Annual HIV programmes report 2014: HTC, VMMC, PMTCT, and ART
The implementation of prevention and treatment and care components of the HIV program has resulted in a number of results. In terms of prevention; the Service Availability Mapping 2013 shows that HTC coverage has increased from 76% in 2008 to 92% in 2013, 150 facilities in 2010 to162 in 2013 for PMTCT and 24 in 2010 to 45 in 2013 facilities providing VMMC.
Treatment and care component has seen a steady increase in the number of health facilities providing ART services with 133 health facilities providing the ART services (SAM 2013). More focus was put on ensuring that health facilities provide comprehensive services.
There were 389,658 antibody and DNA PCR tests performed in 2014 as compared to 336 497 in 2013. Overall, the total tests that were positive in 2014 were 7.5%, indicating a downtrend than the previous years. However gender bias is still evident with younger women testing positive and older men testing positive. The age group 35-39 years had the high percentage positive presenting 17.5% and males had the higher percentage positive with 19.2%. In 2014, 35% of the women who were tested for HIV came out to be HIV positive.
A total of 12,289 males circumcised. The age group 10-14 had the highest number of males circumcised when compared with the other age groups with 6,744.
The introduction of LLAPLa has resulted in an increase of ARV uptake for pregnant women. In 2014, 92% in pilot sites, and 89 % and non-pilot sites received ARVs. In 2014, 36% exposed infants were seen at health facilities and from those who were tested using DNA PCR 3% were HIV positive.
As many as 151, 994 people had been initiated cumulatively over time on ART by the end of 2014 in Swaziland. The ART coverage for 2014 for adults (=>15 years) was at 76% (68% for males and 81% for females), and the coverage for children (<15 years) stood at 54% in 2014. The overall coverage was 74% implying a drop in coverage as compared to the previous years). This drop in coverage can be attributed to the change in the threshold for ART initiation from CD4 cell count =<350 cells/mm3 to =<500 cells/mm3. Secondly, it can be attributed to the change in the treatment guidelines which states that all pregnant and lactating HIV-positive women should be initiated on lifelong ART (LLaPla) regardless of CD4 and WHO clinical stage, preferably on the day of HIV diagnosis.
Generally there is a marked improvement in retention across all cohorts/ time points. The 6-month retention rates increased from 85% in 2013 to 97% in 2014 for children and increased from 86% in 2013 to 96% in 2014 in adults. Retention in care among children (<15 years) increased from 65% in 2013 to 83% in 2014 and among adults a similar trend is observed with retention rate increasing from 62% in 2013 to 78% in 2014, respectively, at 36 months after ART initiation. There is an improvement in the percentage of Pre-ART patients diagnosed with TB who are initiated on TB treatment which stands at 98%.
Other critical program achievements for the program in 2014 included the finalization of the eNSF in collaboration with NERCHA which seeks to address improved HIV preventative, care and treatment strategies.
The program also worked in the development of the first integrated HIV guidelines.