PEPFAR and the Know Your Status Campaign: Sustaining effective partnerships in Lesotho

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PEPFAR and the Know Your Status
CampaignSustaining effective partnerships in
Lesotho

Ms Nthati Lebona KYS Campaign Coordinator
Ms Daniella Fanarof PSI Lesotho Director
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Where is Lesotho
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HIV Testing Sites
Hospitals2 Clinics11
Hospitals2 Clinics11
Hospitals2 Clinics12
Hospitals2 Clinics12
Hospitals1 Clinics9
Hospitals2 Clinics9
Hospitals2 Clinics9
Hospitals5 Clinics26
Hospitals2 Clinics6
Hospitals5 Clinics26
Hospitals2 Clinics6
Hospitals1 Clinics17
Hospitals1 Clinics17
Hospitals2 Clinics6
Hospitals2 Clinics6
Hospitals1 Clinics4
Hospitals1 Clinics12
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HIV and AIDS in Lesotho

• Lesotho Population 1,880,661 (2006 National
  Census)
  
• National prevalence rate 23.2 (MoHSW/UNAIDs/NAC
  2005)
  
• Estimated number of 266,201(23.2 of the
  population) adults children living with
  HIV/AIDs of which 15,600 are children btn 0 14
  yrs of age
• 229,092 or 12 of Basotho know their status(
  MoHSW 2007)
  
• In 2000, His Majesty the King Letsie III declared
  HIV/AIDS a national disaster
  

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The road to the KYS campaign

• In 2004 His Excellence the Right Hon. Prime
  Minister Pakalitha B. Mosisili launched the
  universal access to testing program
  
• In 2005, On World AIDS Day, the Government of
  Lesotho launched the Know Your Status campaign
  

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The KYS Campaign

• Goal To contribute to halting and reversing the
  spread of HIV in Lesotho, in the context of
  comprehensive HIV and AIDS prevention, treatment,
  care and support
• KYS to provide high quality access to CT for all
  Basotho through a variety of models (mobile, door
  to door, facility based)
  

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Community based counsellor during Mafeteng
testing week
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KYS Objectives

• All people above the age of 12 years living in
  Lesotho will know their HIV status by the end of
  2007, so that those who are negative remain
  negative and those who are positive live longer,
  productive lives.
• KYS National Target 70 of the National
  population (1.3Million) offered HTC by end of
  Dec 2007
  
• Estimated planned KYS budget for 2 years M75,
  593, 250 (11, 116, 654.41), Government of
  Lesotho, and UN Partners contributed a portion of
  this in technical support.

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The Lesotho KYS Concept
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Achievements by end of Dec 2007

• HTC policy developed and disseminated
• Demand creation at community level
• By end of Dec 2007 362,103 people were offered
  HTC
  
• Acceptance rate for HIV testing92
• Communications strategic guideline developed
• Human Resource capacity strengthened
• ( 3,590 CBCGs trained, National District
  teams recruited)
  
• Five-fold increase in of people testing for HIV
  in the last 3.5 yrs (2.7 in yr 2004 to 19 in yr
  2007)
  

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HTC service utilization in Lesotho June 04 to
Dec 2007
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August 2007 KYS supervisors and Community Based
Care Givers at Mafeteng testing week
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Community uptake vs facility uptake from Jan to
Dec 07
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Leribe and Mafeteng accelerated KYS Campaigns
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Support Supervision system

• SSS guideline developed for HTC and QA/C
• SOPs for HIV testing developed and distributed
• DHMT trained in SSS and participating in Support
  supervision
  
• Limited technical support supervision

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Quality Assurance/Control

• Quality Assurance officer providing technical
  support
  
• CBCGs (community based care Givers) trained in
  HIV prevention, treatment Care
  
• Use of Serial HIV rapid testing method
• Internal QA/C is in process of being set up
  Panels are being prepared
  
• Refresher training for CBCGs planned
• Professional HTC counselors providing support to
  CBCGs

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Monitoring and Evaluation

• ME framework developed and implemented
• Data management tools developed distributed
• ME technical working group formed
• Increase in of districts reporting timely
• End term review/ evaluation for KYS planned for
  Quarter 1 of 2008.

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Main Challenges/ Constraints

• Limited resources for planning, programming,
  implementation coordination
  
• Quality assurance/ control not yet fully
  operational
  
• Lack of adequate human resources to ensure
  quality of service delivery
  
• Lack of human resources and IEC materials for
  social mobilization
  
• Data management system (ME) is still weak

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New Start Counseling Testing

• The New Start CT network includes five fixed
  sites (3 located in urban areas, 1 in a
  peri-urban and 1 in a rural area), mobile CT and
  a workplace programme.
• Each site has an extensive mobile CT program-
  reaching underserved, vulnerable populations.
  
• Four of these sites are located on the grounds of
  government health facilities in their respective
  districts. The fifth site is located within the
  main taxi rank in the district.
• Total staff complement is 57.

The New Start brand was developed in
Zimbabwe and is now utilized to develop and
promote CT in 6 countries throughout
Southern Africa
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The Way ForwardPSI and Know Your Status( KYS)

• PSI to provide intensive assistance to the KYS
  campaign in 4 districts, selected in
  collaboration with MoH including
  
• New Start counsellors serve as mentors for KYS
  community counsellors.
  
• New Start counsellors ensure quality by
  conducting on-going supervision of KYS
  counsellors during door to door and mobile
  events.
• New Start lab technicians provide quality
  assurance in testing component.
  
• In all districts
• PSI assists in the development of KYS
  communications materials and co-brands certain
  communications materials to include KYS logo.
  
• New Start provides logistical support to KYS
  program, commodities and transport.
  
• KYS counsellors are attached to New Start sites
  as part of their practical training.
  

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Lessons Learned

• Need for long term planning( 3 5 yr)
  operational plan for HTC which will include
  revising the KYS implementation plan
  
• Need for effective fundraising and increased
  donor and government support
  
• Need for on-going supervision and mentorship of
  facility based HTC providers and CBCs
  
• Increased and decentralized post test services

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Lessons Learned (cont)

• Strengthen QA/C need for a Technical Assistance
• Implementation of ONE ME system, standardisation
  of Data management tools, Data analysis etc
  
• Scale up community mobilisation, awareness
  creation education
  
• Involvement strengthening the support groups
  especially for people living with HIV and AIDS in
  Community post test services
  

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Acknowledgements to all of the CT counsellors in
Lesotho and

• Honorable Minister Dr. M. Ramatlapeng-Minister of
  Health, Ministry of Health and Social Welfare
  
• Ms. Mahlapane Lekometsa- Acting Director
  HIV/AIDS/STI Directorate, Ministry of Health and
  Social Welfare
  
• PEPFAR
• IRISH AID
• Mankhala Lerotholi-New Start Lesotho Project
  Manager and the entire New Start Lesotho staff
  
• Dvora Joseph, HIV/AIDS Service Delivery Manager,
  PSI Washington
  

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KEA LEBOHATHANK YOU!