2. World TB Day 2011 March 24, 2011 Mavuso Centre Manzini – Kingdom of Swaziland

3. Project 1 Background MSF & MoH partner project in Shiselweni started in Nov 2007. Integrated TB – HIV project Project site: Shiselweni region (all MoH facilities) and communities Project general objective: Reduce mortality & morbidity linked to HIV & TB

4. Project 1 Background (2) SPECIFIC OBJECTIVES Decentralisation of HIV and TB services all the way to all 18 MoH clinics (+ 4 others) Improve the quality of TB care and treatment at secondary facilites Improve diagnosis and treatment outcome for MDR TB Enhance national capacity to respond to HIV & TB (DST survey carried out in 2009-2010)

5. Project 1 Background (3) STRATEGIES Decentralize services Integrate into exisitng PHC facilities Task shifting Large scale involvement of PLWHA Community activities for prevention & care

6. Project 2 Background MSF & MoH partner project in Manzini Region started in 2010 –Mankhayane and NRL August 2010 –Matsapha site March 2011 Integrated TB – HIV project Project site: Manzini region Project general objective: Reduce mortality & morbidity linked to HIV & TB

7. Project 2 Background (2) SPECIFIC OBJECTIVES Decentralisation of TB services all the way to 3 clinics in Mankhayane sub region Provision of free flexible quality integrated HIV-TB services in Matsapha industrial area Improve diagnosis and treatment outcome for MDR TB Enhance national capacity to respond to TB (including MDR) – Improve NRL capacity for culture and DST

8. Project Background (3) STRATEGIES Decentralize TB services Integrate into exisitng PHC facilities Task shifting Large scale invlovemnt of PLWHA Community activities for prevention & care

9. Achievements Shiselweni Project Decentralisation of HIV & TB services Reinforcement of 3 main TB clinics All 18 MoH clinics integrated for HIV-TB care and treatment. All 18 accredited for TB initiation by NTCP Decentralized management of MDR patients (currently 157 DR TB patients on treatment) Patients support at clinic and community level through TB ECs and support groups IPT available, ICF and IC measures in clinics (rehabilitations)

11. Key successes 3475 TB suspects detected in 2010 at the 2 Health centres and Hlatikulu hospital 2369 TB suspects detected in PHCs in 2010 – from 144 in Q1 to 984 in Q4 2552 patients were enrolled into TB treatment in 2010 706 patients initiated TB treatment in PHCs in 2010 – sharp increase In 2010, 1087 patients initiated IPT in PHCs of Shiselweni region (994 from June to Dec). 90% completed treatment Improving treatment outcomes – 70% of new cases enrolled in 2008-2009 have successful treatment outcomes. Better treatment adherence

12. Major Challenges Drug-resistance survey conducted in 2009-2010 showed that 7,7% of the new smear positive TB cases and 33,9% of the previously treated cases have MDR forms of TB respectively Patients seeking treatment too late (particularly men) More than 10% of TB patients die during the TB treatment and 10% default. Drugs supply to clinics and drug management Patients’ access to facilities remains problematic Community mobilization for support to patients – key to adherence Stigma attached to HIV and TB in communities Diagnosis and treatment of MDR TB patients, and management of side effects In spite of progress, still limited lab capacity – new TB lab Nhlangano

13. Achievements Manzini Project Mankayane TB treatment has been decentralized to 2 peripheral health units. Mankayane is now officially accredited as a DR-TB centre. MSF and MoH teams working hand in hand to treat TB and DRTB patients in the Mankayane sub region. Matsapha: HIV-TB integrated clinic opened early March 2011 (soon officially opened)

14. Conclusion Encouraging results and achievements so far and improved collaboration especially at PHC level All health workers must be on board for the fight against TB from SMOs to RHMs Climate in health sector must be condusive to avoid dispersion and keep focus on patients

15. Siyabonga