| Issue/Objective |
To achieve HIV epidemic control, the Kingdom of Eswatini has aggressively scaled up Pre-Exposure Prophylaxis (PrEP). However, real-world data on long-term retention and seroconversion across diverse priority populations remains limited. This study evaluates a decade of PrEP implementation to identify predictors of retention and clinical efficacy. |
| Methodology/Approach |
A retrospective cohort analysis was conducted using the National Client Management Information System database, comprising 203,656 visit records from 86,575 unique clients enrolled between July 2016 and January 2026. Key indicators included retention at 3, 6, and 12 months, PrEP method switching, and HIV seroconversion. Logistic regression was employed to determine the impact of age and pregnancy/breastfeeding status on 12-month retention, and seasonality was assessed via Chi-square analysis. |
| Results |
The cohort was predominantly female (74.8%), with a mean age of 27.3 years (SD: 8.9). Adolescent Girls and Young Women (AGYW, 15-24) accounted for 44.7% of enrolees, while Pregnant and Breastfeeding Women (PBWF) constituted 43.7%. Enrolment showed significant seasonal variation (chi^2 = 2193.53, p < 0.001), peaking in November. Retention rates declined over time: 36.0% at 3 months, 27.1% at 6 months, and 18.9% at 12 months. Logistic regression revealed that increased age was a significant predictor of 12-month retention (OR = 1.015, p < 0.001), whereas being a PBWF client significantly reduced the odds of remaining active at one year (OR = 0.920, p < 0.001). The overall HIV seroconversion rate was low at 0.73% (n = 635), and 4.6% of clients successfully switched PrEP methods during follow-up.
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| Discussion/Conclusion |
While PrEP demonstrates high clinical efficacy in Eswatini with low seroconversion rates, the rapid attrition particularly among younger women and PBWF presents a critical challenge. These findings suggest that the future of the National Data Repository must integrate AI-driven predictive analytics to identify high-risk defaulters early. Interventions should prioritize tailored adherence support for AGYW and PBWF to sustain the impact of HIV prevention efforts. |
| Presenters and Affiliations |
Mbuso Siwela Ministry of Health |
