Strengthening Local Capacity to Deliver Sustainable Quality-Assured Universal Coverage of Clinical Services in Lubombo Region, and Provide Central Level Technical Assistance to the Eswatini National AIDS Program (ENAP) in the Kingdom of Eswatini


Under the President's Emergency Plan for AIDS Relief (PEPFAR), URC worked with the CDC to contribute to national efforts for HIV epidemic control in Eswatini. The project provided central-level technical assistance to the Eswatini National AIDS Program (ENAP) to strengthen the systems of the Lubombo Regional Health Management Team (RHMT) to deliver sustainable quality HIV/TB services at health facilities in the Lubombo Region.


The Challenge

As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%). The country is also battling the highest TB incidence in the world, further stretching limited staffing and resources. Project activities focus on assisting the Eswatini Ministry of Health (MOH) and the Lubombo Region reduce the incidence of HIV and TB by 50% among adults and by 90% among children, and to avert 20% of deaths among children, adults, and pregnant women living with HIV (especially those with TB co-infection).



  • Provide central-level technical assistance to MOH and ENAP to develop performance standards, up-to-date guidelines, standard operating procedures (SOPs), and data tools to enhance quality HIV service delivery and progress towards epidemic control
  • Build the Lubombo RHMT’s capacity at the regional level to employ strong stewardship and ownership and to improve and sustain high-quality performance in HIV/TB service delivery
  • Support comprehensive and integrated universal scale-up of adult and pediatric HIV and TB clinical services at all facilities (including PIHTC, PMTCT, TB, TB/HIV, care and treatment) and selected communities (including mines and correctional facilities) in the Lubombo Region



Central Level

  • Revised the pre-service training curriculum (that includes modules on HIV care and treatment) for all nursing training institutions
  • Supported the creation of a national quality improvement collaborative to improve viral load results utilization and increase enrollment of eligible ART clients on differentiated service delivery models
  • Provided technical support to various SOPs on HIV prevention, care, and treatment including HIV index testing SOPS, Inter- and Intra-Facility Linkage Case Management SOPs, and HIV re-testing for verification before ART Initiation SOPs
  • Finalized and nationally disseminated Eswatini Integrated HIV Management Guidelines (2018)

Regional Level

  • In collaboration with the Quality Management program and the MOH/CDC CoAg, supported the Lubombo RHMT with the review and development of Lubombo Regional health work plans
  • Developed and disseminated the annual regional health report locally and to the central-level MOH
  • Formulated and established regional technical working groups as sub-committees of the RHMT: a  laboratory services committee; a pharmacy/supply chain management committee; and a committee to improve service delivery
  • Helped the Lubombo Region receive several national awards for significant progress in HIV: Best Performing region in HIV/TB services November 2018; Best Performing region on the Service Availability and Readiness Assessment report; Best Performing region on the linkage of newly diagnosed HIV clients to care and ART initiation; and Best Performing region on the provision of Adolescent and Youth Friendly Health Services
  • Assisted with the development and use of a regional events calendar to coordinate trainings, workshops, and meetings to streamline activity planning and reduce disruption in health care worker services

Facility Level

  • Co-developed and provided updated policies, guidelines, SOPs, and job aides on HTS, HIV prevention, HIV care and treatment to over 95% of facilities visited during the end-term evaluation
  • Health care workers (nurses, expert clients, HTS counselors, lay counselors) reported an improvement in skills and use of updated materials
  • Scaled up integrated HIV services in 42 health facilities
  • COVID-19: supported the rapid scale-up of multi-month dispensing of ART as well as the implementation of community commodity distribution
  • Provided a mobile outreach vehicle to help eight facilities and nine hard-to-reach communities
  • Improved adolescent health services by establishing/strengthening teen and adolescent treatment clubs in the region, integrating youth-friendly services and gender-based violence (GBV) prevention and post-GBV care, and providing resources to establish the One Stop Center for GBV at Lubombo Referral Hospital


2015 to 2020
US Centers for Disease Control and Prevention (CDC)
Regions/ Countries 
Geographic Scope 
Lubombo Region