MaxART informs "Test & Start" approach

March 2, 2017

Swaziland took an amazing step forward towards the goal of ending AIDS countrywide. In 2016, the Ministry of Health officially introduced ‘Test & Start’ as an approach for HIV testing and treatment. MaxART and Médecins Sans Frontières have been implementing pilot studies on early access to HIV treatment in two districts of Swaziland since 2014 and the promising lessons learnt have contributed to Test & Start being adopted even before the studies have been completed.

Test & Start allows for people who are ready to initiate on antiretroviral therapy (ART) immediately after an HIV-positive diagnosis in an effort to improve their health. Swaziland is implementing two Early Access to ART for All implementation studies, one being conducted in Hhohho (MaxART) and the other in Shiselweni (Médecins Sans Frontières) which are designed to inform the Ministry of Health on the feasibility, acceptability, clinical outcomes, affordability and scalability of offering early ART to all HIV-positive individuals in Swaziland. Preliminary lessons learned are now contributing in informing the Test & Start roll-out.

90-90-90 targets

90% of the people living with HIV are aware of their status;
90% of them receive ART; and
90% of them are virally suppressed.

By introducing the Test & Start approach, the Swaziland Ministry of Health aims to achieve universal access to ART and the UNAIDS 90-90-90 targets by 2020. Test & Start is also informed by epidemiological research that shows that when people begin ART soon after they are diagnosed with HIV - regardless of CD4 count - HIV incidence in the population will be significantly reduced.

Lessons learned

The Early Access to ART for All study demonstrates that it is necessary to test the right people, in the right places, with the right strategies. Another lesson learned is that it is important to ensure that individuals are linked to care and initiated early on ART. The last lesson learned is that measures to ensure quality care should be in place to maximise retention and viral suppression. The Test & Start approach puts these findings into practice to improve the lives of people living with HIV.