International Activity Report 2012
MSF in Lesotho, 2012
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More than half of all maternal, infant and under-five deaths in Lesotho can be attributed to HIV.
It is not only HIV treatment that is hard to access, but healthcare in general. Only a small number of the health facilities in the country are adequately staffed. To address the huge gaps in access to medical care, Doctors Without Borders/Médecins Sans Frontières (MSF) runs a program focused on maternal and child health, integrating HIV and TB care at the same clinics. Capacity has been increased through the decentralization of medical services to more health facilities and the shifting of some responsibilities from doctors to nurses.
MSF provides support to St Joseph’s district hospital in Roma, six health clinics in the lowlands and three clinics in the remote Semonkong area, where an ambulance was supplied to transport patients to St Joseph’s in emergencies. MSF also trained counselors and village health workers, who help link patients to the services they need.
Lobbying for Counselors
In 2012, withdrawal and delays in funding from international organizations, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, resulted in a decrease in the numbers of lay counselors at facilities. Counselors are trained to provide one-to-one support through HIV and TB testing and to help ensure patients adhere to treatment. They perform a critical role: without them, the workload for nurses increases and patient care is compromised. MSF lobbied strongly to ensure funding for counselors and began working on a longer-term solution with the Ministry of Health and other partners.
Faster Access to Second-Line Treatment
An HIV patient’s CD4 count is measured to determine when to initiate antiretroviral (ARV ) treatment. The viral load of HIV – the amount of the virus in the blood – is measured to ascertain whether first-line ARV treatment has failed. If it has, the patient needs to be switched to a second-line drug regimen. In Lesotho, viral load tests had to be carried out abroad, and switching to second-line treatment required approval by committee at the Ministry of Health. The time taken by this process often meant the patient died before approval was obtained.
In 2012, MSF received a grant from the financing initiative UNITAID to develop and implement viral load testing, as well as point-of-care CD4 testing, in eight HIV programs in Africa, including Lesotho.
At the end of 2012 MSF had 28 staff in Lesotho. MSF has been working in the country since 2006.