Since January 2006, Médecins Sans Frontières (MSF) and the Ministry of Health and Social Welfare (MOHSW) have been running a pilot programme to provide HIV/AIDS care and treatment at the primary care level in Lesotho.The central objective being to demonstrate the feasibility of providing antiretroviral therapy (ART) at the primary health care level, under the management of nurses.  

At the start of the programme, ART in Lesotho was only available in hospitals, provided by doctors who were in short supply.  

Lesotho has an HIV prevalence of 23.2% among adults aged 15-49, the third highest in the world, with around 270 000 people estimated as living with HIV/AIDS.  

The programme, including ART, has been piloted in Scott Hospital Health Service Area (HSA), a rural area of 200 000 people covering the Maseru and Mafeteng districts. Around 30 000 people in the area are thought to have HIV/AIDS, with approximately 9 000 currently in need of ART.  

The pilot was based on a decentralised strategy to provide testing, care and treatment at primary health care facilities, bringing care and treatment as close to patients as possible.   A severe lack of doctors, as well as geographical and financial difficulties in accessing health care prompted the pilot programme, with the goal of developing a model that would be both replicable and sustainable. Reaching ambitious ART enrolment targets was also a key element of the programme.  

Known in the community as ‘€˜SELIBENG SA TÅ EPO’€™ (‘€˜Wellspring of Hope’€™), the report states that the programme has been the first in Lesotho to decentralise fully HIV care and treatment throughout a whole health service area ‘€“ in this case 1 district hospital and 14 health centres.

The MSF report comes at the end of the first 3-year phase of the programme which is now in a transition phase. MSF intends a gradual handover of full responsibility to the MOHSW and other partners in the locality.  

At the outset, ART availability in the country only covered around 3 000 people. Since then 11 367 people have been enrolled onto HIV care (5% children), with 4 347 of these initiated onto ART (6.5% children). Statistically, 4 in 5 people on ART in the area have been initiated at the primary health care level.  

Nurses were trained to assume high-level clinical responsibility for HIV care, supported by lay counsellors (generally people living with HIV/AIDS) who were trained to provide clinical and pastoral support.  

Integration of TB screening and treatment services also formed a key focus of the project, given that between 80-90% of TB patients in the target region are also HIV-positive. TB screening of all HIV patients and the provision of TB treatment at health centres was implemented, with lay counsellors trained to provide TB education on issues including transmission and treatment.  

A 2-year handover process is now underway, with MSF’€™s target being a full transfer of responsibility by the end of 2010. This will only succeed, however, if sufficient resources – human and financial – are secured, and if challenges regarding clinical and overall management are addressed.  

Read the full report here:  

http://www.msf.org.za/Docs/Lesotho/MSF_Lesotho_Programme_Report_2006-2008_.pdf.pdf