Differentiated Service Delivery in Eswatini (formerly Swaziland)
Because of its small population and high HIV prevalence, differentiated service delivery (DSD) has the potential to dramatically improve care and treatment in Eswatini. Differentiated service delivery is included in national policies and guidelines, which were created (2016) in partnerships with stakeholders, including the Swaziland National Network of People Living with HIV.
Eswatini’s Community-Centered Models of ART Delivery (CommART) approach other than the main stream includes community ART groups, facility-based treatment clubs, fast-track models, and an ART outreach model that uses mobile clinical teams to bring services to communities. No single refill model can address the needs of all the people living with HIV, hence the different model allow patients to choose the ART Refill model that best suits their individual needs. CommART services are available at 52 of the country’s 166 health facilities. The national care and treatment technical working group coordinates DSD activities.
“Treat all” guidance for test and start has created a demand to decongest health systems. Barriers to scale-up include limited monitoring and evaluation systems, competing programmatic priorities, and limited coverage of routine viral load testing. Eswatini is committed to improving DSD for key populations, such as female sex workers and injection drug users. Plans are in place to develop DSD guidelines for patients with advanced disease. Eswatini is working toward a phased implementation targeting hospitals and health centers, high-volume clinics, and other interested facilities.