these guidelines into action. Meaningful engagement of recipients of care from the constituency of PLHIV at all levels of care is vital
in achieving this goal.
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