Preventing HIV/AIDS in Swaziland

Hhukwini Clinic in the Hhohho region of Swaziland is a busy health center in the mountainous central-western part of the country. The clinic is visited by about 850 people per month and provides comprehensive primary health care services including diagnosis and treatment for many of the common ailments in Swaziland. It is also one of 14 clinics throughout the country participating in the innovative Maximizing ART for Better Health and Zero New HIV Infections (MaxART) program.


Hhukwini Clinic (Photo Credit: Claudia Beretta)


Led by the Swaziland Ministry of Health, the MaxART program began in 2011 with the goal of reducing new HIV infections and improving access to treatment throughout the country. In Swaziland, which has the highest rate of HIV infection of the world, 31 percent of the adult population (aged 18-49) are living with the disease. Timely diagnosis, high-quality treatment, and follow-up care are critically needed to keep patients healthy and to limit the spread of HIV/AIDS.

CHAI is proud to have been a founding member with Aidsfonds (formerly STOP AIDS NOW!) of the MaxART consortium—which includes community representatives, government partners, and academic institutions—and part of a team striving to alleviate the burden of HIV in Swaziland.

The initial phase of the MaxART consortium’s work dramatically improved HIV diagnosis and linkage to care. The subsequent phase expanded into a pioneering implementation study to demonstrate the effectiveness of a “Test & Start” approach to providing treatment for HIV. “Test & Start” is an innovative practice that begins antiretroviral therapy (ART) for everyone living with HIV, regardless of their disease progression. Studies show that the earlier patients begin treatment, the better they do and the less likely they are to pass their infection to others.



A young girl examines medications her mother has received through the MaxART program. (Photo Credit: Claudia Beretta)


By early 2017, the study (which is expected to continue through August 2017) had enrolled around 3,000 people through clinics like Hhukwini , helping Swaziland better understand the practical feasibility of implementing “Test & Start” within the national health system.

Swaziland adopted “Test & Start” as the national policy in October 2016. The data collected continues to be used by Swaziland’s Ministry of Health to ensure practical challenges to the newly adopted “Test & Start” approach can be addressed and the potential benefits to both individual health and a national reduction in incidence of new HIV infections can be fully realized.



Gathering data for the MaxART study (Photo Credit: Claudia Beretta)


Since 2014, clinics like Hhukwini have successfully identified and started treatment for thousands of patients, saving many lives and better informing the implementation of the program nationwide.

Not only is the project helping Swaziland to achieve its ambition to end AIDS by 2022, but the lessons learned can be generalized beyond Swaziland to other resource-constrained settings to improve the global response to end the spread of HIV/AIDS.