MSF has been in Swaziland since 2007 with a focus on the HIV and TB co-epidemics. The small Kingdom of Swaziland (1.2 million people) has the highest prevalence of HIV in the world at 26% (for the age group between 15 and 49) and an annual incidence of HIV estimated to be 2.3%. The HIV epidemic is associated with a tuberculosis (TB) epidemic, including multidrug-resistant TB (MDR-TB). TB is the leading killer for patients with HIV and the co-infection rate in Swaziland is greater than 83%. The consequences of this co-epidemic is a life expectancy of 47, resulting in orphaned children and a disappearing workforce. The impact on the social and economic structure of the country is being felt increasingly. MSF Switzerland is focused in Shiselweni, the Southern-most region which is also the most remote and poorest in the country.
MSF Switzerland opened in the mission in Swaziland in 2007 signing a Memorandum of Understanding with the Ministry of Health to fight the co-epidemic. Since that time MSF has been working with the Ministry of Health (MoH) and other organizations to:
- Task shift care from doctors to trained nurses and delegating HIV testing and counselling to lay community health workers (due to the scale of the crisis and limited human resources)
- Decentralize care from the health centers to the more accessible rural clinics
- Focus on the detection and management of MDR-TB (including home based care with lay people supporting patient treatment) as well as managing both public health protection and respecting patient privacy
- Introduce infection control, and
- Strengthen information systems, laboratory resources, medication supply
MSF in Swaziland is committed to reducing morbidity and mortality in Shiselweni and is implementing, working closely with the MoH, better tools for screening, diagnosis, treatment and follow-up. The specific initiatives that support these goals and are the focus of MSF in Shiselweni include:
- Innovative approaches to diagnosis (Fluorescent microscopy, point of care CD4 and viral load, etc),
- Decentralization of treatment in the community (DR-TB home based care, community ART groups, support of rural clinics, etc.),
- Innovative follow-up tools (viral load point of care, SMS reminders of appointments, etc.), and
- Roll-out of treatment as prevention strategies (PMTCT B+, Early Access to ARV for All (EAAA), etc.).
In Shiselweni, MSF is working with the MoH to staff 22 government rural primary health clinics as well as one hospital, two large health centers and one TB ward with inpatient capacity. The MSF team is big and currently consists of approximately 22 expats (7 in the Coordination role in Mbabane, the capital and 15 in Shiselweni) and more than 200 National staff.
As you can imagine, medications are central to this mission. There are many things that will impact the value of medications: an accurate diagnosis; consistent availability of the appropriate medications; patients clear understanding how and why to take the medication; and confirmed effectiveness through monitoring. Patients’ adherence to therapy is critical and support from family and friends is required.
During the next few months of my mission in Swaziland I’ll expand more on the initiatives I’ve mentioned and provide further insights on the role of MSF, giving a pharmacists perspective.