Abstract
IntroductionSwaziland’s severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT).MethodsData triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey.ResultsBy 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm3, with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005–6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005–6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%.ConclusionAgainst a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.
Highlights
Swaziland’s severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004
To monitor and evaluate the health impact of intensified program efforts, World Health Organization (WHO), United Nations Programme on HIV/AIDS (UNAIDS), the GF and partners provide Monitoring and Evaluation (M & E) guidance for national HIV/ AIDS programs to report on policy development, implementation and programmatic progress of HIV Testing and Counseling (HTC), Antiretroviral Therapy (ART), HIVTB and prevention of mother to child transmission (PMTCT) services [3,4,5,6,7,8,9]
HIV data triangulation in Swaziland The current study aimed to address the key questions listed in Table 1, which were agreed between the Ministry of Health Monitoring and Evaluation Team and key partners in a consensus workshop (2011), as representing the priority questions for Swaziland’s national HIV/AIDS programs
Summary
Swaziland’s severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. To monitor and evaluate the health impact of intensified program efforts, WHO, UNAIDS, the GF and partners provide Monitoring and Evaluation (M & E) guidance for national HIV/ AIDS programs to report on policy development, implementation and programmatic progress of HTC, ART, HIVTB and PMTCT services [3,4,5,6,7,8,9] These Global Health Initiatives developed guidance on ‘triangulating’ a combination of relevant existing data sources to understand national and local HIV epidemics and evaluate program outcomes and impact [10,11]. Other examples of successful HIV data triangulation include Ukraine, Republic of Moldova and Estonia [20,21]
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