Eswatini develops system to support cross-border ARV patients -

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By Delisa Magagula

The Ministry of Health, in collaboration with the Southern African Development Community (SADC), is working on a new web-based system aimed at helping patients on antiretroviral therapy (ART) who cross borders informally and risk defaulting on their medication.

This was revealed during a session held last week at the Mbabane UN building. According Zanele Simelane, Acting Chief Strategic Information Analyst at the Ministry of Health the initiative is designed to address one of the key challenges facing the HIV response in Eswatini and the wider region.

This is for treatment continuity for mobile and migrant populations. Many patients living with HIV in border communities move between countries for work, trade, or family reasons, and the absence of coordinated systems has often led to treatment interruptions.

Eswatini, which has one of the highest HIV prevalence rates globally, has made significant progress in expanding access to ART.

However, treatment default remains a challenge, particularly among populations who move between Eswatini and neighbouring countries such as South Africa and Mozambique.

“Patients sometimes travel across borders without notifying health facilities, and when they miss scheduled appointments or drug refills, the risk of default increases.

The web-based system will help us track patients across borders, and ensure they can access ARVs without interruption,” Simelane said.

The system is being developed within the framework of SADC’s efforts to harmonise HIV/AIDS policies among member states.

It will enable health facilities in participating countries to access patient treatment histories securely, verify ART regimens, and provide refills even if the patient is away from their home clinic.

The initiative draws from earlier SADC strategies aimed at addressing HIV among mobile populations. Over the past decade, SADC has worked to improve regional responses to HIV through cross-border wellness clinics, harmonisation of guidelines, and efforts to strengthen health services for truck drivers, migrants, and border communities.

The SADC HIV and AIDS Strategic Framework emphasises universal access to treatment and care, including the harmonisation of policies and legislation across member states.

The new digital platform represents a further step in aligning treatment protocols, ensuring patients can remain adherent regardless of location.

The project also builds on lessons from the SADC HIV and AIDS Cross Border Initiative, launched in 2012, which deployed mobile clinics and behaviour change programmes at border posts.

While that initiative improved access to testing and primary care, it did not include digital tracking of patients’ ART status. The new system seeks to close this gap.

Eswatini’s Ministry of Health has issued several key strategies in recent years to strengthen HIV treatment, including the Integrated HIV Management Guidelines (2022) and the National Multisectoral HIV and AIDS Strategic Framework (2018–2023).

These frameworks outline national targets for treatment coverage, viral suppression, and elimination of barriers to access. Despite this progress, mobility has remained a persistent obstacle.

International studies, including research by the International Organization for Migration (IOM), have highlighted how migrant workers and mobile populations are more likely to interrupt treatment because of movement between countries and limited access to services in host communities.

Eswatini has also introduced multi-month dispensing of ARVs to reduce the number of clinic visits required by stable patients. While this measure helps many, it does not fully address the problem of patients who relocate or spend extended periods outside the country.

The web-based system under development will serve as a regional database accessible by authorised health workers in participating SADC countries.

When a patient crosses the border and presents at a clinic, health staff will be able to retrieve their ART history, confirm current prescriptions, and provide medication without requiring the patient to start the registration process from scratch.

This continuity will help avoid treatment lapses that can lead to drug resistance and poor health outcomes.

The platform is also expected to include features for monitoring patient movements and treatment adherence trends, giving health authorities better data for planning.

According to officials, privacy and data protection are central to the design. Patient information will be handled securely, with safeguards to ensure that sensitive health records are only accessible to authorised personnel.

The initiative reflects broader SADC efforts to address the regional nature of the HIV epidemic. With high levels of labour migration across southern Africa, especially to South Africa’s mining and industrial hubs, coordination among countries is essential.

SADC’s HIV and AIDS Pillar commits member states to collective action on prevention, treatment, and care, recognising that isolated national strategies are insufficient.

By creating systems that transcend borders, the region aims to reduce default rates and strengthen overall health outcomes.

The Ministry of Health has not provided a timeline for full implementation of the web-based system but confirmed that pilot work is underway in collaboration with SADC.

Once operational, the platform is expected to significantly reduce treatment interruptions for thousands of patients who travel regularly across borders.

Simelane noted that sustaining adherence to ART is critical for both individual health and public health outcomes. Defaulting on treatment not only puts patients at risk but also increases the potential for drug resistance, which poses challenges for entire health systems.

Eswatini’s participation in the regional system underscores the country’s on-going commitment to maintaining progress against HIV.

While challenges remain including rising treatment costs, health worker shortages, and the persistent risks posed by population mobility, the initiative represents a major step in protecting gains made in HIV care and ensuring no patient is left behind because of border movements.

Worth noting is that a delegation from the United Nations Migration Agency and the Southern African Development Community (SADC) has visited Eswatini to benchmark with the country’s Client Management Information System (CMIS).

The delegates, who represented various southern African nations, expressed that they learnt a great deal from Eswatini’s innovative approach to healthcare.

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