Rural Lesotho Research Articles

A Study of Volunteer Community Health Workers Promoting Maternal Health Services in Rural Kenya: A Christian Viewpoint

Introduction: Despite the call for community-based health care interventions in the developing world, there is little research examining the effectiveness of paid versus volunteer community health worker (CHW) programs to increase women’s use of maternal health services. From a Christian perspective, the CHW model is, at its root, discipleship: a credible person leads a neighbor to a source of help and health. This effective model can be expanded to address the health of the whole person, both spiritual and physical. This study of a government health center program in rural Kenya addresses these issues.Methods: The current study analyzed the change in maternal health services after a government program, starting with 30 volunteer CHWs, had been in place for nine months. The intervention was designed and carried out by the authors in collaboration with Sigoti District Health Center in the western Kenyan province of Nyanza.Results: The proportion of facility-based deliveries (FBDs) showed a statistically significant increase (p=0.003), from an average of 38 deliveries before the intervention to 60 afterwards. The proportion of health center deliveries of HIV-positive women also significantly increased (p=0.04) from an average of 6.5 to 14 FBDs. Compared to another program in rural Lesotho with paid CHWs, the Sigoti intervention led to a similar increase in FBDs. Despite their successes, the community-based strategies were time-intensive for both programs, with one CHW adding between 1.12 and 1.7 FBDs per year.Discussion: This study demonstrates that a CHW program can be successful, even when using volunteers. Using solely a metric of time and/or money, the CHW model produces value at a high cost. However, the concerns of cost-effectiveness and CHW attrition, as well as the success of the CHW model, can be meaningfully addressed from a Christian perspective. Using the outcome measure of changed lives, volunteer CHWs could be motivated by a Christian call to discipleship. CHWs may be trained and supported to contribute to the health of the whole person. Future research will test these assumptions with a CHW program operating from a Christian health center to be built soon in the study area.

Clinical and socio-demographic predictors for virologic failure in rural Southern Africa: preliminary findings from CART-1.

IntroductionIn 2013, the World Health Organization (WHO) recommended scaling up of routine viral load (VL) monitoring for patients on antiretroviral therapy (ART) in resource-limited settings [1]. During the transition phase from no VL-testing at all to routine VL-monitoring, targeted VL for groups at particular risk of virologic failure (VF) may be an option [2]. We present socio-demographic and clinical risk factors for VF in a cohort in rural Lesotho with no access to VL prior to the study.Materials and MethodsData derive from a cross-sectional study providing multi-disease screening as well as VL testing to adult patients (≥16 years old) on first-line ART ≥6 months [3]. VF was defined as VL≥1000 copies/mL. Assessed potential predictors of VF were: (1) socio-demographic (sex, age, wealth-quintile, education, employment status, disclosure of HIV status to environment, travel-time to facility); (2) treatment history (history of treatment interruption >2 days, previous drug substitution within first-line ART, time on ART, ART-base and -backbone); (3) adherence (pill count) and (4) clinical (clinical or immunological failure as defined by WHO guidelines [1], presence of papular pruritic eruption (PPE)). All variables with association to VF in univariate analysis were included in a multivariate logistic regression reporting adjusted Odds ratios (aOR).ResultsData from 1,488 patients were analyzed. Overall VF-prevalence was 6.9% (95% CI 5.7–8.3). In univariate analysis, the following were associated with VF: age <30, lower wealth-quintile, no primary education, history of treatment interruption, nevirapine-base, zidovudine-backbone, history of drug substitution, travel-time to clinic ≥2 hours, disclosure of HIV status to <5 persons, clinical failure, presence of PPE and immunological failure. In multivariate analysis, 6 out of the above 12 variables were independent predictors: age <30 years (aOR: 2.4; 95% CI 1.1–5.3, p=0.029), history of treatment interruption (2.5; 1.3–4.7, p=0.005), PPE (6.9; 2.5–18.9, p<0.001), immunological failure (11.5; 5.7–23.2, p<0.001), history of drug substitution (1.9; 1.0–3.7, p=0.043), disclosure of HIV status to <5 persons (1.8; 1.1–3.1, p=0.03).ConclusionIn this cohort in rural Lesotho, several socio-demographic and clinical predictors were associated with VF. Particularly age <30 years, history of treatment interruption, PPE and immunological failure were strongly associated with VF. These patients may be prioritized for targeted VL-testing.

Higher rates of metabolic syndrome among women taking zidovudine as compared to tenofovir in rural Africa: preliminary data from the CART-1 study.

IntroductionDue to its side effects stavudine (D4T) has been replaced by zidovudine (AZT) and tenofovir (TDF) in most low- and middle-income countries (LMICs). In 2014 about 38% of adult first-line regimens contain AZT and 62% TDF [1]. Whereas the unfavourable metabolic outcomes of D4T in comparison to TDF have been described extensively, studies from LMICs comparing metabolic profiles between patients on AZT and TDF are scarce. Given the high number of patients in LMICs still taking AZT, data on their metabolic profile are needed. We present rates of metabolic syndrome (MS) in adult patients taking either AZT- or TDF-containing first-line, non-nucleoside reverse transcriptase (NNRTI)-based regimens.Materials and MethodsData derived from a cross-sectional multi-disease screening conducted in ten facilities in two rural districts of Lesotho, Southern Africa [2]. Patients were eligible if aged ≥25 years and on NNRTI-containing first-line ART ≥6 months. The MS definition for Africa of the International Diabetes Federation was applied [3]. Assessed potential predictors for MS were age, time on ART, virologic suppression, body-mass index (BMI), alcohol consumption, wealth quintile, NNRTI (nevirapine (NVP) or Efavirenz (EFV)), history of previous D4T exposure and ART-backbone (AZT or TDF). Statistical analyses – stratified for sex – comprised univariate logistic regression for each predictor variable with subsequent construction of a multivariate model including all predictors with an association to MS at a significance level<0.1 in univariate analysis.ResultsOut of 1026 patients, 660 (64.3%) were female. MS prevalence was 9.8% (95% CI 6.9–13.4) in men and 22.9% (19.7–26.3) in women. In women, aged ≥35 years, AZT-backbone, NVP-base, BMI ≥25kg/m2 and taking ART for ≥4.5 years were associated with MS in univariate analysis. In the multivariate model only AZT (adjusted odds-ratio: 2.2, 95% CI 1.4–3.6; p=0.001) and BMI ≥25kg/m2 (9.8; 2.8–34.1, p<0.001) were associated with MS. For men, age, higher wealth quintile, history of D4T exposure and BMI were associated with MS in univariate analysis. In the multivariate model only a BMI ≥25kg/m2 was associated with MS (8.9; 3.8–20.9, p<0.001).ConclusionsIn rural Lesotho, Southern Africa, the use of AZT instead of TDF among women who are on ART for ≥6 months predisposes to the development of metabolic syndrome. Given that, still 38% of first-line regimens in LMIC contain AZT, this finding needs to be verified in other settings in Sub-Saharan Africa.

Flexible kinship: caring for AIDS orphans in rural Lesotho.

HIV/AIDS has devastated families in rural Lesotho, leaving many children orphaned. Families have adapted to the increase in the number of orphans and HIV-positive children in ways that provide children with the best possible care. Though local ideas about kinship and care are firmly rooted in patrilineal social organization, in practice, maternal caregivers, often grandmothers, are increasingly caring for orphaned children. Negotiations between affinal kin capitalize on flexible kinship practices in order to legitimate new patterns of care, which have shifted towards a model that often favours matrilocal practices of care in the context of idealized patrilineality.

Investigating the Benefits of ICT in Lesotho Rural Communities of Mabote and Kubetsoana

ICT for rural communities has been a topic debated for decades now. Despite the many debates, the issues around this topic have mostly remained unresolved especially in most rural parts of Africa. It is with this in mind that this study; meant to emphasize the importance of Information and Communication Technology ICT by raising awareness of its benefits was found necessary. An investigation on the benefits of (ICT) in rural communities of Lesotho revealed that it will take addressing a number of issues before any benefits can be realized. Results revealed that realizing the benefits of ICT in rural communities require adequate knowledge of the underlying causes of the digital divide. It was also found that while ICT had a number of potential benefits towards the socio-economic status of rural Lesotho, issues like cost, accessibility, lack of infrastructure and illiteracy among others remain a challenge to the full realization of this empowerment. The aim of the study was to find the benefits that ICT contributed to the socio-economic development of Lesotho rural communities. The study used Activity Theory and investigated ICT diffusion and infusion in Lesotho’s disadvantaged communities. The study also applied the ‘cause and effect’ principle and questionnaires were distributed in the two villages of Lesotho that were investigated; Mabote and Khubetsoana. Recommendations were also contributed to the research community on ICTs for rural communities in terms of suggesting the best way that ICT can possibly be implemented for the benefit of rural communities.

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

IntroductionLesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho.MethodsThe two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender.ResultsOf 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73–1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93).ConclusionsIn rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Addressing gender inequity in HIV care in rural Lesotho: the 'Male Initiative'

Lesotho is a nation in Southern Africa with an HIV prevalence of 25%. Males are less likely to access HIV services and there is a need for strategies to improve male participation in HIV care. This paper describes the development and implementation of the Male Initiative to increase male participation in HIV services. A combination of qualitative and quantitative methods were used to describe the components, process, organization, participation and potential impact of the Male Initiative. The Male Initiative was developed in partnership with local village chiefs, traditional healers and spiritual leaders. It used the traditional male meeting structure known as the Pitso-ea-banna to deliver messages about HIV care. 1311 men participated in five Male Initiative meetings over a 30 month period from June 2006-31 December, 2008. Male enrollment increased from 32% in 2006 to 36.8% in 2008, a trend which approached statistical significance (p = 0.07) and suggests potential programmatic impact that merits further study. Gender inequalities in enrollment in HIV care can be addressed through programs developed in partnership with local leaders and delivered in culturally accepted settings.

The Impact Of Dwindling Opportunities For Mine Migration On Rural Household Income In Lesotho

The numbers of Basotho men in the South African mines dropped from almost 126,000 in 1990 to just over 41,000 in 2010. Using primary data, this paper analyses the sources and levels of income in former migrant, current migrant and non-migrant households in rural Lesotho, and then identifies the variables that significantly correlate with both household income and household per capita income. In the absence of panel data, the paper uses the differences in mean incomes between current and former migrant households to highlight the impact of dwindling opportunities for mine migration on household income. The paper finds that with the loss of migration status, monthly household income dropped by M2040 in 2006/2007 when per capita income for the country was M5624. The paper recommends investment in the country’s comparative advantage areas and skills development for productive engagement in the domestic economy of rural men who by tradition look for work in the South African mines.

A Clinical Prediction Score in Addition to WHO Criteria for Anti-Retroviral Treatment Failure in Resource-Limited Settings - Experience from Lesotho

ObjectiveTo assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART) failure in rural Lesotho.MethodsPatients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak CD4-count (1 and 2), hemoglobin drop≥1 g/dL (1), CD4 count<100/µl after 12 months (1), new onset papular pruritic eruption (1), and adherence<95% (3). A nurse assessed the score the day blood was drawn for viral load (VL). Reported confidence intervals (CI) were calculated using Wilsons method.ResultsAmong 1'131 patients on ART≥6 months, 134 (11.8%) had immunological and/or clinical failure, 104 (78%) had blood drawn (13 died, 10 lost to follow-up, 7 did not show up). From 92 (88%) a result could be obtained (2 samples hemolysed, 10 lost). Out of these 92 patients 47 (51%) had viral failure (≥5000 copies), 27 (29%) viral suppression (<40) and 18 (20%) intermediate viremia (40–4999). Overall, 20 (22%) had a score≥5. A score≥5 had a PPV of 100% to detect a VL>40 copies (95%CI: 84–100), and of 90% to detect a VL≥5000 copies (70–97). Within the score, adherence<95%, CD4-count<100/µl and papular pruritic eruption were the strongest single predictors. Among 47 patients failing, 8 (17%) died before or within 4 weeks after being switched. Overall mortality was 4 (20%) among those with score≥5 and 4 (5%) if score<5 (OR 4.3; 95%CI: 0.96–18.84, p = 0.057).ConclusionA score≥5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test.

Gender differences in enrolment in an HIV-treatment programme in rural Lesotho, 2006–2008: a brief report

The southern African nation of Lesotho has an HIV seroprevalence of approximately 25%. To address the need for HIV care in rural Lesotho, a project called the Rural Health Initative (RHI) was launched in seven clinics in 2006. Data on enrolment were collected retrospectively and analysed for trends in gender enrolment over time. Of 6001 enrolled, 3904 were women (65.1%) and 2097 (34.9%) were men. When analysed by month of enrolment, there was a higher percentage of men enrolled in December compared with the other months of the year (χ(2) = 15.98, P < 0.001). This may be due to the migratory work of the men in the mines of South Africa and suggests a need for targeted interventions to increase male enrolments over the entire calendar year.

Comprehensive Approach to Improving Maternal Health and Achieving MDG 5: Report from the Mountains of Lesotho

BackgroundAlthough it is now widely recognized that reductions in maternal mortality and improvements in women's health cannot be achieved through simple, vertical strategies, few programs have provided successful models for how to integrate services into a comprehensive program for maternal health. We report our experience in rural Lesotho, where Partners In Health (PIH) in partnership with the Ministry of Health and Social Welfare implemented a program that provides comprehensive care of pregnant women from the community to the clinic level.MethodsBetween May and July 2009, PIH trained 100 women, many of whom were former traditional birth attendants, to serve as clinic-affiliated maternal health workers. They received performance-based incentives for accompanying pregnant women during antenatal care (ANC) visits and facility-based delivery. A nurse-midwife provided ANC and delivery care and supervised the maternal health workers. To overcome geographic barriers to delivering at the clinic, women who lived far from the clinic stayed at a maternal lying-in house prior to their expected delivery dates. We analyzed data routinely collected from delivery and ANC registers to compare service utilization before and after implementation of the program.ResultsAfter the establishment of the program, the average number first ANC visits increased from 20 to 31 per month. The clinic recorded 178 deliveries in the first year of the program and 216 in the second year, compared to 46 in the year preceding the program. During the first two years of the program, 49 women with complications were successfully transported to the district hospital, and no maternal deaths occurred among the women served by the program.ConclusionsOur results demonstrate that it is possible to achieve dramatic improvements in the utilization of maternal health services and facility-based delivery by strengthening human resource capacity, implementing active follow-up in the community, and de-incentivizing home births.

Feasibility and benefits of scaling up antiretroviral treatment provision with the 2010 WHO antiretroviral therapy guidelines in rural Lesotho

The latest WHO guidelines (2010) for antiretroviral therapy (ART) in adults and adolescents recommend that countries should progressively reduce the use of stavudine in favour of tenofovir or zidovudine and that ART initiation commence at an earlier CD4 threshold of <350 cell/mm(3). In Lesotho, a high-burden, resource-limited setting, these two changes had been recommended since late 2007. A number of practical steps were taken to support implementation of Lesotho's national ART guidelines at the program level including: development of guidelines tailored to nurses working in primary care settings; training and clinical mentorship of different levels of health care workers; laboratory support; pharmacy support; and monitoring and evaluation. Clinical and programmatic benefits included decreased mortality, toxicity, and simplified patient management that was supportive of the decentralized, nurse-led model of care. This experience demonstrates that, despite limited resources, it was feasible to provide a standard of care similar to that of western guidelines and that these changes were supportive of simplified patient management.

Adoption of new HIV treatment guidelines and drug substitutions within first‐line as a measure of quality of care in rural Lesotho: health centers and hospitals compared

In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first-line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC- and a hospital-group. Type of backbone at ART-initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO-stage, baseline CD4-count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART-start, was used. Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds-ratio 1.55; 95%CI: 1.32-1.81) and had a higher rate of drug substitutions while on first-line ART (2.39; 1.83-3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83-2.84). Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART-programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them.

Sexuality education in rural Lesotho schools: challenges and possibilities

The aim of this paper is to present and discuss some of the obstacles to effective sexuality education in rural Lesotho schools and offer some suggestions that could facilitate positive change in the current status of sexuality education. The call for education as a ‘vaccine’ against new HIV infections places teachers at the forefront of the fight against the pandemic, and thus it is imperative to understand how they experience teaching about sexuality. Findings in the present study derive from data generated through a research project that sought to explore women teachers' experiences of teaching sexuality education in rural schools in Lesotho. Twelve women teachers' narratives are used to examine the obstacles to effective sexuality education in rural contexts. The study highlights the role of gender dynamics and culture in the effectiveness of school-based sexuality education. The paper argues for a more concerted effort and collaboration between curriculum developers and education stakeholders such that the Lesotho sexuality education curriculum is more context-specific and relevant to the communities it serves, so that it can achieve the desired goals of, amongst other things, reducing the transmission of HIV.

‘That’s what I see’: Enhancing AIDS intervention research through deep ethnography

This research is based on 13 months of ethnographic fieldwork conducted in rural Lesotho, Africa between 2007 and 2009. The article shows how cultural competence in intervention research can be improved through ethnographic fieldwork, borrowing primarily from anthropological research protocols. Through an exploration of the challenges of caring for AIDS orphans and children with HIV/AIDS, I demonstrate that deep ethnography is an effective way to gain the necessary in-depth cultural insight, particularly in the initial design stages of culturally competent interventions. This is particularly true for rural or remote communities where structural barriers, such as poverty, are pronounced. This interdisciplinary approach provides both valuable information for those interested in orphan care in rural sub-Saharan Africa, and also demonstrates the importance of the ethnographic approach for intervention research in social work.

Lay Health Workers and HIV Care in Rural Lesotho: A Report from the Field

Lay health workers (LHWs) are individuals who participate in a variety of health services, even though they have no formal professional training. They have been used in a variety of settings, especially where health care needs outstrip available human resources. Lesotho faces a severe human resource shortage as it attempts to manage its HIV pandemic, with more than 25% of the population infected with HIV. This article reports on a program that provided HIV services in seven rural clinics in Lesotho. LHWs played an important role in the provision of HIV services that ranged from translation, adherence counseling, voluntary counseling and testing (VCT) for HIV and patient triage, to medication distribution and laboratory specimen processing. Training the LHWs was part of the clinic physicians' responsibilities and thus required no additional funding beyond regular clinic operations. This lent sustainability to the training of the LHWs. This paper describes the recruitment, training, activities, and perceptions of the LHW work between June 2006 and December 2008. LHWs participated successfully in the care of thousands of people with HIV in Lesotho and their experience can serve as a model for other countries facing the disease.

Training Community Health Workers to Scale-Up HIV Care in Rural Lesotho: Implementation Lessons from the Field

Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs around the world, there is little detail about how these workers are selected, trained and utilized in the field. Lesotho has one of the highest rates of HIV in the world, with an estimated 25% of the general population infected with the disease; at the same time, there is a significant health human resources shortage in Lesotho with an estimated 60% of health posts left vacant. Community health workers have the potential to play a major role in HIV treatment scale-up in the country, and in 2006, a CWH-based project called "The Rural Initiative" was started in the remote mountain regions of the country. More than 1000 CHWs were trained and employed through this program between June 2006 and December 2008. This paper will review the CHW program in detail, with a focus on recruitment, training, ongoing supervision and support, and the larger public health implications of the CHW program in Lesotho. It is hoped this program can serve as a practical model for other programs working with or in need of CHWs.

Migration Shocks: Integrating Lesotho's Retrenched Migrant Miners

This paper finds that the decline in the numbers of Basotho1 migrant mine workers since the 1990s was not market induced but rather a result of political and policy changes in South Africa. As a result of these changes, household income throughout rural Lesotho dropped significantly. As current migrant households generally do not have skilled workers or operate family businesses, the paper makes a case for training in skills and entrepreneurship as a means of utilizing Lesotho's comparative advantages to generate domestic employment and absorb retrenched and prospective migrant mine workers.

Cost and Cost-Effectiveness of Switching From d4T or AZT to a TDF-Based First-Line Regimen in a Resource-Limited Setting in Rural Lesotho

Latest World Health Organization guidelines recommend shifting away from Stavudine (d4T)-based regimens due to severe side effects. However, widespread replacement of d4T by Tenofovir (TDF) or Zidovudine (AZT) is hampered by cost concerns. We established the cost-effectiveness of alternative first-line regimens using primary utilization, cost, and outcome data from a program in a rural district in Lesotho. We calculated cost per patient-year, incremental costs, and incremental cost-effectiveness ratios per life year, and per Quality Adjusted Life Year gained. Uncertainty was assessed using multiway and probabilistic sensitivity analyses. Our study included 1260 patients representing 1635 patient-years on antiretroviral therapy (ART). Six hundred eight patients were on TDF, 290 were on AZT, and 362 were on d4T. Patients on d4T experienced more toxicities; toxicities with the biggest impact on quality of life were moderate neuropathy and severe lipodystrophy. The cost per patient-year ranged from US $266 on d4T to US $353 on TDF. Inpatient care and essential drug costs were higher for patients on d4T than on AZT or TDF. Incremental cost-effectiveness ratio results suggest that AZT-based ART is weakly dominated by a combination of d4T- and TDF-based ART. This is one of the first analyses to investigate the cost-effectiveness of TDF using primary data in a resource-poor setting. Although TDF-based first-line ART is more costly than d4T, it is also more effective. Political pressure should be exerted to encourage further price reductions and additional generic manufacturing for TDF and partner drugs such as Efavirenz. This should be met by a commitment from donors and implementers to ensure that supply is met by a clear demand.

The Role of the Nurse in Implementation of an HIV Treatment Program in Rural Lesotho

This paper describes a HIV testing and treatment program in Lesotho in which nursing providers played a key role in the program implementation in the rural regions of the country. It states that the research demonstrates the important and varied roles that nurses can play in the management of HIV in resource-poor high-burden settings such as Lesotho.