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MOAE0102. 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. - PowerPoint PPT Presentation
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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!