Leribe is an agricultural district in northern Lesotho that borders the Free State Province of South Africa, which mines one-fifth of the world's gold--along with mining operations for silver, uranium, and diamonds. Workers in Lesotho are drawn to South African mining jobs as well as peripheral positions, such as in housekeeping.
Migratory workers often face challenges when it comes to adhering to HIV treatment. Some are unable to easily come back to the clinic for prescription refills. Others are scared to disclose their HIV status to employers. And still others hold religious, traditional, or cultural beliefs that result in self-stigma.
However, defaulting on antiretroviral (ARVs) medication, without adequate intervention, eventually leads to advanced HIV disease (AHD), followed by death. HIV is treatable, but it requires consistent adherence to antiretroviral medication.
"Common symptoms of patients that were diagnosed with AHD are meningitis, cervical cancer, TB, pneumonia, and shingles," says Sister Ntefeleng Naha, a nurse at the antiretroviral therapy (ART) clinic at Motebang Hospital in Leribe.
In 2018, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) evaluated the government hospitals in Leribe and Berea and discovered an ADH prevalence rate of 28% of newly diagnosed and defaulting patients--with 10% of them dying as a result.
To address this grim reality, the Lesotho Ministry of Health developed an AHD manual which was implemented at 18 hospitals in 2020. This was expanded to 54 high-volume facilities in 2022 and included training of health care workers and continuous supportive supervision. Now this level of care has been extended to all public facilities in Lesotho.
Along with the adults struggling with adherence, Sister Naha also sees children and adolescents who are experiencing--or are at risk for--AHD. According to guidelines, children younger than 5 years old presenting with HIV infection not on ARVs treatment are considered to have AHD, while those who have been receiving ARVs treatment for more than one year and are clinically stable are safe from AHD.
Quick Tests Results Are Key for Timely Diagnosis and Treatment
AHD is an emergency condition. And since many of these patients may be planning to travel in the near future or live far from facilities, they need quick tests results.
"Some of the AHD patients have symptoms while others have none and are only diagnosed through baseline laboratory tests," says Sister Naha. "We work hand-in-hand with the laboratory unit to ensure that all AHD results are provided immediately."
TB tests are now processed in every facility rather than at a central location. If the result is positive, the sample is then taken to a lab for confirmation.
Starting in November 2023, CD4 tests--measuring white blood cells--have also been decentralized, allowing health workers to counsel clients earlier if they are at risk of AHD. Meanwhile, a patient with a CD4 count below 200 is confirmed diagnosed with AHD. Clinical staff works quickly to provide proper treatment to ensure that the client is not suffering from a deadly comorbidity such as meningitis.
"Implementation of AHD guidelines in the facilities has helped us successfully diagnose AHD patient immediately for timely and effective management of the disease," says Sister Naha. "This has helped to saved lives."
In addition to speedy diagnosis of advanced HIV disease, health workers screen all women living with HIV for cervical cancer every two years. Cervical cancer is among common cause of death among women with untreated AHD.
Patients are also screened for malnutrition and depression and are referred to appropriate professionals for further interventions if needed.
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Fewer Trips to the Clinic
To help keep clients on treatment, the Ministry of Health has implemented differentiated service delivery--a responsive, client-centered approach. One successful program has been multi-month dispensing, which provides clients with several months' supply of medication, reducing the number of times they must visit the clinic.
Community antiretroviral treatment groups (CAGs) likewise reduce the burden of clinic visits, with members of the group taking turns visiting the clinic to pick up medication for everyone in the group. Another method involves community lockers, provided through Bonolo Meds, which allows people to pick up medication confidentially at their own time.
The bottom line; transport fares, working away from home or long distances to the facilities should not hinder people adhering to their lifesaving medication.
