HIV Care for 5000 children/caregivers in Swaziland

Mduduzi is 32 years old. Before his health deteriorated, he worked for the Royal Swazi Sugar Corporation (RSSC) as a seasonal employee. He lost his employment after battling with long term chronic health problems. He resides in Macethuka and lives with the mother on his two children. His first HIV test was in April 2014, where he tested positive and was immediately enrolled in Pre-ART (Pre-Anti RetroViral Treatment). His first CD4 count was 228 per microliter which is by far below the WHO staging threshold. He was enrolled on ART (Anti RetroViral Treatment) in May 2014.

In June 2014, he was diagnosed with abdominal Tuberculosis and referred to the RSSC Health and Wellness Centre for TB treatment. His weight was 49.8kg (110 lb). Six months later his CD4 count dropped to 194 per microliter, even being on ART. He was also complaining of severe abdominal pains. He was referred to Good Shepherd Hospital in Siteki for further diagnosis. That was the beginning of his problems; a trip to Siteki is estimated around E50 ($5) for a round trip. Unemployed now, there was no way he could afford the transport costs.

He could not raise the bus fare so he stayed at home. He went back to the RSSC Health and Wellness Centre for review and explained his ordeal. In January 2015, RSSC wrote a ‘’To Whom It May Concern’’ letter, which he brought to Kudvumisa to seek assistance; along with the letter was his ART down referral. In February, Kudvumisa provided transport for Mduduzi and he was transported to Good Shepherd Hospital. After an ultrasound, he was referred to Mbabane Government Hospital for further review and treatment. From Macethuka to Mbabane it costs E150 ($15) for a round trip. Kudvumisa provided transport for him again in March to Mbabane Government Hospital. After more tests he was referred to the Manzini TB Centre to begin TB treatment. From Macethuka to the Manzini TB Centre the bus fare is about E100 ($10) for a round trip. In March Kudvumisa provided transport again for Mduduzi to the Manzini TB Centre.

At Manzini TB Centre he was counselled to complete his current course of TB treatment to completion, but to come back in a month to be checked. He continued on the TB treatment for a month and then in April he needed to go back to the TB Centre (transport provided by Kudvumisa). He was given a 7-day treatment, and was expected back for review in one week. Again, Kudvumisa provided the transport for his visit.

His current weight is 63kg (139 lb): improved from his earlier weight but still lower than normal. Still too weak to work, he survives by food handouts from concerned friends and relatives.

Mduduzi had contemplated suicide when there was no hope for him to access care. He also thought about just waiting for his sure death from HIV/AIDS and TB. The care and support Kudvumisa provided for him meant neither of the two options were necessary.

A key component of providing access to health care in the rural areas is providing transport to services which cannot be provided locally. Poverty reduces options and the ability to access care which is not provided locally.

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