Key medical figures:
• 1,300 patients on first-line ARV treatment
• 1,400 births assisted
More than half of all maternal deaths in Lesotho are attributed to HIV and tuberculosis (TB).
Although basic healthcare is free, accessing it is not easy in this mountainous country, where many people live far from facilities. There is also a shortage of skilled healthcare workers.
Médecins Sans Frontières (MSF) aims to close some of the gaps in care by providing integrated HIV and TB care in a programme focused on maternal and child health. Antenatal, postnatal and emergency obstetric care are offered at St Joseph’s district hospital in Roma, six basic healthcare clinics in the lowland area and three clinics in the more remote Semonkong area. An ambulance and maternity lodge provided by MSF, where women can come to give birth, have also improved emergency care.
Increased decentralisation of the HIV and TB component of the programme is providing people with the specialised care they need closer to their homes. In order to meet staffing needs, nurses have been trained to initiate and follow up HIV and TB treatment with the supervision of doctors, and village health workers and lay counsellors have been trained in key support roles. Several advances in the programme were made during 2013. Beginning in April, all women who tested positive for HIV were put on antiretroviral treatment to prevent the transmission of HIV to their babies. A community adherence group was also piloted in one health centre. Here, patients get together to discuss concerns and pool resources so that only one of them, on a rotating basis, has to collect the medicines for the entire group. Technological improvements were made with the installation of CD4 testing machines (the CD4 count is an indicator of an HIV patient’s immunity level) in nine health centres, and the introduction of a rapid TB test (GeneXpert).
MSF was also granted permission to expand viral load monitoring within its programme ahead of changes in the national protocol. Measuring the amount of HIV virus in the blood is used to ascertain when first-line HIV treatment has failed and a patient needs an alternative drug regimen.
Year MSF first worked in the country: 2006