From Door to Door: Providing Home-based HIV Testing and Care in Rural Lesotho
Photographer: Christian Heuss
Antiretroviral therapy suppresses HIV replication. If a person living with HIV takes the therapy on a daily basis and manages to suppress HIV replication, he or she is unlikely to transmit the virus. Universal test-and-treat has thus become a corner stone of global efforts to end the AIDS epidemic.
Lesotho is a small landlocked country in Southern Africa. Its population is globally among the most hit by the HIV epidemic. Particularly for the rural population access to HIV testing and care is a major challenge due to long distances to clinics. In 2016 and 2017 our consortium, consisting of the Swiss Tropical and Public Health Institute, SolidarMed, the Ministry of Health of Lesotho and the Molecular Virology Group of the University of Basel, conducted a research project aiming at improving access to HIV testing and care in Lesotho.
SolidarMed teams composed of HIV testers and a nurse left the clinic early in the morning and drove up to five hours on bumpy roads. Once arrived in the village, the village chief was met for approval to visit all households in his village. Thereafter, the SolidarMed testers started walking from household to household, knocking at each door to offer HIV testing and care services. Once the head of household allowed the team to enter, every household member was offered an HIV test. The test needs a finger-prick. The waiting time for the result is 15 minutes. Some household members decided to test as a whole family or in couple. Others preferred to be tested alone in a confidential place. As part of our randomized clinical trial, the nurse conducted baseline blood tests on the spot to those tested HIV positive. She then offered these patients to start with life-saving antiretroviral therapy the same day with the indication to seek further care at their nearest clinic within one month after treatment initiation. The success of this approach was assessed six and twelve months after tested positive. For this, our teams analysed blood samples in the district laboratory to see if there was still replicating HIV in the blood or if HIV replication was successfully suppressed through therapy.
The r4d project provided HIV testing to more than 10’000 people in over 60 villages. We found that offering same-day initiation of antiretroviral therapy improves treatment outcomes. We published the results widely. Informed global guidelines took up the recommendation of same-day initiation of antiretroviral therapy. Since then, most settings in Sub-Saharan Africa adopted the practice of offering rapid start of antiretroviral therapy to persons who test HIV positive.
Swiss Tropical and Public Health Institute, Basel, Switzerland
This photo gallery was submitted in the r4d call for photo galleries in June 2019 and selected for publication by an international jury. This contribution emerges from the r4d project “Improving the HIV care cascade in Lesotho: Towards 90-90-90 – A research collaboration with the Ministry of Health“, financed by the r4d programme (http://www.r4d.ch).