Swaziland: urgent action needed to address TB/HIV co-infection as life expectancy halved in 20 years

Mbabane, 18 November 2010 – Médecins Sans Frontières (MSF) today launches a report on the fight against a dual epidemic of tuberculosis (TB) and HIV that is devastating the southern African kingdom of Swaziland, cutting life expectancy from 60 years to 31. With a population of just over a million, Swaziland is at the epicentre of a co-epidemic affecting all of southern Africa. The Fighting a dual epidemic report defines the urgent action needed to respond to this major health emergency.

“Swaziland has the highest HIV prevalence in the world among adults. Disturbingly, more than 80 percent of TB patients are also co-infected with HIV,” says Aymeric Péguillan, MSF’s head of mission in Swaziland. “Life expectancy has halved within two decades, plummeting from 60 to just 31 years. People are dying in large numbers, and tuberculosis is currently the main cause of mortality among adults. As a result, many children are being made orphans and the adult workforce is declining.”

Swaziland also has an alarmingly high prevalence of multidrug-resistant TB (MDR-TB), which accounts for 7.7 percent of all new TB cases and places Swaziland amongst the countries with the highest prevalence of MDR-TB (revealed by the joint MSF/National TB Programme 2009-10 Drug Susceptibility Survey). Tackling this crisis is hindered by an acute shortage of local health staff, inadequate diagnostic facilities and by patients failing to complete their treatment, often because of the prohibitive cost of making long and frequent journeys to distant health facilities.

In November 2007, MSF and the Ministry of Health introduced a decentralised, integrated and patient-centred approach to fight the co-epidemic in Shiselweni, the country’s poorest and most remote region. As a result, innovative ‘one-stop services’ for HIV and TB care are today available in 21 health facilities. Numbers of people tested for HIV each month has more than tripled in 18 months, reaching 1,617 in June 2010.

“Decentralising integrated HIV and TB services all the way down to rural clinics and communities has dramatically improved patients’ access to care, and significantly reduced the number of patients defaulting from treatment,” says Péguillan.

Other innovative approaches have been implemented with great success, in particular making better use of human resources by shifting responsibilities from doctors to nurses, and from nurses to lay community.

The challenge now is to build on these successes. Improved infection control measures, implementation of new diagnostic techniques and task-shifting amongst health workers to manage the growing number of people with HIV in need of treatment (set to increase in line with the latest WHO recommendations*) need to be expanded nationwide.

“Introducing these measures is vital. The scale of the co-epidemic in Swaziland demands urgent political commitment translated into immediate action. We can save thousands of lives if we act now,” says Péguillan.