Advanced HIV disease among newly diagnosed clients identified through community- and facility-based HIV testing services in Eswatini: a cross-sectional study.

Background: Despite the Kingdom of Eswatini surpassing the UNAIDS 95-95-95 targets, the persistence of Advanced HIV Disease (AHD) remains a clinical concern. Advanced HIV Disease increases morbidity and mortality. This study evaluated the rate of AHD among newly diagnosed clients aged ≥15 identified through the community-based testing in comparison to the facility-based testing. Methods: A cross-sectional study was conducted in two groups (community and facility) of individuals newly diagnosed with HIV using secondary program data (October 2022-September 2025) to identify clients with WHO clinical stages 3 and 4 or defining disease which represent advanced HIV disease with severe immunosuppression or with a CD4 count <200 cells/mm Results: The AHD rate was 19.0% ( Conclusion: Community testing did not demonstrate an advantage in early diagnosis of HIV in this study, but reached a younger, mobile population than facility testing. Hence community testing can be a complementary strategy for sub populations who often bypass facility-based care as well as used in addressing localized drivers of late presentation. Facility-based testing, meanwhile, remains essential for symptomatic late presenters and people returning to care.