MaxART (phase II): Early Access to ART for All

MaxART (phase II): Early Access to ART for All


Research shows that early ART for people living with HIV not only has individual health benefits, but also contributes to the prevention of HIV transmission. In eSwatini (previously known as Swaziland), we are testing this strategy in practice for the first time. In fourteen clinics, we are studying the clinical outcomes of early ART, the cost-effectiveness of the approach, the social and cultural outcomes of the implementation and treatment adherence among people living with HIV.

Project details

Time frame
01 July 2014 - 30 September 2018
€ 5,445,000
Active in


To evaluate the feasibility, acceptability, clinical outcomes, affordability, and scalability of offering early antiretroviral treatment to all HIV­?positive individuals in eSwatini’s government­?managed health system.

Community groups

The implementation study has open enrolment for all people > 18 years across 14 health facilities, with a population catchment of circa 118,000 individuals in Swaziland’s Hhohho region. MaxART expects to enrol and follow up 4,353 clients not yet on ART, among whom 2,376 with newly diagnosed HIV infection.


Despite considerable progress in terms of HIV prevention and treatment, sub-Saharan Africa remains the most heavily affected region, representing 69% of the global burden of HIV. Something new and ambitious must be done to stop new infections. While compelling research shows the use of early ART substantially reduces new HIV infections, practical questions remain. These questions include whether or not people will seek health services, accept and start treatment, and stay in care. MaxART Early Access to ART for All is designed to answer these questions and to learn how to scale up early access to ART.

ESwatini is uniquely positioned to evaluate the implementation of an Early Access to ART for All strategy within its current health system. The country has the world’s highest HIV prevalence rate (31% among 18-49-year-olds), a relatively small size and population and strong government leadership. In recent years, eSwatini has successfully scaled up HIV testing and treatment. Among many interventions leading to this success is Maximizing ART for Better Health and Zero New HIV Infections (MaxART phase I). The achievements of the first phase (2011-2014) prepared the ground for MaxART’s second phase (2014-2017): the Early Access to ART for All implementation study.

The MaxART programme in a nutshell

We´ll take you through the MaxART programme in 3.20 min. Watch the animation video in which the programme approach and results are being showcased, in an easy comprehensible and digestible form.

Scaling up HIV testing and treatment

Over the past first three years of implementation of the MaxART programme, Swaziland has made great progress towards reaching targets as set in phase 1 of the programme: dramatically scale-up testing to 250.000 people per year, 90% of those in need are on treatment, 90% of people on ART adhere to treatment after one year. An attractive video summarizes activities and results of the first phase of the project.

MaxART newsletters

During the MaxART programme a total of 10 newsletters were published providing an update on the progress, lessons learned and impact of the programme. 

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