Peers speed HIV diagnosis to treatment start in country with world’s highest estimated prevalence

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In the Kingdom of eSwatini, the nation formerly known as Swaziland, where the percentage of the population who live with HIV is estimated to be the highest in the world, efforts to provide testing for the virus have been widespread and successful. It’s the next step, from testing to treatment for those who test positive, that has proved challenging. Although the country adopted a policy providing immediate access treatment for all people diagnosed with HIV, fewer than a third of those begin taking the medicine that protects their health and prevents transmission within the six months that follow, according to a report released by the U.S. Centers for Disease Control and Prevention Thursday. For men and young adults — two populations that tend to go untreated in large numbers — the lag between discovery of an HIV diagnosis and treatment can last years, the report says.

A project funded by the U.S. President’s Emergency Plan for AIDS Relief, and delivered by peers, however, made a significant difference, according to an analysis documented in this week’s Morbidity and Mortality Weekly Report. The project, carried out by two mobile teams, each including HIV testing counselors, a nurse, and three experienced peer counselors, living with HIV themselves and consistently taking antiretroviral treatment, offered HIV testing in homes, work places, bars, markets and other places people gathered. Over the course of two years, the project saw the standard for treatment eligibility evolve from requiring an immune system diminished to immune cell counts of 350 or less, to 500 or less, to treatment for all people diagnosed with HIV. By the time immediate treatment was available all, 96 percent of those who tested positive for the virus accepted the opportunity, 87 percent on the same day.

The findings, the authors write, indicate that the peer-driven project offers the potential for eSwatini to reach the goals of 90 percent of all people living with HIV knowing they have the virus, 90 percent of those diagnosed accessing treatment, and for treatment to be consistent and effective in 90 percent of those to suppress the virus, preventing illness and transmission, that if reached worldwide, UNAIDS has projected could control the HIV pandemic by 2030. PEPFAR now is supporting a nationwide expansion of the project, the authors write.

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