Tuberculosis is the leading cause of morbidity and mortality among people living with HIV; yet uncoordinated clinical care imposes heavy burdens on co-infected patients. In Eswatini, task shifting and the decentralization of TB and HIV treatment services to primary health centers allowed for TB/HIV integrated service delivery, or a ‘one stop shop’. These health system changes resulted in a 28 percent increase in ART initiation of co-infected patients between 2012 and 2017 and in a cohort study, almost 90 percent of TB and HIV co-infected individuals initiated ART within eight weeks per national guidelines. Overall, since implementation began, both morbidity and mortality related to TB have decreased significantly.
Mother-baby pairs who do not continually utilize critical integrated maternal, newborn, and child health (MNCH) and HIV services often have poor health outcomes in resource limited settings. The Community Focal Mother (CFM) model in Eswatini has demonstrated success in improving use of and retention in integrated MNCH and HIV services. This includes final knowledge of HIV status of 18-24 month infants, timely vaccination, and provision of mother baby health visits. Trained CFMs visit all mother baby pairs in their homes before they miss a visit to encourage continued attendance at health facilities for care. This model has seen 100 percent retention in services of mother baby pairs since its inception in 2017; all children have completed their child welfare visits per the Ministry of Health recommended schedule and received key integrated HIV and MNCH services.