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MSF in Lesotho, 2006
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Lesotho, a small mountain kingdom landlocked by South Africa, has the third highest HIV prevalence in the world. With 28.9 per cent of adults infected, it comes after only Botswana and Swaziland, and is the poorest of the three.
Patients waiting outside one of the 14 health centers in the
MSF arrived in Lesotho in January 2006 with the goal of launching a decentralised approach to HIV/AIDS care and treatment. Whilst HIV/AIDS care is typically only available at major centers in resource-poor countries, here the program would offer access beyond hospitals and urban areas, providing HIV care and antiretroviral therapy (ART) at 14 clinics in Scott Health Service Area (HSA), a rural health district with a population of 220,000.
The team has benefited from the many years of experience MSF has accumulated operating AIDS treatment programs elsewhere, particularly in Khayelitsha and Lusikisiki in nearby South Africa. Key factors were built into the program from the start, such as provision of free HIV/AIDS care and treatment; delegation of tasks to lower levels of health workers; simplification of treatment guidelines; and protocols and empowerment for persons living with HIV/AIDS (PLWHAs).
In less than six months, the MSF team trained more than 100 nurses, village health workers, peer educators, and PLWHAs; enrolled more than 1000 people into HIV care; and initiated ART for nearly 300 people. Mobile medical teams visit each health center on a weekly basis, many in remote, mountainous areas, to provide direct clinical care for patients and offer on-the-spot supervision and training for nurses. Intensive support is also provided in the outpatient department, wards, laboratory, and pharmacy at Scott Hospital.
Essential to the project has been the development of strong partnerships with the health staff and management and PLWHAs in Scott HSA (one of the many health districts managed by the Christian Health Association of Lesotho), as well as the Ministry of Health and Social Welfare, which provides all antiretrovirals for the program through a grant from the Global Fund. Through these partnerships, MSF aims to reduce AIDS-related deaths whilst strengthening the capacity of health workers and communities to cope over the long term with Lesotho’s truly overwhelming HIV/AIDS emergency.
MSF began working in Lesotho in 2006.