The uncertain future of lay counsellors : continuation of HIV services in Lesotho under pressure

Between 2006 and 2011, when antiretroviral therapy (ART) was scaled up in a context of severe human resources shortages, transferring responsibility for elements in human immunodeficiency virus (HIV) care from conventional health workers to lay counsellors (LCs) contributed to increased uptake of HIV services in Lesotho. HIV tests rose from 79 394 in 2006 to 274 240 in 2011 and, in that same period, the number of people on ART increased from 17 352 to 83 624. However, since 2012, the jobs of LCs have been at risk because of financial and organizational challenges. We studied the role of LCs in HIV care in Lesotho between 2006 and 2013, and discuss potential consequences of losing this cadre. Methods included a case study of LCs in Lesotho based on: (1) review of LC-related health policy and planning documents, (2) HIV programme review and (3) workload analysis of LCs. LCs are trained to provide HIV testing and counselling (HTC) and ART adherence support. Funded by international donors, 487 LCs were deployed between 2006 and 2011. However, in 2012, the number of LCs decreased to 165 due to a decreasing donor funds, while administrative and fiscal barriers hampered absorption of LCs into the public health system. That same year, ART coverage decreased from 61% to 51% and facility-based HTC decreased by 15%, from 253 994 in 2011 to 215 042 tests in 2012. The workload analysis indicated that LCs work averagely 77 h per month, bringing considerable relief to the scarce professional health workforce. HIV statistics in Lesotho worsened dramatically in the recent era of reduced support to LCs. This suggests that in order to ensure access to HIV care in an under-resourced setting like Lesotho, a recognized and well-supported counsellor cadre is essential. The continued presence of LCs requires improved prioritization, with national and international support

Estimated Adjusted Odds Ratio and 95% Confidence Intervals for ARV exposures and non ARV-related parameters.

<p>Estimated Adjusted Odds Ratio and 95% Confidence Intervals for ARV exposures and non ARV-related parameters.</p

Mother and child characteristics.

<p>Mother and child characteristics.</p

Rate of positive PCR by time period of DBS collection and by children's age group.

<p>Rate of positive PCR by time period of DBS collection and by children's age group.</p

Rate of positive PCR by “who received ARV drugs”, mothers' ARV regimen, mothers' age at the time of delivery, HIV status disclosure, and by children's age group.

<p>Rate of positive PCR by “who received ARV drugs”, mothers' ARV regimen, mothers' age at the time of delivery, HIV status disclosure, and by children's age group.</p

Rate of positive PCR by feeding mode, place and type of delivery, and by children's age group.

*<p>This means the child was still breastfeeding at the time of dried blood spot (DBS) collection for PCR.</p>**<p>This means the child was breastfed but stopped by the time of DBS collection. The timing when breastfeeding was stopped was not specified.</p

Quest Volume 3 Number 2

Contents: Treasury of fishes - What it takes to set up a fish collection facility and make it accessible to all: Building the new SAIAB Collection Facility - Client, architect, and engineers construct a store for the nation's fishes: Biological barcoding - Check the DNA to discover what fish you're handling: Desktop access to biodiversity Data online and the SAIAB Information Portal: Museum fish collections in South Africa - some highlights - How and where it all began: Human origins and the African connection - A skull newly dated show we did come out of Africa!: Pluto - when is a planet a planet? - Why Pluto lost its status: Looking after wasps and bees Farmers and pollinators need each other: Dangerous times for baby fishes - Survival is tough for larvae in the wild: Fact file -The National Fish Collection - New facts about larvae: Science news - Norway's 'doomsday' seed bank; Mafia boss caught by DNA - The Great Comet of 2007 - Things are hotting up - The problem with air travel: Viewpoint Africa's natural history collections - riches or fool's gold?: The S&T tourist Learn green living in Joubert Park - Green living in downtown Jo'burg: Books The Meaning of the 21st Century • and other title: Letters to QUEST Suggestions from young and older: Your questions answered - Why such floods in Mozambique?:The Department of Science and Innovation: Academy of Science of South Afric