The Swaziland Partnership for Familycentered HIV Programs

1
The Swaziland Partnership for Family-centered
HIV Programs
International Center for AIDS Care and Treatment
Programs Annual Meeting, March 2006 Dar Es Salaa
m, Tanzania

• Raymond Byaruhanga
• Joris Vandelanotte
• March 7, 2006

2
Presentation overview

• Partnership program
• Swaziland profile
• Swaziland HIV/AIDS program
• Partnership overview
• Planned activities
• Conclusion

3
Partnership in Swaziland

• Similar to Lesotho yet distinctly different
• Mirror program EGPAF lead agency
• EGPAF in country since 2004 (PMTCT)
• ICAP and AED/LINKAGES staff joined the Swazi
  office in 2006
  

4
Swaziland Demographics
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Swaziland HIV profile
Source UNAIDS 2004 update
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ANC sero prevalence trend
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Swaziland HIV/AIDS response

• As in Lesotho, Swaziland has been slow to act
• 1986 Swaziland National AIDS/STI programme
  (SNAP)
  
• 1992 start of two yearly sero prevalence
  surveys
  
• 1998 new HIV and AIDS policy approved by
  cabinet King declared HIV/AIDS national
  disaster
  
• 2001 establishment of NERCHA (National Emergency
  Response Committee on HIV/AIDS)
  
• Multi-sectoral committee
• Poor coordination with SNAP

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Swaziland PMTCT Services

• PMTCT implemented in 63 of health facilities
• 5/6 Hospitals
• 5/6 Health Centres
• 58/96 Clinics
• EGPAF (15 facilities) and UNICEF (47 clinics)
  main agencies
  
• PMTCT statistics (Jan Sep 2005) (national)

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Swaziland ART Programme

• ART services
• Partnership program
• 11 public sites (6 hospitals and 5 health
  centres)
  
• 5 private sites and 1 NGO site
• The Kingdom of Swaziland thru GF supports ART in
  all these facilities
  
• ART start Dec 2003
• To date 13,000 people on ART
• No outcome information No follow up systems

10
Swazi HIV/AIDS strengths

• Basic health infrastructure is available
• Stable country
• PMTCT functions well in certain sites
• Government is committed to tackle HIV/AIDS
• Small country if well managed, could reach all
  patient who need care and treatment
  

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Swaziland HIV/AIDS challenges

• Staff shortages (at national and at facility
  level)
  
• Limited skills at all levels
• Space shortages
• No follow up system for mother or exposed
  child/No follow up system for ART patients
  
• Lack of coordination within government and
  between donor agencies
  
• Vertical approach of donor agencies
• Quantity before quality
• Very high prevalence could destroy the fabric of
  the society
  

12
Swaziland HIV/AIDS Strategic Plan

• PMTCT
• Expand PMTCT to all facilities
• Presumptive prophylaxis for PMTCT (high sero
  prevalence)
  
• In PFHP sites
• Cotrimoxazole prophylaxis
• Introduce AZT/NVP for PMTCT
• Provide HAART to pregnant women
• Treatment and care
• Review outcomes and follow up systems in current
  sites
  
• Develop referral systems involvement of clinics
  in follow up and care
  

13
The Swaziland PFHP
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Partnership just taken off

• 2 ICAP Clinical Advisors arrived beginning 2006
• AED/LINKAGES new staff in the field since Jan
  2006
  
• Joint office established
• Planning rapid appraisal of facilities

15
PFHP PMTCT Accomplishment

• EGPAF implementing PMTCT services in Swaziland
  since July 2004
  
• Started in 3 facilities in KS II PHU, RFM and
  Mankayane Hospital Expanded to 15 sites in 2005.
  
• High uptake of Counselling and Testing

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Partnership PMTCT Site
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Planned activities

• Rapid appraisal of Health Facilities
• Develop strategies (based on rapid appraisal) to
  attain targets
  
• Support national MOHSW in strengthening
  treatment and care
  
• Training Health Care Workers
• Formal training
• On the job training
• Analyze and improve health systems
• Patient flow
• ME

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Site Level Activities

• Build and expand PMTCT work EGPAF established
• Establish follow up system for pregnant women and
  exposed infants
  
• Initiate cotrimoxazole to pregnant women and
  exposed infants
  
• Support early infant diagnosis
• Initiate ART services for PMTCT clients (pregnant
  women, partners, children)
  
• Phased approach from hospital to clinics

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Partnership strengths

• Different agencies, different specialties
• Synergy
• Economies of scale (sharing offices and admin
  support)
  

20
Partnership challenges

• Different start up times
• Different funding agencies, different reporting
  periods
  
• Need for increased communication
• Sensitivities around datasharing
• Different corporate cultures

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Conclusion

• New program
• Partnership poses unique challenges and
  opportunities
  
• Need to document partnership

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Final thought

• HIV has declared war on Swaziland.
• If the country is to survive it has to declare
  war on HIV and behave like a country at war.
  
• It should no longer be business as usual for
  every citizen and for all sections of society
  civil, public and private.