Differentiating Service Delivery for HIV and NCDs in Eswatini

Is Blood Pressure Self-Monitoring Feasible and Acceptable for Patients with HIV and Hypertension?

Eswatini has the world’s highest HIV prevalence and a substantial cardiovascular disease (CVD) burden, which accounts for approximately 11 percent of deaths. A recent study of HIV patients 40 years and older on antiretroviral therapy (ART) at an urban hospital in Swaziland showed that 39 percent had at least one CVD risk factor; the most common was hypertension (HTN), which was found in 25 percent of the study population.

Eswatini has adopted a differentiated service delivery approach to HIV program design, but although rates of HIV-HTN co-morbidity are high, there currently no plans to differentiate treatment for HTN, which is generally treated at the health-facility level. If people living with HIV and HTN need to make frequent visits to health facilities for clinical monitoring and medication pickups for HTN, they will not achieve the benefits that differentiated service delivery (DSD) is meant to offer, even if their HIV services are largely delivered at the community level. If they are not eligible for DSD, a large percentage of older patients on ART will not benefit from this innovation.

Identifying contextually appropriate ways to differentiate both HIV and HTN services is a priority. Swaziland recommends integration of NCD screening in ART service delivery as part of a comprehensive service package, including at the community level, encouraging DSD for patients with HIV and NCDs through the formation of special clubs, but it is not clear how this screening should be done and by whom.

Working with the Ministry of Health, CQUIN will test the feasibility and acceptability of a self-measured blood pressure package of care for patients with HIV and HTN in Eswatini.

The Big Picture

This small pilot study is intended as a first step towards identifying ways to differentiate service delivery for patients with both HIV and HTN. If the self-monitoring package proves to be feasible and acceptable at the facility level, the next step will be to pilot its use at the community level, in the context of various DSD models.

For more information on the study, contact Miriam Rabkin at mr84@columbia.edu.

Learn about ICAP’s broader portfolio of work in Eswatini.