Swaziland halves rate of new HIV infections
Swaziland, which has the highest HIV prevalence and incidence of any country in the world, reduced its rate of new infections by nearly half over the past 5 years by implementing expanded prevention and treatment services, researchers said.
Between 2011 and 2016, the small country in southern Africa experienced a 44% decrease in HIV incidence and a more than twofold increase in viral load suppression among adults aged 18 and 49 years, according to promising findings presented at the International AIDS Society Conference on HIV Science by Rejoice Nkambule, MPH, deputy director for public health in Swaziland’s Ministry of Health.
The new data came from the second Swaziland HIV Incidence Measurement Survey (SHIMS2), a type of population-based HIV impact assessment (PHIA) led by the Swazi government and funded by the United States Presidents’ Emergency Plan for AIDS Relief (PEPFAR). The program is also supported by the CDC and the International Center for AIDS Care and Treatment Programs at Columbia University’s Mailman School of Public Health.
“These findings show a dramatic transformation in Swaziland where, at one time, HIV was destabilizing family structures, communities and its economy,” CDC Director Brenda Fitzgerald, MD, said in a statement.
According to Nkambule and colleagues, it was the first measurement of the impact that a national scale-up of HIV programs has had in Swaziland since the previous SHIMS1 survey was conducted in 2011. SHIMS2 included household-based, rapid HIV testing of 10,934 participants aged 15 years or older between August 2016 and March 2017.
According to the new results, Swaziland has an HIV prevalence rate of 27% (95% CI, 25.7-28.3) and an incidence rate of 1.36% (95% CI, 0.92-1.81). Among adults aged 18 to 49 years, the HIV incidence rate was 1.39% (95% CI, 0.83-1.94) — a 44% decrease from the 2011 estimate. The incidence rate in women was higher than in men — 1.95% vs. 0.86% — but declined among both genders since 2011, 38% in women and 53% in men.
Moreover, rates of viral load suppression among adult patients with HIV aged 18 to 49 years increased from 34.8% in 2011 (95% CI, 33.4-36.2) to 71.3% (95% CI, 69.0-73.5) during the survey period.
The results in Swaziland followed recent findings from PHIAs conducted in Malawi, Zambia and Zimbabwe that showed progress toward eliminating HIV in those countries.
“These groundbreaking findings from Swaziland show that we are making strong progress toward controlling the HIV epidemic in the country with the highest HIV prevalence in the world,” Ambassador-at-large Deborah L. Birx, MD, coordinator of the United States Government Activities to Combat HIV/AIDS and U.S. Special Representative for Global Health Diplomacy, said in a statement.
“Combined with the results from three additional PEPFAR-supported surveys that we released last December, we now have clear evidence that four African countries are approaching control of their HIV epidemics using the 90-90-90 fast-track strategy,” Birx said. – by Gerard Gallagher
Nkambule R, et al. Substantial progress in confronting the HIV epidemic in Swaziland: first evidence of national impact. Presented at: IAS Conference on HIV Science; July 23-26, 2017; Paris.
Disclosures: Birx, Fitzgerald and Nkambule report no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.