Program Expansion Supplement: Strengthening Local Capacity to Deliver Sustainable Quality Assured Universal Coverage of Clinical HIV/TB Services and Provide Central Level Technical Assistance to the NTCP in Swaziland under PEPFAR

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Swaziland is among the countries with the most severe HIV and TB dual epidemic in the general population. The current annual adult HIV incidence is estimated as high as 2.4%. HIV prevalence among adults aged 18-49 years is 31% and TB incidence rate is 1380/100,000 persons. About 6,000 TB cases are expected to be diagnosed by 2015. Approximately 75-80% of TB cases are co-infected with HIV. HIV prevalence among pregnant women in Swaziland is among the highest globally at 41%. While Swaziland has made significant strides in addressing the HIV and TB dual epidemic, more effort is needed to reach universal coverage at new WHO 2013 recommended guidelines; improve delivery of quality clinical services across the entire continuum of HIV testing, care, treatment and retention such that it is seamless, comprehensive, and integrated within existing structures; and increase capacity for sustainable MOH stewardship at the national, regional, and facility level. Swaziland is planning on rolling out viral load monitoring and test and start ART programs as per recent WHO guidelines. This FOA is aligned to the following goals and objectives of the different programs as referenced in the extended National Strategic Framework (eNSF): To have all children, adolescents, women, and men undertake a HIV test and know their status; To improve availability, access, and utilization of HIV prevention and treatment services by key populations; To eliminate new infections among children and keep mothers alive; To improve the quality of life of people living with HIV (PLHIV) through treatment and strengthen treatment as a prevention strategy. The purpose of these funds is two-fold. First, to support viral load training for clinical staff and procurement of supplies for managing viral load results at the facility level, and second, for expanding services for test and start which will support enhanced linkages to and retention in care, particularly for male clients, including expansion of clinic hours and community outreach. These funds are to assure sufficient funding to support the roll-out of viral load monitoring and implementation of test and start in the 38 facilities in Manzini region, potentially affecting 18,996 HIV-positive clients who will not receive viral load monitoring, and 326 HIV-positive individuals who would not have access to immediate treatment. Of particular concern is the population of HIV-positive men who do not access traditional health care services, and for whom proving more-male-friendly services is a priority.

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