Swaziland integrated HIV management guidelines
Antiretroviral therapy has been identified as one of the interventions that can help lower the risk of HIV transmission from one person to another. The protective nature of ART was demonstrated in the HPTN 052 study, but this protection is at the individual level and translating this to the entire population is a function of ART coverage and efficiencies at the national level. Swaziland has achieved universal ART coverage under the 3 previous treatment guidelines (CD4 <350 cells/mm), however the benefits of early ART initiation (CD4<500cells/mm) in reducing opportunistic infections and other co-morbidities have also been demonstrated. It is also recognised that HTC is the gateway to treatment and prevention and there should be a deliberate move to expand the reach of our HIV testing services. As part of Swaziland's vision to prevent AIDS-related morbidity and mortality, and to eliminate new HIV infection, the country has adopted the 2013 WHO consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. This includes providing lifelong ART to pregnant and lactating women to maximise the contribution of ART in eliminating paediatric HIV, and to keep the mothers alive and healthy. In line with this vision, Swaziland is strengthening its policies to ensure that all children receive early HIV diagnosis and are linked immediately to appropriate care. Other key innovations in this document include ART for all children under 5 years and the HIV-positive partner of a sero-discordant couple.
The new integrated guidelines takes a more public health approach to address the country's HIV epidemic at the population level while maintaining the individual benefits of early HIV diagnosis and access to quality care and treatment services. The Government of the Kingdom of Swaziland is also investing in enhanced patient monitoring to improve treatment outcomes such as retention in care and viral suppression.