THE Shiselweni region has witnessed a reduction in HIV related death incidences between 2008 and 2012.
The Medicins Sans Frontieres (Doctors without Borders) says the death incidences were reduced from 461 per 100 000 people in 2008 to 216 in 2012.
This is contained in the MSF’s report on the decentralisation of TB in the Shiselweni region between 2008 and 2013. The report was released on Wednesday.
It attributes this to the high level of anti retroviral treatment (ART) coverage and the improvement in quality care.
The report further states that from the time HIV hit Swaziland in the early 90s, life expectancy dropped steadily. In the Shiselweni region, mortality rate seen in inpatient and outpatient departments stabilised by 2008 to 2009 then declined two-fold between 2010 and 2012.
The MSF states that in a high HIV prevalence context such as Shiselweni, increasing coverage is expected to reduce overall HIV related morbidity.
In order to fight HIV and TB successfully, the organisation has recommended among other things continuity of the current Shiselweni programme.
It encourages decentralisation of laboratory services by establishing mini- laboratories at all clinics and implementing a sample transportation system to reference laboratories.
It also recommended the introduction of nurse-led ART and TB at all health facilities, introduction of strong patient support, education and counselling by expert patients.
Further it recommended the introduction of implementation of full integration of HIV and TB treatment, including MDR-TB into general health care.
Stigma still a barrier to disclosure of HIV status
WHILE stigma related to HIV and TB is widely seen to have decreased significantly in recent years, it is still considered a major barrier to disclosure of HIV status and to the management of HIV/TB care.
This is the observation of the Medicins Sans Frontieres (Doctors without Borders) in its five-year decentralisation project of HIV/TB care in the Shiselweni region.
According to the five- year report that was released on Wednesday, disclosure is generally seen as a necessary determinant of treatment adherence and well being of HIV positive people. MSF says its patients often described their disclosure experience as relief from a burden and as the beginning of a new and more confident life. They also recognised that reduction of fear and stigma in the community is linked to disclosure.
It says cultural expectations of men discourage early health seeking behaviour and this is often compounded by men’s stronger fear of HIV related stigmatisation and by perceptions that clinics are not sufficiently male friendly. It says men and youths in many other parts of the world are hard to reach. In the Swaziland setting, MSF has observed that one big opportunity for reducing stigma arises from the fact that community leaders are highly respected and influential in the rural society. Involving them therefore is perceived as an important strategy for enhancing acceptance of services and decreasing HIV/TB related stigma at the community level.
Retaining patients on ART a challenge - MSF
THE Medicins San Frontiers (Doctors Without Borders) has said that retaining people on lifelong treatment for HIV is challenging in most settings around the world and Shiselweni is no exception.
In its report, MSF says retention in care has consistently improved over time at every follow-up interval assessed.
The report also states that gains in retention were also seen for HIV patients with the highest risk of death, indicating a higher quality of care in later years. It says the combined risk of death loss to follow up decreased by 14 percent in 2009/10and 42 percent in 2011/12. Easy patient access to HIV/TB care enhanced patient support through a comprehensive counselling package and increased community awareness about the importance of adherence to long term treatment were all key to gradually improve ART retention across the entire region.
Increase in HIV testing
Coverage of annual HIV Testing and Counselling (HTC) in Shiselweni increased to more than 20 percent in 2012.
This shows an increase from 10 percent in 2009. According to the MSF report on decentralisation of TB in the Shiselweni region between 2008 and 2013 the number remained low and pointed to a need for additional strategies that reach a wider population and improve HIV Testing and Counselling (HTC) uptake.
The report states that the decentralisation of HIV services and greater focus on provider initiated testing as compared to voluntary counselling and testing (VCT) led to an increase of more than 500 percent in the uptake of HTC between the start of 2009 to the end of 2012. It says during the same period, the proportion of HIV positive people identified at HTC decreased from 30 percent to 11 percent, indicating that more HIV negative people were accessing HTC.
The World Health Organisation (WHO) recommendations and guidelines call for negative people to undergo HIV testing once a year.