During 2015, MSF continued to improve access to diagnostics and treatment for HIV and tuberculosis (TB) patients through decentralised and integrated care and innovative approaches.
Swaziland is struggling to cope with the dual epidemic of TB and HIV. It has the world’s highest incidence of TB, and the number of people with drug-resistant forms of the disease (DR-TB) is increasing. Furthermore, around 80 per cent are co-infected with HIV. Since 2007, MSF has been collaborating with the Ministry of Health to tackle this crisis.
Responding to the growing number of extensively drug-resistant TB (XDR-TB) cases in the country, MSF advocated the introduction of new drugs (bedaquiline and delamanid) in 2014. In 2015, staff started treating XDR-TB patients with these in combination with repurposed drugs – a major change for these patients. By the end of the year, 22 XDR-TB patients were on this treatment programme in MSF projects in Manzini and Shiselweni.
MSF teams in Shiselweni continued to support the integration of HIV and TB care in 22 community-based health clinics. As part of this support, MSF has been operating 20 point-of-care mini-labs since 2012. In 2015, these labs carried out 47,842 biochemistry tests, 19,340 CD4 tests and 30,726 viral load tests – the latter of which measure the amount of HIV in a sample of blood and are the strongest predictor of HIV progression. To improve adherence to treatment, MSF has trained people living with HIV as ‘expert clients’ or lay counsellors to work with patients.
This year, to bring services closer to home, MSF piloted multiple community outreach models, including community antiretroviral (ARV) treatment groups and clubs and new ways of delivering medication to patients. Following the positive outcomes in the Shiselweni pilot, these models will now be implemented as a national strategy.
The ‘test-and-treat’ approach implemented in Nhlangano was also successful and has now been adopted as the standard in the health zone. It had a high acceptance rate, with 84 per cent of people agreeing to be initiated on ARV treatment. Acceptance was even higher among pregnant women (96 per cent).
Since 2013, MSF has been carrying out research into thin layer agar, a drug sensitivity test for multidrug-resistant TB treatments that would cost less and provide a more sustainable option for the region than the mycobacteria growth indicator tube (MGIT) typically used.
In Matsapha, the industrial heart of Swaziland where HIV prevalence is the highest, MSF continued to offer comprehensive healthcare with integrated HIV and TB services. In 2015, teams carried out 34,101 consultations, ranging from maternity care, infant immunisations, family planning, general outpatient services, and medical and psychosocial care for victims of sexual violence, as well as HIV and TB treatment.
MSF also supported TB drug-resistance diagnostics at the National TB Reference Laboratory. In Matsapha and Mankayane, alongside the standard 20-month regimen for DR-TB patients, the team continued the roll-out of the nine-month regimen as part of an observational study. The results so far are promising.
MSF launched a new project supporting the national TB hospital in Moneni, the referral hospital for DR-TB in the country. A key aim of the programme is to strengthen outpatient care. By the end of the year, the team had treated 117 DR-TB patients.
No. staff in 2015: 439 | Expenditure: €9.4 million | Year MSF first worked in the country: 2007 | msf.org/swaziland