COUNTRY PRESENTATION' LESOTHO

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COUNTRY PRESENTATION.LESOTHO

• FOLA ADEBANJO
• SIMONE BENATTI
• OBI BEN

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LESOTHO AS A COUNTRY

• Completely embedded within South Africa
• With a population of 1.8 million and two-thirds
  living in the rural areas.
• Climate completely temperate. Four seasons well
  defined.
• Known for diamonds, electricity and water.
• Country is mountainous.
• There are 20 hospitals (9 government, 7 mission,
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• military, 3 private), plus 180 health centers.
• Lesotho Flying Doctor Services (LFDS) covers all
• hard-to-reach areas of the country.
• All facilities offer ART services.

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HIV/AIDS MAP 1
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HIV/AIDS MAP 2

• Prevalence currently stands at 23.2 - third
  worlds highest.
• 33 in 2006 and sharply dropped to 29 in 2007
  presumably due to mortality as revealed by
  national census.
• This figure may rise to 36 in 15 years (UN).
• Life expectancy M48, F56 (LBS 2001)
• Average life expectancy now 40.38 years (Recent
  statistics).
• Cultural practices are still a stronghold and
  enhance easy transmission.
• Poor staffing/staff remuneration has led to
  failure of good programs.

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• Not doing too badly despite persistently high
  prevalence and battle with various opportunistic
  infections predominantly TB, MDR-TB and STI,s.
  Lesotho terrain is difficult to meander leaving
  many areas yet uncovered. Poverty is major.
• Over the last 3 years CD4 count cut-off has moved
  from 200 to 250 and 350 in the last 18 months.
  Proposed move to 500 cells.
• Pregnant women left with very little choice as
  good PMTCT programs remain the gold standard for
  ultimate prevention.
• Together with a high rate of temporary emigration
  (mainly male adults in RSA mines)
• 4th highest incidence of TB in the world
  (635/100000/yr), probably also linked to mine
  work.

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HIV and TB

• 90 of TB patients are also HIV co-infected.
• TB is the main cause of mortality for HIV
  patients
• Atypical presentation in immune-depressed
  patient. (AFB NEG, CXR not equivocal,
  co-morbidity)1
• Difficult diagnosis in a resource-poor setting
• Delays HAART initiation (IRIS risk, drug
  toxicity)
• 1. The Lancet 2007, 369 (9578), p.2042

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ARVs available in Lesotho
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Eligibility for HAART
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GOVERNMENT INITIATIVES

• 1999 Finalized the National Strategic Plan
  (NSP) on HIV/AIDS
• 2000 Declared a national emergency owing to
  HIV/AIDS crisis
• 2003 GOL hosted a SADC extraordinary summit on
  HIV/AIDS
• 2005 Passed legislation to create the National
  AIDS Commission
• 2009 On-going review and update of the NSP.
• Decentralisation1.
• Task-shifting2.
• Integration.
• Free care.
• Bedelu et al., JID 2007, 196 (S3) implementing
  ARV therapy in rural communities the Lusikisiki
  model of decentralized HIV/AIDS care.
• 2.WHOIMAIprojecthttp//www.who.int/3by5/publicat
  ions/documents/en/IMAI_chronic.pdf

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MULTI-SECTORAL INVOLVEMENT

• Currently in place is a new partnership framework
  of the U.S. Presidents Emergency Plan for Aids
  Relief (PEPFAR). This will be aligned with
  revised national policies.
• The donor community is collaborating with
  government with key international stakeholders
  including PEPFAR, UN agencies, Irish AID, other
  international donors and dozens of NGOs

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• REA LEBOHA
• THANK YOU