Country Spotlight: Swaziland

Country Overview

There are currently 210,000 people living with HIV in Swaziland. Less than half of both children (0-14) and adults (aged 15 and up) living with HIV were receiving life-saving antiretroviral medications as of 2013.

Our Work in Swaziland

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) began supporting the Kingdom of Swaziland in 2003 to prevent mother-to-child HIV transmission (PMTCT) and to provide HIV and AIDS care and treatment services. EGPAF-Swaziland’s work ensures every client has access to HIV testing and treatment, high-quality counseling, and psychosocial support within a variety of easily-accessible health settings throughout the country.

EGPAF supports the Kingdom of Swaziland’s Ministry of Health to plan, implement, monitor, and evaluate programs according to disease patterns across the country. We are currently expanding and improving PMTCT services to ensure effective national implementation of the 2013 World Health Organization (WHO) PMTCT guidelines, which recommend initiation of lifelong antiretroviral therapy (ART) among all HIV-positive pregnant and lactating women. EGPAF-Swaziland provides support to improve local infrastructure for health service delivery, and works to strengthen health systems through trainings, mentorship, and procurement of essential HIV drugs and commodities. We also work to increase community engagement around and utilization of PMTCT, early infant HIV diagnosis, and male circumcision. Currently, EGPAF-Swaziland supports 66 health facilities in Hhohho and Shiselwei with PMTCT, HTC, ART and TB services..

In addition, Swaziland has conducted several research studies aimed at improving program implementation and efficacy. Our research has focused on evaluations of mother-to-child HIV transmission, best practices in HIV counseling and testing, and approaches which foster community engagement in PMTCT and maternal, newborn and child health care services.


Key Projects in Swaziland

Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project

(2015-2020) The goal of AIDSFree is to improve HIV and tuberculosis (TB)/HIV outcomes in the Hhohho and Shiselweni regions and provide support to the Kingdom of Swaziland’s national PMTCT and pediatric HIV care and treatment programs. The project aims to: expand coverage of high-quality integrated, decentralized and comprehensive HIV and TB services and HIV prevention, care and treatment; build the capacity of rural health teams; and provide technical assistance in maternal, neonatal, and child health to Swaziland’s Sexual Reproductive Health Unit and National AIDS Program. The project also provides HIV testing and counseling mentorship to health care workers and lay counselors.

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Investing in Pediatric HIV Diagnostics to Save the Lives of HIV-Infected Infants

(2015 – 2019) This four-year project, supported by UNITAID, aims to increase the number of pediatric HIV patients diagnosed and ensure more HIV-positive infants are started on ART earlier (before the 12th week of life). The project will introduce early infant point-of-care technology, which enables health professionals to diagnose infants on-site and in a range of new maternal, newborn and child health settings. In Swaziland, the project also hopes to generate a 40% cost savings for HIV diagnostics. This project lays the foundation for universal access to pediatric HIV care and treatment in health facilities, ensuring that all clients accessing EGPAF-supported services receive comprehensive care including palliative care, HIV counseling services, and reproductive and child health services.

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Expanding Access to Pediatric HIV Testing and Treatment through Intensified Case Finding and Universal Offer of HIV Testing

(2015-2019) The goal of this project is to rapidly scale up pediatric HIV testing for children aged 18 months and older, and initiate HIV-infected children on ART. EGPAF will work with and through the Ministry of Health and its network of national partners in Kenya, Rwanda, Swaziland, and Zambia. EGPAF intends to use a hybrid model of intensified case finding in established points of care and universal offer in selected communities to actively seek out and diagnose infected children and link them to pediatric HIV treatment. As part of EGPAF’s commitment to increasing national capacity to sustain quality HIV services, EGPAF will strengthen and/or create essential system enablers, and build capacity to ensure quality and sustainability of the proposed interventions.

This project will utilize a comprehensive, four-pronged approach to scale up pediatric HIV testing and linkages to treatment. Based on the best available evidence, EGPAF’s approach is designed to strategically reach and test children in venues where they are currently being missed. For this reason, through this project EGPAF will introduce intensified case findings bot at facility and community level.

The four prongs are:

  • Prong 1: Support the roll-out of intensified case finding for children older than 18 months in child-centered services.
  • Prong 2: Scale up a family-centered model to test and treat children with HIV-infected parents and siblings.
  • Prong 3: Conduct campaigns for universal offer of pediatric HIV testing in selected communities.
  • Prong 4: Build capacity of national and decentralized health authorities and civil society partners to implement and sustain high-quality pediatric HIV testing and treatment services.

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Improving Access to Essential Pain Medicines in Swaziland

(2014-2016) We are currently partnering with the American Cancer Society on a two-year grant, through the Treat the Pain program. The project aims to improve clinician knowledge and skills to assess and manage pain. EGPAF will support a physician to join the palliative care team within the Swaziland National AIDS Program and connect the physician to counterparts for training and mentorship on palliative care in selected facilities. The project reflects EGPAF’s commitment to a holistic approach to improve the lives of those in our care.

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Strengthening Facility-Based HIV Testing and Counseling Services in Swaziland

(2012-2015) The goal of this five-year project funded by U.S. President’s Emergency Plan for AIDS Relieve through the U.S. Centers for Disease Control and Prevention, is to strengthen, expand and improve HIV testing and counseling services in all four regions of Swaziland. Through this project, EGPAF promotes universal access to HIV testing and counseling within all health facilities, strengthens linkages and referrals between health facilities and treatment centers, and builds capacity of health facility staff and management.

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Advancing Community-Level Action for Improving Maternal and Child Health and Prevention of Mother-to-Child Transmission of HIV (ACCLAIM)

(2012-2016) Project ACCLAIM seeks to increase local communities’ use of maternal, newborn and child health and PMTCT services. The project is supported by the Department of Foreign Affairs, Trade and Development Canada and is being implemented over four years. ACCLAIM works to shift community norms and attitudes toward healthy behaviors, to increase the number of pregnant women who access and complete PMTCT services.

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EGPAF Country Fact Sheet: Swaziland

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Swaziland Annual Report 2014

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An Exploratory Study of the Behaviors and Practices That May Increase HIV Risk among Pregnant and Lactating Women in Communities in Swaziland 

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Haba Na Haba: Spotlight on Pediatric Care and Treatment

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Lessons learned from early implementation of B+: The Elizabeth Glaser Pediatric AIDS Foundation experience

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