Project Fact Sheet | Lesotho

What the project was University Research Co., LLC (URC) began working in Lesotho in 2005 under the USAID-funded Quality Assurance Project (QAP), followed by the USAID Health Care Improvement (HCI) Project from 2007-2009. The Lesotho TB program was guided by the vision that health care quality can be significantly improved by applying proven quality improvement (QI) approaches to various TB program elements.

The project aimed to:

¡ Strengthen collaboration between TB and HIV programs at both national and district level

¡ Decrease the burden of TB in people living with HIV/AIDS

¡ Decrease the burden of HIV/AIDS in TB patients

Responding to TB/HIV co-infectionIn Lesotho an estimated 80% of people with active TB disease are co-infected with HIV, placing a double burden on treatment and care facilities. A key obstacle to effective management and support of co-infected patients is the lack of personnel with adequate abilities to screen for HIV and TB, appropriately administer and monitor DOTS and ART; and manage long-term coordinated TB/HIV care. The human resource shortage is especially severe for the laboratory services.

HCI worked closely with the Ministry of Health and Social Welfare to establish the framework for TB-HIV co-infection. This included creation of relevant policies and revision of reporting forms, training of both healthcare workers and lay counselors, communication and social mobilization, as well as the strengthening of the laboratories involved.

HCI also collaborated with Christian Health Association of Lesotho (CHAL), which operate half of the hospitals in Lesotho, in the implementation of the three I’s.

USAID Health Care Improvement Project: Improving TB and TB/HIV Services2005-2009

The project piloted use of face masks by patients for TB infection control

October 2010

Lesotho

MASERU

Where we work

Focus areas¡ Improvement collaboratives: HCI facilitated district-level

meetings with district management and clinic staff to review performance data; develop strategies for performance improvement and to share best practices among health facilities

¡ Policy level support to develop key TB/HIV and MDRTB guidelines

¡ VCT for TB patients, cotrimoxazole preventive therapy, and referrals

¡ “Three I’s” (intensified TB case finding, infection control, and isoniazid preventive therapy [IPT]) to decrease burden of TB among PLWHA

¡ Advocacy, communication and social mobilisation on TB/HIV

¡ HIV counseling and testing

¡ Infection control

¡ Public Private Mix (PPM)

¡ Laboratory Services

¡ TB/HIV Surveillance

Innovative approaches in ACSMAdvocacy, communication, and social mobilization are key elements in increasing awareness of TB and TB/HIV, encouraging screening and treatment compliance, and reducing stigma.

HCI used a multi-pronged approach to increase information about TB and TB/HIV co-infection.

¡ Partnerships were developed with cell phone network providers to send awareness messages to their clients in conjunction with World TB day.

¡ Information on TB and TB/HIV was placed in the local newspapers during World TB day and World AIDS day commemorations.

¡ Radio messages on TB/HIV were broadcasted on radio stations.

¡ Community awareness campaigns on TB and HIV were carried out in hard-to-reach areas. During the campaigns, people were offered voluntary HIV testing and counseling and screening for TB.

¡ Thousands of pamphlets on TB/HIV in Sesotho and English were reprinted and distributed to health facilities.

Key achievements¡ Completion of the National Tuberculosis Policy Manual,

MDR TB case management guidelines, and draft of PMTCT guidelines on TB management among pregnant mothers’ in collaboration with the Ministry of Health and Social Welfare.

¡ Revision and printing of the Ministry’s TB Register, the TB Suspects Register, the MDR-TB/XDR-TB Register, TB Patient Card, and Quarterly Case Finding and Treatment Outcome Report forms.

¡ 950 lay counselors and healthcare workers were trained and mentored on TB and TB-HIV co-infection.

¡ Number of TB diagnostic centers increased from 4 to 15.

¡ The number of TB patients tested for HIV, and of HIV-positive patients on CPT has increased significantly.

University Research Co., LLC • Block B, Rigel Park Offices • 446 Rigel Avenue • South Erusmasrand 0181 [Pretoria suburb] • South AfricaTel: 27-12-484-9300 • aliyanage@urc-chs.com • www.urc-chs.com

Improving systems to empower communities

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Trend of TB patients tested for HIV, testing positive, on CPT and ART, and TB Diagnostic Centers, 2007-2009

# of registered patients # of TB patients tested for HIV # of TB patients HIV+

# of HIV+ TB patients on CPT # of HIV+ TB patients on ART