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

The Challenge

As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%). Eswatini also has one of the highest TB incidences in the world, further stretching limited health care resources, including that of the health workforce. The health workforce requires additional support to address gaps at all levels to provide high quality integrated HIV services to target populations, including children, adolescents, and pregnant women. In the Lubombo Region in particular, a high level of poverty and food insecurity limit the primarily rural population’s access to HIV services.

Overview and Objectives

With CDC/PEPFAR support, URC supported Eswatini’s Ministry of Health efforts, and the Lubombo Region specifically, to control the HIV epidemic. The project aimed to reduce the incidence of HIV and TB by 50% in adults, 90% among children, and avert 20% of deaths among children, adults, and pregnant women living with HIV.

The project provided central-level technical assistance to the Eswatini National AIDS Program (ENAP) to strengthen Lubombo Regional Health Management Team (RHMT) capacity to deliver sustainable quality HIV/TB services at health facilities in the region.

The project sought to:

• Assist MOH and ENAP to develop performance standards, up-to-date guidelines, standard operating procedures, and data tools to enhance quality HIV service delivery and progress towards epidemic control;
• Build the Lubombo RHMT’s stewardship and ownership and improve and sustain high-quality performance in HIV/TB service delivery; and
• Support comprehensive and integrated universal scale-up of adult and pediatric HIV and TB clinical services at all facilities and in selected communities (including at mines and correctional facilities) in the region.

Achievements

Strengthened HIV Workforce: URC successfully strengthened the HIV workforce with improved trainings, tools, standards, and mentorship. The project finalized the Eswatini Integrated HIV Management Guidelines and supported the creation of a national HIV quality improvement collaborative.

Expanded Service Provision: Integrated HIV services were scaled up in 42 health facilities. Adolescent health services were strengthened through the establishment and strengthening of teen and adolescent treatment clubs. The One Stop Center for Gender-Based Violence was established at Lubombo Referral Hospital. URC also provided a mobile outreach vehicle for facilities to access hard-to-reach communities.

COVID-19 Continuity: During COVID-19, the project scaled up multi-month dispensing of ART and implemented community commodity distribution.

The Lubombo Region received several national awards during the course of the project to recognize significant achievements in HIV care and treatment, including Best Performing Region in HIV/TB Services in 2018.

URC supported the planning phase and start-up of Georgetown University’s follow-on project, Support Eswatini to Achieve Sustained Epidemic Control. URC provided mentorship related to HIV care and treatment activities and transfer of the HIV supply chain and project equipment to ensure uninterrupted HIV care and treatment in all supported sites in the Lubombo Region.