Swaziland Country Report FY16

In the same age group, women are disproportionately affected, with a prevalence of 38% compared to 23% in men. In the context of the entire population, 31% of all women are living with HIV, compared to just 20% of men. Tuberculosis (TB) is also a major public health problem currently confronting Swaziland, with a TB incidence rate of 733/100,000 population, the highest in the world. Approximately 8% of new and 36% of previously treated TB patients have multi-drug-resistant TB (MDR-TB), yet only 60% of MDR or rifampicin-resistant (RR) TB patients are initiated on treatment. Treatment success stands at 78% among susceptible TB cases and 60% among MDR-TB cases. Swaziland has made commendable progress in recent years in scaling up HIV and TB treatment and prevention services. TB and prevention of mother-to-child transmission (PMTCT) of HIV services are integrated within maternal, newborn, and child health services to ensure that as many HIV-positive women and children as possible are identified and cared for. Given Swaziland's generalized HIV epidemic and high HIV prevalence, voluntary male medical circumcision (VMMC) was adopted as an HIV prevention strategy in 2008 at the community level. In addition, VMMC was integrated into most health care facilities across the country. Other fixed site and mobile VMMC services are provided by non-governmental organizations (NGOs) and other community-based organizations. Swaziland concentrated its efforts on young men aged 15-24 years, where HIV prevalence was lowest for males. However, less than 50% of the target has been reached to date. The Swaziland Ministry of Health (MOH) made significant investments in building the capacity of its health workforce to deliver quality health services related to HIV and TB through in-service training (IST). Despite these investments, IST in Swaziland continues to be faced with immense challenges, including inadequate resources, lack of qualified trainers, and limited access to training facilities. To address these challenges, the MOH has implemented various strategies, including the development of a comprehensive training plan, the establishment of a training needs analysis (TNA) system, and the provision of training equipment and materials. The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, implemented by University Research Co., LLC (URC), has been working closely with the MOH to strengthen the health system in Swaziland. The project has been supporting the MOH in improving the quality of HIV and TB services, including the implementation of continuous quality improvement (CQI) activities, the development of a laboratory information system (LIS), and the provision of technical assistance to health facilities. The project has also been working to improve the capacity of the MOH to manage and coordinate HIV and TB programs, including the development of a program management information system (PMIS) and the provision of training to MOH staff. The ASSIST Project has also been supporting the MOH in implementing various interventions to improve the quality of HIV and TB services, including the implementation of Option B+/ART laboratory-related care and treatment monitoring, in-service training, and the improvement of quality in the national VMMC program through strengthening the national QA/QI/CQI oversight and support for the program. The project has also been working to improve the capacity of the MOH to manage and coordinate HIV and TB programs, including the development of a program management information system (PMIS) and the provision of training to MOH staff. The project has made significant progress in improving the quality of HIV and TB services in Swaziland, including the implementation of CQI activities, the development of a LIS, and the provision of technical assistance to health facilities. The project has also been working to improve the capacity of the MOH to manage and coordinate HIV and TB programs, including the development of a PMIS and the provision of training to MOH staff. However, despite these efforts, challenges remain, including inadequate resources, lack of qualified trainers, and limited access to training facilities.