Lesotho has the second highest incidence of TB in the world, according to the World Health Organization, due in part to the large number of Basotho migrant miners who work in hazardous conditions in South African mines. Separated from their families and communities, this population is also at increased risk for acquiring HIV, which in turn worsens the risk of TB illness and death.

Through a sub-contract with the Lesotho Ministry of Health, ICAP in Lesotho has been engaged to provide technical support for Point of Care (POC) centers in three employment offices run by TEBA, the sole formal employment agency for miners from Lesotho working in South Africa.

The primary aim of this project is to increase access to TB and HIV services for miners, ex-miners, and their families in Lesotho, in collaboration with the Ministry of Health. Addressing HIV and TB together is part of the mandate of the Southern Africa Tuberculosis and Health Systems Support (SATBHSS) Project.

From November 2017 through June 2019, ICAP in Lesotho will support the implementation of integrated TB/HIV services at three high-volume regional TEBA POC centers, and work to strengthen the referral system for TB services across the Lesotho-South Africa border, helping to ensure that miners are connected to TB care and stay with it.

Initial project activities include clinical training, TB education and outreach, and nurse mentorship. Overall, the project aims to improve detection of TB cases, treatment, referrals, and follow-up.  The project will also seek to enhance clinical training and mentoring for identified needs.

“There is a lot we can do in terms of community education and outreach to raise awareness and decrease stigma around getting tested and treated for TB and HIV, but we also have to make sure that the systems are working and responsive to people’s needs,” said Koen Frederix, MBBS, MPH, technical director for ICAP in Lesotho. “This project will ensure that staff are trained and positioned to offer excellent TB and HIV care, and that they are supported with equipment and clinical mentorship to enable them to achieve their goals.”

This current project builds on the partnership ICAP first formed with TEBA when the TB REACH project was launched in 2013. TB REACH aimed to improve health outcomes among 26,000 miners and their families through health education, TB screening, same-day diagnosis, and treatment initiation. The project utilized innovative approaches developed through ICAP’s extensive experience scaling up the TB response in Lesotho.

“ICAP has been working in Lesotho since 2005 and has built strong relationships with the ministry of health and other partners to tackle TB/HIV comorbidity,” said Andrea Howard, MD, MS, director of ICAP’s Clinical and Training Unit. “Especially in this context, where we have high disease burdens and a mobile population with limited connections to health care and the social support of their home communities, we need to strengthen the available systems to ensure that patients are linked to care and supported throughout their treatment.”

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