HIV and TB Overview: Eswatini

Strategic focus

The U.S. Centers for Disease Control and Prevention (CDC) established its partnership with the Government of the Kingdom of Eswatini in 2004, maintaining an in-country presence since 2007. Through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), CDC supports Eswatini's response to HIV and tuberculosis (TB). CDC strengthens public health systems through evidence-based programs, evaluation, surveillance, and population-based surveys.

CDC advances health system resilience by prioritizing collaboration with the Ministry of Health (MOH) and other ministries, academic institutions, non-governmental organizations, faith-based organizations, and private sector partners. CDC's goals are to advance healthcare service delivery, implement proactive disease prevention and response measures, support evidence-based decision-making, enhance transparency and accountability, and strengthen partnerships that expand program reach.

Read more about CDC's most recent key activities and accomplishments below.

Building public health capacity

• Improved service delivery and surveillance data for monitoring HIV and TB program activities for sustainable programs. Surveillance systems and infrastructure, such as data dashboards, situation reports, and surveillance sites, were leveraged to monitor for other public health threats, such as cholera.
• Supported the establishment of Eswatini CDC as a National Public Health Institute to coordinate public health preparedness and response.
• Established and supported the point of entry surveillance to quickly detect importation of communicable diseases.
• Grew the disease surveillance capacity of frontline healthcare workers by establishing a Field Epidemiology Training Program.

Strengthening laboratory systems and networks

• Expanded viral load testing capacity from 3,000 tests per month in 2012 to over 20,000 tests per month in 2024.
• Introduced new methods for identifying advanced HIV disease, drug resistance, and TB.
• Optimized the Eswatini Health Laboratory Services tiered diagnostic network through multiplexing and transitioning to updated platforms.
• Expanded specimen transport referral network and laboratory information systems for the timely delivery of laboratory tests and results for improved decision-making and patient management.
• Trained laboratory staff on the genomic sequencing of HIV for targeted interventions.
• Established a national public health laboratory and its organizational structure with professional development and strategic planning support.
• Improved laboratory quality management systems to move toward accreditation. Engaged with local agencies to develop a sustainable certification strategy for smaller laboratories. Two national reference laboratories have maintained international accreditation for three years.

HIV prevention and treatment

• Assisted the MOH to decrease HIV infections by over 70 percent, from 14,000 in 2010 to less than 4,000 in 2024.
• Supported an HIV prevention strategy that merged biomedical, structural, and behavioral evidence-based interventions to maximize program effectiveness and efficiency.
• Focused on case finding, connecting people to care, and maintaining viral load suppression by supporting the MOH to update national and regional-level guidance and improve service delivery, clinical mentorship programs, and quality assurance systems.

Tuberculosis prevention and treatment

• Supported the national TB response by integrating HIV and TB service delivery, improving TB screening and diagnosis, drug-resistant TB management, and preventive treatment. Between 2015 and 2021, these efforts contributed to a 46 percent decrease in TB incidence, a 62 percent decrease in notified cases, and a 55 percent decrease in TB-related deaths.

By the numbers

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Resources

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