Determining Minimum Resources Required by Eswatini to Meet Its Ending the HIV Epidemic 2030 Goal

With declining HIV/AIDS funding globally, countries need to identify the optimally efficient mix of HIV interventions to avert new HIV infections. We evaluated optimal HIV/AIDS intervention portfolios to enable Eswatini to meet the 2030 Ending the HIV Epidemic (EHE) goal of a 90% reduction in HIV incidence compared with 2010.

Using Eswatini national demographic data and expenditure data on clinical, behavioral, and public health HIV interventions, we employed a validated HIV transmission model to simulate the effects of HIV interventions on diagnosis, treatment, and viral load suppression (costs, infections averted, life years gained, and quality-adjusted life years gained) for the Eswatini adult population from 2022 through 2030. We evaluated 11 alternative combinations of scaling-up interventions to goal coverage levels, with and without reallocating resources away from other interventions.

With the current resource allocation, Eswatini will be delayed in meeting the EHE goal. However, with additional programmatic funding of US$8 million to additionally scaling-up HIV self-testing and long-acting preexposure prophylaxis for the highest risk population and additional funding for defaulter tracing and risk communication, Eswatini will meet its EHE goal by 2030 by averting an additional 3500 infections.

Eswatini could meet its EHE goal with additional funding or resource reallocation from less efficient toward highly efficient interventions. These findings can inform allocation decisions that are more practical and realistic in this resource-limited setting with high HIV disease burden.