Lesotho is successfully doing nurse-initiated AIDS treatment at a primary health care level, a study in the current issue of the Journal of the International AIDS Society shows.

And Lesotho is doing better than South Africa despite having fewer resources.

Patients in Lesotho are starting treatment earlier than in South Africa – at CD4 counts of below 350 instead of below 200.

Their programme is using tenofovir in its first line regimen, which is better for patients.

Once again MSF – which initiated a programme in Lusikisiki in the Eastern Cape – is a major player in this rural care and treatment programme.

MSF, the Lesotho Health Ministry and the Christian Health Association of Lesotho rolled out the decentralized HIV/AIDS care programme in a rural area with 14 clinics and one district hospital.

“More than 13 243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level,” according to the study – and the results are encouraging.

“The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008.

“Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%).

“At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care.”

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