In Eswatini, HIV Testing Increases during the COVID-19 Pandemic

In Eswatini, health workers at the PSI-run New Start Clinic and Litsemba Letfu Men’s Clinic are moving mountains to provide treatment and prevention services for HIV to their clients in the midst of shifting challenges created by COVID-19.

Since the confirmation of the country’s first COVID-19 case in mid-March, PSI Eswatini has been active in implementing safeguarding measures, building staff capacity and working to continue services, including screening and treatment for HIV and tuberculosis. The New Start Clinic and the Litsemba Letfu Men’s Clinic, whose HIV programming is funded by the U.S. Centers for Disease Control, have been recognized by the Eswatini Ministry of Health as essential, allowing them to remain open. In addition to their regular services, the clinics have integrated testing for COVID-19 into all their procedures.

However, PSI Eswatini’s Deputy Country Representative, Makhosazana (Khosi) Dlamini, knows that there is still much work to be done to defeat COVID-19 in Eswatini.

“With the partial lockdown, people in Eswatini feel safe in their homes, but there is still an outcry related to poverty, and the economy, as the lockdown continues,” she says. “Some people are not taking COVID-19 seriously. They still think that the virus only affects certain populations around the world.”

With Khosi’s leadership, the clinics have operationalized physical distancing, mentored and redirected staff to provide additional COVID-19 support, sourced personal protective equipment, trained staff on infection prevention and began to offer multi-month dispensing of medication, allowing patients to stay safely in their homes and continue the treatment they need.

Seats in the waiting room at New Start Clinic are placed six feet apart to promote physical distancing.

Here are some of the new measures implemented to protect clients and staff:

  • Both clients and staff are screened for COVID-19 before entering the clinic at a “screening corner” outside the building.
  • Hand sanitizer is provided for both staff and clients at the “screening corner.”
  • Seats in waiting rooms are placed six feet apart to keep an appropriate physical distance.
  • Clients at a higher mortality risk from COVID-19 are fast-tracked through the clinic and do not spend more than ten minutes accessing the services they need.
  • Clinic staff advises clients on safe physical distancing and other preventative measures.
  • Clinic staff change into scrubs and wear face masks as soon as they enter the building.

It took the PSI Eswatini team and clinic staff about a week to implement COVID-19 protocols, following guidance from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Eswatini Ministry of Health. PSI Eswatini also selected staff to be COVID-19 champions in their communities and departments, monitoring compliance of preventative measures for the virus.

The pandemic has also created some unanticipated side effects at both clinics. “Because of a fear of going to public facilities [due to crowding], we are seeing an increased number of clients coming in for services,” PSI Eswatini’s Country Representative, Dr. Endale Workalemahu explained. “We’re diagnosing more HIV positive clients [than before the pandemic]. People are also more interested in learning their underlying conditions.”

Dr. Ngwaru Munodawafa, Senior Clinic Manager of the New Start Clinic and Litsemba Letfu Men’s clinic, has observed that it hasn’t been easy for clients to follow the new protocols. “When they are called to be given six months of drugs, [clients] always lament that they have enough stock [right now] and don’t need to return to the clinic,” he says.

“However, some clients are calling the clinic now to ask for six months of drugs due to restrictions in movement, [like a lack of] public transportation, and security forces turning them back,” Dr. Ngwaru says.

While the COVID-19 pandemic spreads throughout Eswatini, staff are constantly working to iterate upon their protocol to curb the virus. PSI extends our deepest gratitude to the staff of the New Start Clinic, Litsemba Letfu Men’s Clinic and PSI Eswatini for quickly moving to limit the spread of COVID-19 in their workplaces—all while continuing to serve their clients with the care they need for HIV.

Banner image: PSI Eswatini Country Representative, Dr. Endale Workalemahu, takes a selfie with clinic staff.

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