Right to Care Lesotho

Right to Care Lesotho is committed to strengthening endeavours towards controlling the HIV epidemic as part of its USAID-PEPFAR funding mandate. Our work here prioritises evidence-based interventions and innovations that fast-track progress towards the UNAIDS 95-95-95 target.

Our Multi-Month Scripting and Dispensing (MMSD) programme in Lesotho was launched in 2017, and rolled out in three USAID-supported districts:

  • Maseru,
  • Mafeteng and
  • Mohale’s Hoek.

We work with 30 selected facilities in both rural and urban areas.

Our Multi-Month Scripting and Dispensing (MMSD) project

Right to Care Lesotho has focused on providing alternative or differentiated service delivery models for Antiretroviral Treatment (ART) distribution through Multi-Month Scripting and Dispensing (MMSD) of ART for stable HIV-infected patients.

MMSD is a differentiated model of care which sees stable HIV patients:

  • receive scripts for periods in excess of one month and
  • receive their drugs though innovations such as:
    • fast lanes at health facilities or
    • alternative dispensing sites.

There were three arms of the project which has sought to:

  • retain patients in care,
  • achieve viral suppression,
  • assess the cost-effectiveness of the different models,
  • create a model to implement the project nationally and
  • provide data for research.

The three arms were:

  • three-monthly ART supply at facilities (3MF) as the control.
  • three-monthly ART supply through community ART groups (3MC) as intervention 1 and
  • six-monthly ART supply through community ART distribution points (6MCD) as intervention 2.

We measured different criteria, namely:

  • retention in ART care 12 months after enrolment,
  • retention in study arms 12 months after enrolment,
  • viral suppression 12 months after enrolment and
  • mortality and loss to follow-up (LTFU) 12 months after enrolment.

Differentiated models of ART delivery while retaining patients in care

Our project in Lesotho has shown that it is feasible to implement community differentiated models of ART delivery outside the standard facility model and still achieve:

  • high retention,
  • minimum loss to follow-up and
  • high viral load suppression
The dispensing of three-month intervals of ART in Community ART Groups (CAGs) and six-month intervals of ART in the community did not compromise retention in care or viral load suppression for the stable HIV patients.

Strengthening HIV management in Lesotho

Working with our local partners, we are looking at:

  • longer patient follow-up periods to see how longer ART dispensing intervals positive impact patient outcomes,
  • strengthening laboratory services to:
    • reduce viral load turnaround times and
    • improve access to timely viral load results,
  • improving data management systems and
  • giving stable HIV patients, including migrant populations, longer ART dispensing intervals (≥6 months) to promote adherence and retention in care.

Lesotho HIV Self Testing project

An HIV Self Testing (HIVST) programme was deployed to improve testing among hard-to-reach populations in Lesotho. HIVST, when coupled with innovative high yield solutions, identifies and links individuals living with HIV to treatment. The initiative is aligned with UNAIDS’ 90-90-90 targets.

The project is made possible by RTC Lesotho, in collaboration with the Ministry of Health (MOH), Elizabeth Glacier Paediatric AIDS Foundation (EGPPAF), Population Services International (PSI) and Mother to Mothers (M2M), with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR), through the United States Agency for International Development (USAID).

The project was implemented in 18 health facilities in three districts – Maseru, Mafeteng and Mohale’s Hoek. It took place between 14 March 2018 and 30 September 2018.

5,304 people participated in the project. The age of the participants was between 21 and 38 and 61% were females. Most of the participants had attended school and only 4% had no education.

A total of 5,321 test kits were distributed.

HIVST results were available for 2,322 participants. 5.2% were HIV-positive. Positivity was generally high amongst 15- 29 year-olds, and especially young girls and women.

All tested participants were linked to clinic services consisting of:

antiretroviral treatment (ART)

prevention services including pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC)

Out of the 1,725 participants (where information was available):

166 (10%) were linked to care

those that were confirmed HIV positive (45%) were linked to ART

four participants were linked to PrEP

three were linked to VMMC and

105 to other services.

Closing the treatment gap – SA and Lesotho

This innovation is in support of a cross-border approach aimed at finding Basotho people on antiretroviral treatment (ART) that have been lost to follow up (LTFU). Many of these patients were assumed to be in South Africa. These patients were tracked and traced using electronic matching algorithms. Right to Care Lesotho worked with stakeholders in Lesotho and South Africa.

Some 200 patients selected from ten facilities in Lesotho demonstrated that 23% of ART patients lost to follow up in Lesotho could be traced to four districts where Right to Care is implementing care and treatment programs in South Africa. Some were found to be on treatment.

These four districts are:
  • Ehlanzeni district in Mpumalanga province,
  • Thabo Mofutsanyane district in Free State province,
  • City of Johannesburg (Gauteng province),
  • City of Tshwane (Gauteng province).

This initiative will enhance efforts to achieve epidemic control in Lesotho. Right to Care has been asked to extend this programme.

Right to Care Lesotho Board

Right to Care Lesotho Success Stories

Multi-month dispensing serves patients and improves adherence 1400 933 Right to Care

Multi-month dispensing serves patients and improves adherence

USAID provides antiretrovirals (ART) to most of the Southern African population that need them. Through the provision of free antiretrovirals, HIV patients who are adhering to their daily regimen are able to live full lives and plan for the future. Previously, in most of Southern Africa, patients had to attend the clinic to collect their…

Treating health seriously, caring, making treatment available in South Africa and abroad.

Contact Us

Email : info@righttocare.org
Phone : +27 (0) 11 276-8850