Support Eswatini Achieve and Sustain Epidemic Control (SEASEC)

Background:

The overarching aim of the Georgetown University’s (GU) SEASEC Program is to work in partnership with Ministry of Health (MOH) of the Kingdom of Eswatini (KoE) to build capacity and provide technical assistance through the health system from community level, designated health facilities, the regional health management structures, and at national level, to optimize comprehensive HIV and TB prevention and treatment services in two regions, Manzini and Lubombo. Expected outcomes include first, sustaining the already achieved UNAIDS 95-95-95 targets across all populations in the supported regions while identifying and addressing any last-mile gaps, decreasing cervical cancer disease burden, and maintaining high TB case finding and treatment success rates in supported facilities, towards the goal of TB control; and secondly transitioning program planning, oversight and implementation to the Ministry of Health within the grant cycle.

Implementation of SEASEC:

GU supports the Ministry of Health (MOH) of the GkoE in two administrative regions, Manzini and Lubombo, to deliver quality assured comprehensive HIV prevention, case identification and successful long term chronic care for each person living with HIV;  cervical cancer screening for HIV positive women; laboratory services viral load (VL) testing and other HIV related laboratory tests, TB prevention; TB diagnosis and treatment services for HIV positive patients; HIV prevention; diagnosis and treatment services for patients with TB; pediatric and adolescent HIV/TB services; Prevention for Mother to Child Transmission of HIV (PMTCT) and follow up of HIV exposed infants (HEI); voluntary medical male circumcision (VMMC); and Preexposure prophylaxis (PrEP). These services are delivered through site level support to MOH health facilities with complementary activities in the surrounding communities to reach populations with communication, prevention, and treatment messages and services to sustain epidemic control. Unique to the GU SEASEC Program is the stated objective of transitioning programmatic implementation, planning, accountability and oversight of this grant deliverables to the Ministry of Health at facility, regional and national levels working within a broader context with the GKoE to strengthen mechanisms for sustaining the comprehensive HIV and TB epidemic control efforts.  

Embedded, Layered Technical Assistance: 

GU SEASEC has embeded high-capacity technical assistance (TA) teams within the ENAP, NTCP and both RHMTs for deliberate skills transfer to strengthen organizational capacity to provide HIV and TB response oversight and drive quality implementation of high impact health services. Through chain-linked policy translation into practice, SEASEC is strengthening national clinical care delivery systems along the TB/HIV care continuum, and improving the uptake of high quality, high impact interventions. 

Adoption of the LISTEN Approach in Service Delivery Design: 

By harnessing lessons from other GU Programs implementing the LISTEN (Local Innovations Scaled Through Enterprise Networks) approach, including experience within Eswatini, SEASEC is leveraging communities of practice (CP), human-centered design (HCD), and data-driven decision-making to catalyze, capture, and scale locally driven health system innovations. Through a bottom-up approach in service design, implementation, and monitoring, SEASEC is establishing mechanisms for the health service delivery system to be accountable to the consumers of the services and meaningfully integrate patient/community voices in the national HIV/TB response. 

Optimizing Information Technology Solutions: 

Building on the work done by the MoH and its partners in operationalizing the e-Governance strategy of the Government of the Kingdom of Eswatini, SEASEC brings a lot of expertise in universal adoption of electronic platforms to support HIV and TB case management, sample referral, and commodity management. By working with the Health Information Management Systems (HMIS) Unit within the MoH, SEASEC is supporting the optimum use of the CMIS, LIS and LMIS to monitor real time program status for seamless clinical services delivery. In response to COVID-19, SEASEC is also expanding the virtual learning platforms for training/mentoring of healthcare workers.

Integrating Data Science for Precision Programming: 

Last-mile interventions in HIV Epidemic Control require targeted, micro-data driven approaches to understanding the dynamism of the epidemic within Eswatini. Data not only enables us to accurately identify last-mile gaps, but also assist in prioritization quality improvement initiatives and enables objective assessment of whether change and improvement have indeed occurred. Collecting and analyzing data are therefore central to the support the GU SEASEC Program will be providing to the MoH. SEASEC is leveraging technology and data science methods including population level epidemiological analysis and geographical hot spotting using surveillance data to investigate transmission pockets, and tailor strategies and resources to find those cases not yet diagnosed and to optimize HIV prevention interventions. SEASEC will use precision programming to fine tune differentiated service delivery models (DSDM), client centeredness, case-based surveillance, and to maximize long term retention.

Partners and Collaboration