Improved Testing Reduces HIV Infections in Some African Regions

Among the HIV population in Swaziland, rates of viral suppression have doubled since 2011 and new HIV infections have decreased by nearly half.

The findings are from the Swaziland HIV Incidence Measurement Survey (SHIMS2), a population-based HIV impact assessment survey that included more than 14,000 children and adults.

SHIMS2, conducted by Columbia University’s Mailman School of Public Health, is the second survey conducted in Swaziland and follows the 2011 SHIMS1 survey among adults aged 18 to 49 years.

The results of SHIMS2 showed that the annual rate of HIV incidence among adults 15 years and older was 1.36%. Among adults aged 18 to 49 years, HIV incidence was 1.39%—–nearly half of the rate in 2011 at 2.48%.

Twenty-seven percent of the adult population in Swaziland was found to be HIV-positive. The prevalence among adults aged 18 to 49 years was 30.5%, a figure similar to the 2011 HIV prevalence percentage.

Viral load suppression was achieved in 73.1% of adults living with HIV. Twice as many individuals aged 18 to 49 years in SHIMS2 achieved viral load suppression at 71.3% compared with 34.8% in 2011.

Nearly eight-five percent of adults living with HIV knew their status, of whom 97.4% reported the current use of antiretroviral treatment. Furthermore, 91.9% of individuals on treatment had viral load suppression.

The substantial progress made in Swaziland can be contributed to the increase in HIV testing across the country, and the significant increase in patients on antiretroviral agents from 2011 to 2016. Other HIV control interventions also played a key role.

“Because of the severe HIV epidemic in Swaziland, it was critical for us to implement a combination HIV prevention package, scale up HIV care and treatment services, and engage in ongoing measurement of HIV incidence in order to assess the impact of these efforts,” said Sen Sibongile Ndlela-Simelane, honorable Minister of Health, Swaziland.

The findings demonstrate the country’s substantial progress toward achieving UNAIDS’ 90-90-90 targets to end the HIV epidemic.

“These remarkable findings from Swaziland add to the evidence base that we are beginning to control the HIV epidemic in several high-burden countries,” said Ambassador Deborah L. Birx, MD, US Global AIDS Coordination and Special Representative for Global Health Diplomacy. “They both demonstrate our extraordinary progress in ensuring that older HIV-positive adults are on life saving treatment and virally suppressed as well as reveal key gaps that remain in reaching younger men and women with HIV services.”

The results were presented at a press conference by the Prime Minister’s office in Mbabane, Swaziland and at the International AIDS Society conference in Paris.

“The findings from SHIMS2 are a testimony to the remarkable commitment by the Government of Swaziland in confronting the HIV epidemic,” said Wafaa El-Sadr, MD, MPH, MPA, director of ICAP. “It is a demonstration that all the efforts put into the scale-up of HIV prevention, care, and treatment services have borne fruit.”

Principal investigator Jessica Justman, MD, added that “each population-based HIV Impact Assessment survey provides a ‘report card’ on how each country is doing in responding to its epidemic as well as a blueprint for future response. Swaziland has made notable progress and is poised to continue making great strides forward with the implementation of test and start and ongoing scale-up of routine viral load monitoring. The SHIMS2 results will help focus efforts and prioritize specific populations in need of urgent attention and innovative approaches.”