Opportunities for improved HIV prevention and treatment through budget optimization in Eswatini - Research Findings

Jul 19, 2026

The study evaluates how optimized allocation of existing HIV resources could improve prevention and treatment outcomes in Eswatini. After strong scale-up reduced new infections by 44% from 2014–2019, the country still faces high incidence and a national target of 85% fewer new infections by 2023. Using the Optima HIV model, the analysis optimizes investments across programs and delivery modalities for VMMC, HIV testing, antiretroviral refill, and switching to lower-cost regimens to estimate avertable infections and deaths.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages15

Reading Time38 min

Abstract

Introduction

Methods

Findings

Significance

Public Disclosure Authorized Public Disclosure Authorized PLOS ONE OPEN ACCESS Citation: Minnery M, Mathabela N, Shubber Z, Mabuza K, Gorgens M, Cheikh N, et al. (2020) Opportunities for improved HIV prevention and treatment through budget optimization in Eswatini. PLoS ONE 15(7): e0235664 . [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.1371/journal.pone](10.1371/journal.pone).0235664 Editor: Nicky McCreesh, London School of Hygiene and Tropical Medicine, UNITED KINGDOM Received: September 13, 2019 Accepted: June 20, 2020 Published: July 23, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: [https://doi.org/10.1371/journal.pone.0235664](https://doi.org/10.1371/journal.pone.0235664) [Copyright:](Copyright:) © [2020 Minnery et al](2020 Minnery et al). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper or detailed in the references provided in the paper, or contained in the Supporting Information files. The optima HIV RESEARCH ARTICLE Opportunities for improved HIV prevention and treatment through budget optimization in Eswatini Mark Minnery1, Nokwazi Mathabela2, Zara Shubber3, Khanya Mabuza4, Marelize Gorgens3, Nejma Cheikh3, David P. Wilson1,5,6,7, Sherrie L. Kelly1 * 1 Burnet Institute, Melbourne, Australia, 2 Independent, formerly National Emergency Response Council on HIV/AIDS, Mbabane, Eswatini, 3 World Bank Group, Washington, DC, United States of America, 4 National Emergency Response Council on HIV/AIDS, Mbabane, Eswatini, 5 Kirby Institute, University of New South Wales, Sydney, Australia, 6 University of Maryland, Baltimore, Maryland, United States of America, 7 Monash University, Melbourne, Australia * [sherrie.kelly@burnet.edu.au](sherrie.kelly@burnet.edu.au) Abstract Introduction Eswatini achieved a 44% decrease in new HIV infections from 2014 to 2019 through substantial scale-up of testing and treatment. However, it still has one of the highest rates of HIV incidence in the world, with 14 infections per 1,000 adults 15–49 years estimated for 2017. The Government of Eswatini has called for an 85% reduction in new infections by 2023 over 2017 levels. To make further progress towards this target and to achieve maximum health gains, this study aims to model optimized investments of available HIV resources. Methods The Optima HIV model was applied to estimate the impact of efficiency strategies to accelerate prevention of HIV infections and HIV-related deaths. We estimated the number of infections and deaths that could be prevented by optimizing HIV investments. We optimize across HIV programs, then across service delivery modalities for voluntary medical male circumcision (VMMC), HIV testing, and antiretroviral refill, as well as switching to a lower cost antiretroviral regimen. Findings Under an optimized budget, prioritising HIV testing for the general population followed by key preventative interventions may result in approximately 1,000 more new infections (2% more) being averted by 2023. More infections could be averted with further optimization between service delivery modalities across the HIV cascade. Scaling-up index and self-testing could lead to 100,000 more people getting tested for HIV (25% more tests) with the same budget. By prioritizing Fast-Track, community-based, and facility-based antiretroviral refill options, an estimated 30,000 more people could receive treatment, 17% more than model visual interface can be accessed at: [http://](http://)[ ](http://)[hi

FAQs

What problem does the study address in Eswatini’s HIV response?

Eswatini has achieved a 44% decrease in new HIV infections, but it still has high HIV incidence and missed progress toward an 85% reduction target by 2023. The study aims to identify investment optimizations that can produce larger health gains from available resources.

How does the study model improved HIV outcomes?

It applies the Optima HIV model to estimate the impact of efficiency strategies. Investments are optimized across HIV programs and across service delivery modalities for VMMC, HIV testing, antiretroviral refill, and switching to a lower-cost antiretroviral regimen.

What key findings are reported under optimized budgeting?

Prioritizing HIV testing for the general population and key preventative interventions could avert about 1,000 more new infections by 2023. Additional optimization across delivery modalities could increase testing and treatment reach, and concentrating or shifting options may yield budget savings.

Jul 19, 2026

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