Swaziland: new infections halved in five years as HIV treatment scales up

July 27, 2017

New HIV infections have nearly halved in Swaziland since 2011 at the same time as the proportion of people on antiretroviral treatment with fully suppressed viral load has doubled, the 9th International AIDS Society Conference on HIV Science (IAS 2017) heard in Paris, France. It is the first direct evidence that expanding HIV treatment results in fewer HIV infections in a country with a major epidemic, researchers said. The Aidsfonds MaxART programme contributed significantly to this achievement.

Increase in HIV treatment coverage associated with HIV incidence fall

Although the effect of HIV treatment on stopping HIV transmission is well established at the individual or couple level, the impact of wider uptake of treatment on HIV transmission at the population level is less well understood. Research in Kwazulu-Natal province, South Africa,has shown that an increase in HIV treatment coverage is associated with a fall in HIV incidence. What has been lacking, until now, is evidence that increasing the proportion of people living with HIV who have fully suppressed viral load is associated with a decline in new HIV infections.

Pilot studies on Early ART contributed to Test & Start

The Maximizing ART for Better Health and Zero New HIV Infections (MaxART) programme and Médecins Sans Frontières have been implementing pilot studies on early access to HIV treatment in two districts of Swaziland since 2014. Both studies 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. The promising lessons learnt have contributed to the official introduction of Test & Start by the Ministry of Health in 2016 as an approach for HIV testing and treatment. 

MaxART: pioneer in treatment regardless CD4 count

MaxART initiated the pilot study in the Hhohho region whereby people who tested positive received treatment with ART regardless of their CD4 count or stage of disease. This was the first time ever that this method underwent large-scale testing. Prior to the pilot, in 2010-2014 MaxART raised awareness nationwide about the importance of testing and treatment in communities, mobilizing people to get tested and start treatment when necessary and strengthening the health care system in Swaziland. Since then, the number of people who go for a test annually has more than doubled, amounting to 285,000 people each year. In addition, 90 per cent of the people who were tested positive, receive treatment when eligible for treatment at that time. 

Swaziland’s HIV response in numbers

The Kingdom of Swaziland has one of the most severe HIV epidemics in the world. In a country with a population of 1.4 million, just under a third (32%) were estimated to be living with HIV in 2011.

Since 2011, Swaziland has scaled up access to antiretroviral treatment and testing, adopting the 'treat all' approach recommended by the World Health Organization. The number of HIV tests carried out each year has almost tripled since 2011 and the number of men who have undergone medical circumcision has more than doubled. The number of people on antiretroviral treatment grew from 72,402 in 2011 to 171,266 in 2016 and viral load suppression doubled between 2011 and 2016-17, from 34.8 to 71.3%. A significant reduction in new HIV infections occurred in the same period: In men, HIV incidence fell by 53%, from 1.83 to 0.86%. In women, HIV incidence fell by 38%, from 3.16 to 1.95%. Overall, HIV incidence fell by 44%. 

Source: NAM Aidsmap

More about the 9th International AIDS Society Conference on HIV Science at www.ias2017.org 

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