Background Tuberculosis diagnosis in pregnancy is complex because tuberculosis symptoms are often masked by physiological symptoms of pregnancy. Untreated tuberculosis in pregnant and postpartum women may lead to maternal morbidity and low birth weight. Tuberculosis in HIV-positive pregnant women increases the risk of maternal and infant mortality. Objective This study aimed to determine tuberculosis prevalence stratified by HIV status and identify screening algorithms that maximise detection of active tuberculosis among pregnant and postpartum women in Eswatini. Methods Women were enrolled at antenatal and postnatal clinics in Eswatini for tuberculosis screening and diagnostic investigations from 01 April to 30 November 2015 in a cross-sectional study. Sputum samples were collected from all participants for tuberculosis diagnostic tests (smear microscopy, GeneXpert, MGIT culture). Blood and urine samples were collected from HIV-positive women for cluster-of-differentiation-4 cell count, interferon gamma release assay and tuberculosis lateral flow urine lipoarabinomannan tests. Results We enrolled 990 women; 52% were pregnant and 47% were HIV-positive. The prevalence of tuberculosis among HIV-positive pregnant women was 5% (95% confidence interval [CI]: 2–7) and among postpartum women it was 1% (95%CI: -1–3). Tuberculosis prevalence was 2% (95%CI: 0–3) in HIV-negative pregnant women and 1% (95%CI: -1–2) in HIV-negative postpartum women. The national tuberculosis symptom screening tool failed to identify women who tested tuberculosis-culture positive. Conclusion Routine tuberculosis symptom screening alone is insufficient to rule out tuberculosis in pregnant and postpartum women. Only sputum culture maximised the detection of tuberculosis, indicating a need to balance access and cost in developing countries.

Setting: Five human immunodeficiency virus (HIV) care facilities in Eswatini.Objective: To identify critical factors that enabled persons living with HIV to successfully complete a 6-month course of isoniazid preventive therapy (IPT) provided through a choice of facility-based or community-based delivery, coordinated with antiretroviral therapy (ART) refills.Design: This was a mixed methods, retrospective cross-sectional study.Results: Between June and October 2017, we interviewed 150 participants who had completed IPT in the previous year. Fourteen participants did not recall being offered a choice, and were excluded from the analysis. Of the remaining 136, 56.6% were female and 64.7% chose facility-based care; the median age was 42.5 years. Most participants reported that having a choice was important to their treatment completion (87.7%) and that linking IPT and ART refills facilitated undergoing IPT (98.5%). Participants were knowledgeable about the benefits of IPT and valued the education received from their providers. Participants also reported a high rate of IPT disclosure (95%) to friends and family members.Conclusion: Offering patients a choice of IPT delivery, linking IPT with ART refills, emphasizing patient education and engagement with healthcare workers, and supporting disclosure of IPT are critical factors to enabling IPT completion. These interventions should be incorporated throughout Eswatini and in similar high tuberculosis and HIV burden settings.

Background Cryptococcal meningitis is a leading cause of death amongst people living with HIV. However, routine cryptococcal antigen (CrAg) screening was not in the national guidelines in Eswatini. Objectives A cross-sectional study was conducted between August 2014 and March 2015 to examine CrAg prevalence at Mbabane Government Hospital in Eswatini. Methods We collected urine and whole blood from antiretroviral-therapy-naïve patients with HIV and a cluster of differentiation 4 (CD4) counts < 200 cells/mm 3 for plasma and urine CrAg lateral flow assay (LFA) screening at the national HIV reference laboratory. Two CD4 cut-off points were used to estimate CrAg prevalence: CD4 < 100 and < 200 cells/mm 3 . Sensitivity and specificity of urine CrAg LFA was compared to plasma CrAg LFA. Results Plasma CrAg prevalence was 4% (8/182, 95% confidence interval [CI]: 2–8) amongst patients with CD4 counts of < 200 cells/mm 3 , and 8% (8/102, 95% CI: 3–15) amongst patients with CD4 counts of < 100 cells/mm 3 . Urine CrAg LFA had a sensitivity of 100% (95% CI: 59–100) and a specificity of 80% (95% CI: 72–86) compared with plasma CrAg LFA tests for patients with CD4 < 200 cells/mm 3 . Forty-three per cent of 99 patients with CD4 < 100 were at World Health Organization clinical stages I or II. Conclusion The prevalence of CrAg in Eswatini was higher than the current global estimate of 6% amongst HIV-positive people with CD4 < 100 cell/mm 3 , indicating the importance of initiating a national screening programme. Mechanisms for CrAg testing, training, reporting, and drug and commodity supply issues are important considerations before national implementation.

Background Eswatini (formerly Swaziland) has one of the highest rates of TB and HIV co-disease in the world. Despite national efforts to improve service delivery and prevent TB and HIV transmission, rates remain high. A recent prospective, observational study of integrated, patientselected IPT delivery showed extraordinary improvements in IPT adherence, running counter to previous assumptions. This prompted the need to understand contextual and unseen study factors that contributed to high rates of adherence. Objective To investigate high rates of IPT adherence rates among people living with HIV who participated in an observational study comparing modes of IPT delivery. Methods Community-based participatory research guided the development of in-person administration of semi-structured questionnaires. Observational and field note data were analyzed. Qualitative data were analyzed using content analysis. Results We interviewed 150 participants and analyzed responses from the 136 who remembered being given a choice of their IPT delivery method. Fifty-seven percent were female and the median age was 42. Nearly 67% of participants chose to receive facility-based IPT. High rates of self-reported IPT treatment adherence were linked to four key concepts: 1) adherence was positively impacted by community education; 2) disclosure of status served to empower participant completion; 3) mode of delivery perceptions positively impacted

Background: Cancer is a major public health problem for both developed and developing countries, and more than 70% of cancer deaths occur in developing countries. In Eswatini, cancer is the third leading cause of morbidity and mortality among non-communicable diseases. Cancer is therefore a major health problem for the country that needs urgent attention. Amongst the major contributing factors is lack of knowledge about the disease, lack of awareness on need to screen, issues related to availability and access to screening, diagnosis and treatment services. Health workers have a direct contact with patients hence can pass information to them. This study assessed the knowledge, attitudes and associated factors of health workers towards cancer in Eswatini. Methods: A quantitatively designed cross-sectional study was conducted among health workers using a structured questionnaire. Health workers were enrolled from 12 health facilities countrywide which included hospitals, health centres and clinics. Data were analysed using quantitative methods and presented on tables. Results: A total of 748 health workers were enrolled in the study. Most of them (84.9%) had average knowledge about cancer. Their knowledge differed by age (p<0.001), marital status (p=0.006), employment position (p<0.001), professional qualification (p=0.001), level of education and years of employment (p<0.001). Almost all the HCWs (99.3%) had positive attitudes towards cancer. Conclusion: The HCWs had average knowledge and positive attitudes. There is a need for training programs for HCWs to improve their knowledge as they act a source of information for the population.