Department of Defense HIV/AIDS Prevention Program Eswatini (DoD Eswatini URC Project)

The Challenge

The Kingdom of Eswatini has the highest HIV prevalence rate in the world. Its military – the Umbutfo Eswatini Defence Force (UEDF) – has been greatly affected by high rates of HIV. URC found that there are 2,718 people living with HIV, including both military and civilians, receiving antiretroviral therapy (ART) in the UEDF health services. Also, a disproportionately high level of non-military community members use the UEDF HIV treatment services because they believe the services are high-quality.

Overview and Objectives

URC is supporting the Government of Eswatini to reduce the number of new HIV, TB, and sexually transmitted infections among UEDF members, their families, and the civilian communities served by UEDF health services. The UEDF Health Services is working to achieve 95-95-95 UNAIDS targets towards epidemic control, with which the country has been making progress, including expanding ART.

URC implemented the first project from 2018-2020. The second project continues the work and runs from 2020-2024.

The second project’s objectives are:

• Scaling up the provision and uptake of high impact HIV prevention services to all military and other uniformed services, including priority populations served by the military health services;
• Expanding quality, targeted HIV testing, index testing, self-testing, and linkage case management to ensure rapid ART initiation (same-day ART);
• Scaling up HIV treatment and optimizing clinical systems for HIV retention in care and management of opportunistic infections;
• Scaling up laboratory capacity for viral load testing, coverage, and access;
• Strengthening organizational and health systems for military health services leadership; and
• Establishing and implementing quality management systems in the military.

Achievements

The first project was successful in fostering a positive working relationship with the UEDF and made huge strides to meet project objectives. It documented the HIV prevalence in the military, provided institutional support and capacity building opportunities, and educated the military and surrounding community about HIV.

The first project found that 71% of UEDF personnel were aware of their HIV-positive status. However, 94% of those who knew their HIV-positive status reported being on ART, and 96% of those on ART were virally suppressed (<1000 copies/mL). Other achievements of phase one are an expanded service package, ISO 9001 certification of Phocweni clinic, 85% reduction of new HIV infections in people 15+, and 90% TB/HIV treatment coverage.