Eswatini surpasses UNAIDS Fast-track Targets for treatment and viral suppression

The Government of the Kingdom of Eswatini and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) announced the results of the 2021 Eswatini Population-based HIV Impact Assessment survey, locally known as “SHIMS3”, which demonstrate sustained progress towards the ambitious UNAIDS 95-95-95 targets set for 2025. SHIMS3 reveals that in Eswatini, 94 percent of adults 15 years and older living with HIV are aware of their status, 97 percent of those aware of their status are on antiretroviral therapy (ART), and 96 percent of those on ART have achieved viral suppression. This is compared to the SHIMS2 (2016-2017) results of 87-89-91, reflecting laudable progress despite the threats presented by the COVID-19 pandemic. Women achieved the 95-95-95 targets at 95–98–96 in SHIMS3, while men reached 92-96-97. Such achievements indicate that epidemic control for all is within reach.

Overall, the results of SHIMS3 show tremendous progress toward HIV epidemic control in Eswatini and demonstrate the impact of the national HIV response through the Government of the Kingdom of Eswatini’s outstanding commitment to collaboration with partners, including the U.S. government through PEPFAR.

“As a country, we remain committed in our leadership and prioritization of HIV prevention and treatment services. Our health sector staff and our people living with HIV have maximized the opportunities offered through our HIV programs,” said Senator Lizzie Nkhosi, Eswatini Minister of Health. “All emaSwati are encouraged to continue accessing HIV testing services and antiretroviral therapy to maintain their health and protect their loved ones.”

To confront one of the most severe HIV epidemics in the world, Eswatini used data-driven approaches to increase the number of persons tested for HIV, adopted “test and treat” for rapid initiation of ART for persons testing HIV-positive, and enhanced national capacity for viral load testing to monitor the response to ART.  To secure further gains, Eswatini implemented six-month dispensation of ART and decentralized distribution of medication and health services at community access points beyond health facilities. The combined effect of these strategies minimized treatment interruptions and supported strong outcomes, including viral suppression.

According to U.S. Global AIDS Coordinator and Special Representative for Global Health, Ambassador Dr. John Nkengasong, _“Eswatini implemented a multi-pronged approach to achieving the UNAIDS targets that has been highly successful. The impressive progress they’ve made between SHIMS2 and SHIMS3 indicates that they are on track to achieve epidemic control and eliminate HIV/AIDS as a public health threat.”

Eswatini has made significant strides in closing gaps in HIV-related service delivery for all adults. Marked improvement is seen among young adults, a group that is more difficult to reach and has experienced high population growth over the past decade. Among young women aged 15-24 years, the clinical cascade results are 84-96-90 in SHIMS3 compared to 76-84-81 in SHIMS2 (from 2016-17). In young men of the same age, the clinical cascade is 91-96-87 in SHIMS3 compared to 60-92-58 in SHIMS2.

“Eswatini is to be congratulated for its HIV response, one that is distinguished by a determined leadership, a laser focus on gaps in services and by attention to the unique needs and priorities of recipients of care,” said Wafaa El-Sadr, global director of ICAP at Columbia University. “These have propelled the country towards achieving its goal of controlling its HIV epidemic.”

The power of partnerships and leadership is reflected in these results and will continue to play a critical role moving forward, as noted by U.S. Ambassador to Eswatini, Jeanne Maloney. _“Eswatini exemplifies the tremendous progress that can be made when governments, multilaterals, partners, and civil society come together with a unified purpose. All of the tools needed to stop transmission of HIV exist in Eswatini. Sustained leadership across government is needed to holistically address the underlying conditions and drivers of new infections, including gender-based violence, to protect vulnerable populations.”

SHIMS3 is the third nationally representative household-based survey conducted in Eswatini since 2011. The study took place between May and November 2021 with the goal of providing information on national and subnational progress towards key HIV targets and to measure the impact of Eswatini’s HIV response. A full summary sheet of results is scheduled for release in December 2022.

“Data from surveys such as SHIMS3 are showing us what can be achieved by using detailed data to guide the national HIV response for targeted impact,” reflects Michelle Adler, CDC Country Director in Eswatini. _“The data shows that we need to redouble our prevention and service delivery efforts for the youth, including expanded access to pre-exposure prophylaxis (PrEP) – antiretroviral medicine taken daily by an HIV-negative individual to lower his or her risk for acquiring HIV through sexual intercourse, and increase awareness of individual HIV status among men.”

SHIMS3 is part of a multi-country effort to obtain population-based survey data to guide the global response to the HIV epidemic. By implementing SHIMS3 during the COVID-19 pandemic, the Government of the Kingdom of Eswatini affirmed its commitment to sound HIV surveillance and delivery of quality HIV services and programs while safeguarding the health and wellbeing of all emaSwati. The Government of the Kingdom of Eswatini, represented by the Ministry of Health and the Central Statistical Office led the implementation of the survey with technical support from the U.S. Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University, funding from PEPFAR through CDC, and data management support from Westat.

Overall, the results of SHIMS3 show tremendous progress towards HIV epidemic control in Eswatini and demonstrate the impact of the national HIV response through the Government of the Kingdom of Eswatini’s outstanding commitment to collaboration with partners, including the U.S. Government through PEPFAR.