Expansion of HIV testing in Eswatini: stakeholder perspectives on reaching the first 90

Abstract

Achieving the United Nations' 90-90-90 goals has proven challenging in most settings and the ambitious 95-95-95 goals seem even more elusive. However, in Eswatini-a lower-middle-income country in sub-Saharan Africa with the highest HIV prevalence in the world-an estimated 92% of people living with HIV know their status. We conducted 26 in-depth interviews with stakeholders from policy, implementation, donor, local advocacy and academic sectors to elicit the facilitators and inhibitors to HIV testing uptake in Eswatini. Background data and related reports and policy documents (n = 57) were also reviewed. Essential facilitators included good governance via institutional and national budgetary commitments, which often led to swift adoption of globally recommended programs and standards. The integration of HIV testing into all points of care fostered a sense that testing was part of routine care, which reduced stigma. Challenges, however, centred on social norms that disadvantage certain groups with high ongoing HIV risk (such as key populations, adolescent girls and young women), a heavy reliance on external donor funding, and stigma that had subsided but nevertheless persisted. Amid concerns about whether the 90-90-90 targets could be achieved by 2020, the experience of Eswatini provides tangible insights into factors that have successfully influenced HIV testing uptake and may thus prove informative for other countries.

Factors Associated With Virological Suppression of HIV Viral Load in Patients on Antiretroviral Therapy in Conakry, Guinea

“…This rate is comparable to that reported by Diourra et al, 80% on 379 DBS samples (7). This rate is even lower than the UNAIDS and National AIDS and Hepatitis Control Programme target of 90% by 2020 (15). This result also suggests that three out of ten patients could transmit the infection to their contacts even though they are all on antiretroviral treatment.…”

“…Since the United Nations AIDS Programme (UNAIDS) set its target of three out of 90 by the end of 2020, viral load has become the essential tool for assessing the success or otherwise of ART in PLHIV (Kitchen et al, 2020;UNAIDS, 2014). It also allows biological monitoring of these people (5) The rst viral load (VL) tests in Guinea among PLHIV began in 2006 on a cohort of patients followed by the NGO DREAM (an Italian Christian organisation involved in caring for people living with HIV/AIDS).…”

Feasibility of oral HIV self-testing in female sex workers in Gaborone, Botswana

“…HIV self-testing is generally perceived to be convenient, reducing some of the known barriers to HIV testing among marginalized key populations [22][23][24]. Stigma and fear of discrimination by healthcare providers represent some of the previously identified barriers [23,25].…”

Exploring the experiences of school-going children with HIV in Eswatini: A qualitative inquiry

“…20 , 21 The majority of the Eswatini population (63%) lives below the poverty line. 22 The HIV prevalence in Eswatini is 27.3% among those aged 15 years and older, which is the highest percentage in the world. 23 , 24 The current HIV prevalence is at 2.8% among those aged 0–14 years, 25 with AIDS-related illness being the lead cause of death for under-fives.…”