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ICAP began partnering with the Government of the Kingdom of Swaziland in 2005 to reduce mother-to-child transmission of HIV and support the rapid scale-up of HIV care and treatment.

ICAP now provides technical leadership and assistance at a national and regional level, working with the Ministry of Health (MOH) to strengthen TB/HIV service delivery, improve health information systems and disease surveillance, conduct research, and build laboratory and research capacity.

Current Projects

Strengthening Capacity for TB/HIV Services

ICAP works with the MOH to enhance capacity and service delivery at the national level for tuberculosis (TB), MDR-TB, and HIV/TB activities. At the regional level, in Manzini, ICAP is working to build capacity of the Regional Health Management Team and improve coverage and quality of adult and pediatric HIV testing, prevention, care, and treatment. This approach emphasizes systems development, training and mentoring for health care workers, and integrating systematic, continuous quality improvement. (funded by PEPFAR through the CDC)

Strengthening Epidemiologic and Research Capacity

ICAP is partnering with the MOH to build capacity in epidemiology and research and strengthen the monitoring and use of data to inform policy and programming. The scope of work includes support for epidemiology, surveillance, research ethics, and the Health Research Training Program.

ICAP also provided technical assistance and support to conduct the second Swaziland HIV Incidence Measurement Survey (SHIMS2) to assess HIV prevalence, incidence, and access to prevention, care, and treatment services. The survey consisted of household-based interviews and HIV counseling and testing for adults and children. Survey findings revealed impressive progress in confronting the HIV epidemic. Between 2011, when SHIMS1 was conducted, and SHIMS2 in 2016, HIV incidence among adults fell by nearly half (2.5% to 1.4%) and the percentage of HIV-positive adults with viral load suppression (VLS), as a measure of control of the virus, doubled (35% to 71%). HIV prevalence among adults was stable at 30%, similar to the 2011 HIV prevalence of 32%.

These findings will help guide and target future investment and programs. SHIMS2 is part of the PHIA Project, which will conduct surveys in nearly 15 countries in sub-Saharan Africa. (funded by PEPFAR through the CDC)

Strengthening Laboratory Quality and Services

ICAP is enhancing laboratory capacity as a critical element of a strong health system. This includes education and training for lab accreditation, improving equipment and supply chain management, strengthening lab information systems, and improving access to testing. (funded by PEPFAR through the CDC)

Safe Generations Plus

ICAP is conducting a two-year study to evaluate retention and engagement in care among HIV-infected pregnant women receiving lifelong antiretroviral treatment—known as Option B+—at ten health facilities in Swaziland’s Manzini and Lubombo regions. (funded by NIH)

Global TA

HIV Drug Resistance

ICAP is partnering with the MOH to implement a national HIV drug resistance surveillance plan, including developing protocols, implementing baseline surveys, and establishing a quality M&E system for ongoing surveillance. (funded by PEPFAR through the CDC)

Pediatric HIV Surveillance

ICAP is working with the MOH to gather information on new pediatric HIV infections, and supporting the development of surveillance protocols for pediatric HIV case reporting and monitoring of the data quality of the surveillance system. (funded by PEPFAR through the CDC)

TB/HIV Nursing Curricula

ICAP is providing technical assistance to the Swaziland Nursing Council and stakeholders to update the pre-service HIV and TB curricula and implement its use at three nursing schools in Swaziland. (funded by PEPFAR through the CDC)

Early Infant Diagnosis

ICAP is collaborating with the MOH to implement birth testing for early infant diagnosis. The program is testing all HIV-exposed infants at birth using dried blood spots for DNA PCR testing. ICAP is also creating a system for returning results to mothers and immediately linking infected children to ART services. (funded by PEPFAR through the CDC)

Improving Retention in Option B+ Programs

ICAP is collaborating with the MOH to implement an anonymous patient feedback survey and healthcare worker sensitivity training to enhance PMTCT services. Through patient feedback and provision of sensitivity training to healthcare workers, the project aims to improve patient experiences at health facilities in order to increase retention of PMTCT patients. (funded by PEPFAR through the CDC)

Evaluating TB/HIV Service Integration

ICAP is collaborating to pilot the World Health Organization (WHO) toolkit for the integration of PMTCT/TB services. In order to pilot the toolkit, ICAP is adapting monitoring and evaluation (M&E) tools, providing guidance to facilitate the process of integration, and training health care workers in service delivery. (funded by PEPFAR through the CDC)

Monitoring Viral Load

ICAP is working with the MOH to optimize facility-based components of the viral load cascade (pre-test, test and post-test) including use of evidence-based approaches for enhanced adherence interventions that are essential for successful implementation of viral load monitoring and improved outcomes for patients on ART. (funded by PEPFAR through the CDC)

Recently Completed Projects

The Link4Health Study (2014-2017)

Link4Health was an implementation science study that used a randomized trial design to evaluate the effectiveness of various HIV intervention strategies on linkage and retention in care. (funded by the NIH)

The Safe Generations Study (2013-2016)

ICAP collaborated with Swaziland’s Ministry of Health and the University of Cape Town to conduct an ambitious implementation science study called Safe Generations or, in Siswati, Sitkulwane Lesiphephile. The study aimed to evaluate the impact of Option B+ on maternal retention and mother-to-child transmission of HIV, as well as the approach’s feasibility, acceptability, and projected costs and cost-effectiveness.(funded by PEPFAR through USAID). Read the project brief here.

Swaziland Rapid Scale-Up (2009-2015)

Through this five-year project, ICAP worked with the MOH and with regional health management teams and health facilities in Hhoho, Lubombo, and Manzini regions to improve and expand access to adult and pediatric HIV care and treatment. This scope of work included innovative approaches to expand nurse-initiated antiretroviral treatment (ART), enhance referral systems, and improve patient retention in care. (funded by PEPFAR through the CDC). Read the project report here.

TA for HIV Prevention, Care and Treatment (2009-2015)

Through this five-year award, ICAP provided technical assistance to the MOH to improve use of national HIV program data to inform public health decision-making and ART programs. (funded by PEPFAR through the CDC)

Capacity Building for Nursing and Midwifery

Through this five-year award, ICAP worked with the MOH to update national nursing strategies, policies, and guidelines and with nurse education institutions to improve training, resources, and support for a broader clinical scope of work for nurses. (funded by PEPFAR through HRSA)