PEPFAR

Family Health Days:An innovative approach to providing

integrated health services for HIV and non-communicable diseases among adults and children in hard-to-reach areas of Lesotho

A. Tiam, J. Khonyana, O. Oyebanji, A. Ahimbisibwe, R. Pakela, A. Isavwa, L. Buhendwa, M. Mokone, M. Putsoane, M. Foso, M. Tsoeu, M. Nyabela.

MOAE0102

Kingdom of Lesotho

Lesotho Demographic Information

Population 1.9 million 2006: Census

HIV prevalence - adults 23.7% 2009: LDHS

HIV prevalence - pregnant women

27.7% 2009: Sentinel Surveillance

Hypertension prevalence 37.6% 2001: MOHSW Survey Report

Maternal mortality ratio 1,155/100,000 2009: LDHS

Infant mortality ratio 91/1,000 2009: LDHS

Fertility rate 3.4 per woman 2006: Census

Demographic Information Continued

ANC attendance 91.8% (first visit) 2009: LDHS

Deliveries in health Facilities

69.8% 2009: MOHSW

HIV test uptake at ANC 95% Program data

PMTCT coverage 81% 2010 Cumulative Health Facility Data

Background

• In Lesotho, considerable resources have been allocated to the HIV/AIDS response, while resource allocation for non-communicable diseases has lagged.

• Due to geographic location and weak transportation and infrastructure, a number of clients find access to health care facilities challenging.

• The Family Health Day (FHD) campaign is a national mobile health program, which brings integrated health services to communities and families.

Goals and Objectives

FHD aims to make integrated health services accessible tocommunities in Lesotho through use of mobile clinics, and use ofmulti-disciplinary teams and family-centered approaches

Objectives: • Test all HIV-exposed children• Increase early infant diagnosis of HIV and timely enrollment into

care and treatment• Increase adult access to HIV care and treatment services• Increase screening for hypertension, diabetes, malnutrition, and

TB• Increase access to integrated family services

Methods

• EGPAF supported Lesotho’s Ministry of Health (MOH) to assemble a multidisciplinary team, composed of medical doctors, nurses, and nutritionists, pharmacists, mental health officers, social workers, counsellors.

• EGPAF provided logistics support to the MOH, technical support for the monitoring and evaluation component, and worked with other service delivery partners to strengthen the campaign.

Services Provided at FHD

Population group Chronic disease services provided

HIV-, STI- and TB-related services provided

All adults Screening: hypertension, diabetes, malnutrition, outpatient care

Screening: HIV testing and counseling, TB screening, STI screening

Pregnant women ANC services HIV testing and counseling, STI

Children and infants Vitamin ADe-wormingImmunizationsGrowth monitoringMalnutrition screening

HIV testing and counseling, including DBS for infantsNVP initiation/administration for HIV-exposed children

HIV-positive individuals

CD4 blood drawClinical stagingCo-trimoxazoleAdherence counseling

Other services OphthalmicSocial welfareMental observation/therapy

Condom distributionFamily planning

Table 2: Services

Results• Between October 17 and November 25, 2011, 10 rounds of FHDs

were carried out in the 10 districts of Lesotho.• Of the 8,396 adults tested for HIV, 7% were positive.• Of HIV-positive individuals, 68.5% received CD4 testing and 36.6%

were enrolled into HIV care• 324 defaulters were linked back to care• 990 children were immunized• Of the 4,454 adults screened for hypertension, 24.2% had elevated

blood pressure*

• 3.1% of 3.045 adults had elevated blood sugar, and all were linked to care**

*JNC7 report. See table 3 for details.

** hypertension.ADA. I. Classification and Diagnosis. Diabetes Care 2011;34 (suppl 1):S13. Table 2. defined as random plasma glucose ≥200 mg/dl (11.1 mmol/l) according to national guidelines

Distribution of Blood Pressure by Age Group

Female Male

Age group MSBP MDBP Range MSBP MDBP Range

20-29 149 103 143-15893-108

152 100 146-16295-117

30-39 155 101 142-16491-111

153 123 145-163102-131

40-49 159 100 158-17497-109

Incomplete data Incomplete data

155-160100-104

50-59 162 103 148-189102-137

177 115 156-20295-127

60-69 162 104 145-19397-147

171 106 150-20299-124

≥70 174 100 151-21391-132

164 108 149-18394-121

Discussion

HIV screening• HIV prevalence was quite

low compared to national prevalence

• High number of treatment defaulters identified; this provided an opportunity to link defaulters back to HIV care and treatment services

• Enthusiasm about knowing HIV status

Non-communicable diseases• FHD gave first opportunity in

Lesotho to carry out hypertension screening in hard-to-reach communities

• The mean blood pressure seemed to be quite high; selection bias is one hypothesis

Patients queuing for services at different work stations

Pharmacy unit in a converted car boot

Thank you!