Increasing adult ART uptake under Test and Treat in Lesotho through ART initiation at the village health post level
Globally, Lesotho ranks second in HIV prevalence. Prevalence rates vary among Lesotho’s 10 districts and range from 17% in Mokhotlong to 28% in Maseru (LDHS:2014).
In June 2016, per the new Universal Test and Treat (UTT) guidelines released by the World Health Organization (WHO), Lesotho became the first African country to implement UTT guidelines. While these guidelines removed all restrictions to antiretroviral therapy (ART) initiation for HIV-affected people, actual ART coverage remained at 41% for adults and 40% for children. Many facilities face a backlog of patients now eligible for treatment, and many patients faced access challenges, in part due to Lesotho's mountainous terrain and incomplete road system.
With an ART initiation rate of 47% in September 2016, Tebellong Hospital in Qacha's Nek District faced many of these challenges; with support from the USAID ASSIST Project, a quality improvement (QI) team was formed to understand and address root causes of the low ART initiation rate. After deeper analysis and implementation of QI methodology, the QI team tested a change idea in December 2016: dispatching a nurse-midwife to the remote Qabane Health Post for ART initiations. Data collection and analysis revealed that by March 2017, all eligible patients had been initiated on ART, a success that has been maintained as of August 2017.