Protocols
It is a great pleasure to be here as we disseminate the SHIMS 2 results and announce the upcoming SHIMS 3 survey. The U.S. government, through the PEPFAR program, is pleased to collaborate with the Ministry of Health and the Central Statistics Office in carrying out these important surveys.
HIV-focused household surveys, also known as population-based HIV impact assessments, or PHIAs, are critical to PEPFAR’s work because they measure the status of the national HIV response. Eswatini was among the first countries to conduct a PHIA survey, leading the way with the first SHIMS survey in 2011. SHIMS 2 was one of 14 PHIA surveys conducted between 2015 and 2018, which have measured the success of HIV programs across Africa at reaching the aggressive UNAIDS goals of 90-90-90 by 2020. The SHIMS 2 survey provided critical data to inform the Eswatini HIV program, and all together, these surveys provided PEPFAR, UNAIDS, and other global partners with critical information about strategies that were working and those which needed adjustment.
In Eswatini, SHIMS 2 results showed us many successes of the HIV program. It revealed that the rate of new HIV infections among adults was nearly cut in half in five years. And it showed that viral load suppression, an indication that the infection is under control, was 73.1 percent, meaning that three quarters of people living with HIV are not transmitting it to their partners.
The SHIMS 2 data also showed us that Eswatini had met the second and third 90 targets and was close to meeting the first 90: 87% of all HIV-positive adults knew their status, and of these, 89% reported current use of antiretroviral treatment. Among those reporting treatment, 91% were virally suppressed. These successes are the result of years of coordination and leadership by the Government of Eswatini, investment by PEPFAR and other donors, and dedicated work of the many ministry and implementing partner staff that implement HIV prevention, testing, and treatment programs.
While the SHIMS 2 results demonstrated tremendous progress, they also showed us that, despite all these gains, there is substantial work to be done to achieve epidemic control. The data show there are key gaps in HIV prevention and treatment programming for younger people. Young women and men under age 35 were less likely to know their HIV status, be on HIV treatment, or be virally suppressed compared to older adults. The data have helped to shape the program so that it targets those who are not being reached.
The upcoming survey, SHIMS 3, is an opportunity to once again take measure of the program’s achievements. It will document Eswatini’s achievements against the 90-90-90 targets and how close Eswatini is to reaching the next set of targets, which is 95-95-95.
As the Eswatini program transitions into epidemic control, SHIMS will once again show us the challenges ahead. It will determine if our efforts to reach young people have paid off. SHIMS 3 won’t just benefit the Eswatini program, it will provide evidence to the world that the HIV epidemic can be controlled and that epidemic control is achievable in countries which are most affected by HIV. Eswatini will join Lesotho, Uganda, Zimbabwe, Malawi, and Zambia in conducting surveys and releasing data on World AIDS Day 2020.
I would like to take this opportunity to thank all the study participants for their engagement in this important survey and the Ministry of Health’s leadership as we begin a new phase in our partnership.
Siyabonga.
