Department of Defense HIV/AIDS Prevention Program Eswatini (DoD Eswatini URC Project)

The Challenge

The Kingdom of Eswatini has made great strides toward achieving the UNAIDS 95-95-95 targets for HIV epidemic control. However, it still has the highest HIV prevalence rate in the world. Eswatini’s military – the Umbutfo Eswatini Defence Force (UEDF) – is also adversely affected: military service members, their families, and non-military community members depend on UEDF health services for comprehensive HIV/AIDS prevention, treatment, and care services.

Overview and Objectives

URC supports the Government of Eswatini to reduce the number of new HIV, TB, and sexually transmitted infections (STIs) among UEDF members, their families, and the civilian communities served by their health services. URC supports the military’s 10 accredited health clinics to deliver services to over 120,000 people each year. The DoD Eswatini URC Project focuses on HIV/AIDS prevention, testing, care and treatment, clinical monitoring, quality management systems, and HIV systems strengthening.

The DoD Eswatini URC Project plays a crucial role in supporting UEDF to monitor progress toward the UNAIDS 95-95-95 targets and aim to end HIV/AIDS by 2030. The efforts of the project have contributed to substantial advancements toward achieving these goals. 

• Optimize HIV case finding
• Attain universal ART coverage
• Attain universal viral suppression
• Improve access to combination prevention services for UEDF members (with an emphasis on new recruits), their families, and surrounding communities
• Strengthen HIV clinical monitoring systems and military health systems
• Strengthen UEDF’s institutional capacity to lead, plan, and monitor the HIV response

Achievements

The UEDF, with URC’s support, has achieved the following results:

• Expansion and Decentralization of Quality Services
  Decentralized comprehensive and integrated services from the main clinic at Phocweni to the other nine UEDF clinics. All clinics provide combination prevention services for priority populations, including condom and lubricant distribution, mobilization for voluntary medical male circumcision (VMMC), pre-exposure prophylaxis, and post-exposure prophylaxis. All clinics also provide HIV testing services, ART, screening and treatment for other diseases including TB and STIs cervical cancer screening, and gender-based violence (GBV) screening and support. They also screen for and treat noncommunicable diseases.
• Case Finding
  Improved index testing contact elicitation ratios by providing anonymous contact elicitation lock boxes, leading to a 133% increase in the number of clients tested.
• Care and Treatment
  Institutionalized “test and start” strategy and trained 30 nurses in nurse-led ART, leading to 99% coverage of eligible clients with dolutegravir-based regimens. Increased the ART retention rate among clients to 96% and strengthened implementation of differentiated service delivery models, including six-month multi-month dispensing, fast-track ART refills for stable patients, and decentralized drug distribution.
• Cervical Cancer Screening and Treatment
  Strengthened screening of HIV-positive women on ART for cervical cancer. In 2023, 100% of women with precancerous lesions or cancer were linked to treatment.
• Gender-Based Violence Screening and Response
  Achieved 171% achievement of UEDF’s GBV screening and response target in 2023 with tools and systems in place for effective identification and referral of GBV cases.
• Quality Management System Implementation
  Established quality management system (QMS), which was endorsed by the Military Executive. QMS documentation deployed to all facilities to standardize systems for supply chain management, monitoring and evaluation, infection prevention and control, and clinical care.