THE NEXT FUTURE: POWER IN MY HANDS - PSI
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THE NEXT FUTURE: POWER IN MY HANDS PSI
Community HIV
testing continuity in
the context of COVID-
19 lockdown and
physical distancing in
Eswatini
Ralitza DEKOVA
HIV Self-Testing Program Manager
PSI Eswatini 8 July 2020
Co-chairs’ choice session
14:00 PT
Kingdom Achieved all three 90s (2018) HIV prevalence,
of Eswatini
Unaids, 2019
Botswana Eswatini Namibia
HIV age 15-49 (2018)
Denmark Netherlands United Kingdom 27%
No HIV
73%
Proportion PLHIV unaware of HIV-
Population: 1,140,000 positive status (2016-7)
Rural population: 76%
15 - 24 y.o. LHIV* 34%
Median age: 21.7 years
Male LHIV 23%
Urban pop. LHIV 20%
Female LHIV 11%
Total pop. LHIV 15%
SHMIS, 2019
0% 10% 20% 30% 40%
*LHIV = living with HIV
HIVST in Eswatini
• Oral HIV self-tests piloted in 2017
• STAR project began in 2017 in Eswatini, largest evaluation of HIV self-testing worldwide
• Scale-up in 2019 with PEPFAR support; multiple implementing partners in communities and in facilities
National AIDS Program guidance on HIVST:
Targeted Distribution in the Distribution in Tihlole wena!
populations: community: health facilities:
Do it yourself!
1. At
workplaces
1. At high-
1. Young (factories; PSI Eswatini supports MOH in
volume health
women manufacturin ✓ community HIV testing,
facilities;
g plants;
(16-24) 2. Secondary ✓ community ART initiation and
logistics
2. Men distribution to ✓ HIV prevention interventions
companies)
(all ages) pregnant ✓ NCD interventions
2. Community
3. Key women,
hotspots/ in all four regions of the country.
Populations clients with
events
STIs; PLHIV
3. Index contact
tracing
COVID-19 in Eswatini
28 March 2020:
National lockdown announced
- Non-essential businesses closed
- Pharmacies, healthcare facilities, food
stores open
- Work from home order in place
- Community HTS paused thus previous
As of June 29: HIVST distribution channels
inaccessible; fewer clients accessing
Total population of Eswatini: 1,140,000
health facility services
Total number of confirmed cases: 795
(7 per 10,000 people)
Total recoveries: 380 (48%)
Total deaths: 11 (0.01% mortality rate)
Recommendation for HIV testing services from Ministry of Health
HIV self-testing at PSI Eswatini:
before and after lockdown
Total number of HIVST kits distributed (2019/2020)
16000
MODALITY: MODALITY:
-----------------Lockdown------------------
14104
14000
Index contact tracing Primary & secondary
in the community 12000 distribution at
pharmacies and food
• HCW elicits contacts
10000 9019 shops
from a newly 8000
diagnosed PLHIV • Eligibility screening
• HCW approaches 6000 and risk assessment
the associates of a is conducted
PLHIV to do assisted 4000 • Consent for follow up
onsite HIVST • Phone call for follow
• Reactive HIVST can 2000 1220 up support, including
677
be confirmed onsite 379 linkage to prevention
– meet the client 0 and HIV treatment
where they are November December March April May
Distribution in front of pharmacies; grocery stores
Distribution of oral HIVST kits
during lockdown, April & May 2020
Primary HIVST distribution by age, sex and testing frequency
(n=18,564)
3000 30%
27%
2500 25%
Primary HIVST distribution by sex 23% 22%
(n=18,564) 22%
2000 20% 20%
19% 18% 18%
17% 17%
16%
15%
1500
15% 15%
13% 13%
% male 49% 12%
1000 10%
% female 51%
500 5%
0 0%
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
Male Female % never tested (male) % never tested (female)
Further analysis of never-testers
Number of clients received HIVST kits (primary distribution)
who had never tested for HIV before, April - May 2020 (n=3,213)
450 30%
400
25% 25%
350 23%
300 20% 20% 17% of all clients reached had
never tested for HIV in the past:
250
15%
200 • 53% of those were males
12% (n=1,714)
150 10% • 13% were age 40+ (n=423)
7%
100 6%
5%
50 4%
3%
0 0%
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
Male Female % of totalLinkage to care cascade; follow-up calls in April, May 2020
6000 100%
5090 89%
5000
4508 80%
4000
59% 60%
3000
42% 45%
40%
2000
20%
1000
151 3% 64 39 23
0 0%
Successfully Used kit Reactive Already on Newly Initiated
reached ART diagnosed ART
(primary)
Total %Conclusions
Community HTS are an important component of HTS in
Eswatini, so we were required to act quickly to continue
providing this important service to the public
Rapid adaptation of HTS after lockdown: both by MoH & by
HTS partners
HIVST is ideal for physical distancing and screening for
HIV
This modality is likely playing an important role in
normalizing HTS, decreasing HIV-testing related stigma &
creating demand for the HIV self-test
Reaching clients we normally wouldn’t through our
standard targeted means (e.g. clients who may not go to
sports events; cultural events; at the typical workplaces that
we service; tertiary institutions)Acknowledgements
CONNECT WITH US
Lenhle Dube
VISIT US National HTS Coordinator
PSI.ORG Ministry of Health
Kingdom of Eswatini
lenhlephil@gmail.com
LIKE US
/PSIHEALTHYLIVES Nokuthula Mdluli
Director of Testing and Linkages
PSI Eswatini
FOLLOW US
nokuthulam@psi.sz
@PSIIMPACT
Ralitza Dekova
FOLLOW US HIV Self-Testing Program Manager
@PSIIMPACT PSI Eswatini
Twitter: @swazibg
ralitzad@psi.sz
FOLLOW US
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