PIH in Lesotho

PIH’s (Partners In Health) project in Lesotho is the second in Africa and the first in a country suffering from an extremely high prevalence of HIV. One-quarter of Lesotho’s adult population is HIV-positive. Lesotho also has the fourth highest reported TB incidence in the world, as well as one of the world’s highest rates of HIV-TB coinfection.

The government invited PIH to Lesotho in 2006 to bring testing and treatment of HIV/AIDS to remote rural areas. Launched at a single clinic in Nohana, PIHL’s rural initiative has expanded to seven clinics in four mountain districts. As of June 2010, the PIH supported clinics have counseled and tested more than 40,000 individuals for HIV, and provide lifesaving antiretroviral therapy for more than 4,000 HIV-positive adults and children. All of this takes place in the context of providing comprehensive primary care services to more than 300,000 people.

In 2007, responding to the extremely high rates of HIV/TB coinfection and the growing threat of multidrug-resistant tuberculosis (MDR-TB), PIHL created the first community-based MDR-TB program in the nation. As part of that project PIHL renovated an old leprosy treatment facility, turning it into a state of the art MDR-TB hospital for critically ill patients, with its own laboratory and pharmacy. Working with the Ministry of Health, the community-based MDR-TB program supports 456 patients as of June 2010.

Both initiatives are based on the community-based approach employed successfully by PIH in Haiti, Peru, Rwanda, and Boston. More than 1,000 local residents currently work and receive training as village health workers to visit HIV and TB patients in their homes on a daily basis to accompany them in their treatment and serve as a crucial link between the health clinics and the communities they serve.

The waiting area outside a clinic

Services delivered by PIHL (PIH-Lesotho) include clinical support, training for nurses and village health workers, medications, treatment for prevention of mother-to-child transmission of HIV, comprehensive primary care, maternal/child health services and psychosocial and socioeconomic support – including food aid.

Country Information

• Total population: Less than 2 million
• Population living on <$2/day: 62.2%
• Life expectancy at birth: Estimates range from 36-40
• Child mortality: 79 per 1,000 live births
• Adult prevalence of HIV: 23%
• Prevalence of TB: 490 per 100,000
• TB patients coinfected with HIV: 76%
• Maternal mortality: 964 per 100,000 live births
• Number of orphans: 160,000 (17% of children under age 16)
• Patients tested for HIV by PIH: > 40,000 as of June 2010
• HIV patients enrolled on ART: >4,000 as of March 2010
• Primary care: >221,000 individual clinic visits as of June 2010
• Pediatric care: 37% of all primary care visits under the age of 14
• MDR-TB patients under treatment: 456 as of June 2010
• Active community health workers and MDR-TB treatment supporters: > 1,000
• Households receiving food aid: 1,445 in June 2010
• Orphans receiving education, food and medical support: >100 as of June 2010

PIHL supports and runs hospitals and health centers in these communities:

Nohana, Bobete, Nkau, Lebakeng, Tlhanyaku, Methalaneng, ManamanengPIHL also runs the national MDR-TB treatment program, which includes the Botsabelo MDR-TB Hospital in Maseru