Lesotho is the poorest, high HIV -prevalence country in the world, with an estimated 280,000 people living with HIV/AIDS. More than 10,000 people have tuberculosis (TB) and 76 per cent of them are HIV positive. In 2010, Médecins Sans Frontières completed a pilot project in collaboration with national health authorities that provided integrated HIV and TB care in local health centres.

The project was carried out in 14 rural clinics and a hospital south of the capital Maseru, serving a population of around 220,000. At the start of the project, around 31,000 people in the area were living with HIV and about 9,000 were in need of antiretroviral (ARV) treatment.

Integrated HIV and TB treatment

The project adopted a new operational strategy in order to have a rapid impact on the lives of people with TB and HIV in a context of extreme health needs. The team in Lesotho applied strategies and best practices from Médecins Sans Frontières projects in other countries in the region. Staff integrated HIV and TB care in local clinics, so that co-infected patients could receive all their treatment in one place, not too far from home. To enable provision of integrated HIV and TB care in a context with a critical shortage of health workers, routine tasks that had been previously carried out by doctors were shifted to trained nurses. This not only increased the number of medical staff available to carry out the work, but also built up the skills of local health staff and encouraged a cooperative professional network. The project also employed lay counsellors, many of whom are HIV positive. By June, when the project was handed over to the national health authorities, close to 7,000 people had been initiated on ARV treatment. All 15 sites were staffed and equipped to provide comprehensive HIV and TB services, including HIV counselling and testing, ARV and TB treatment for adults and children, follow-up, and prevention of mother-to-child transmission (PMTCT) of HIV.

Focus on maternal health

The annual number of deaths from pregnancy-related causes has more than doubled in Lesotho since 2000. According to the World Health Organization, almost 60 per cent of these deaths are a result of HIV, as pregnant women with HIV are more susceptible to opportunistic infections.

In 2011, our team will start a new project focusing on reducing the rates of illness and death among pregnant women and babies in Lesotho. It aims to demonstrate that the number of infant and maternal deaths can be reduced by integrating HIV and TB care with maternal and reproductive health services, and by starting patients on ARV treatment sooner. The project will also reinforce basic healthcare services, decentralise services to bring them closer to people’s homes, encourage nurse-centred care and improve HIV care, particularly prevention of mother-to-child transmission. Médecins Sans Frontières will encourage robust community involvement in order to reduce stigma, increase awareness and provide advocacy.

Médecins Sans Frontières has worked in Lesotho since 2006.