Journal articles: 'Maseru (Lesotho) – Medical care'

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Jessani, Abbas, Mir Faeq Ali Quadri, Pulane Lefoka, Abdul El-Rabbany, Kirsten Hooper, Hyun Ja Lim, Eketsang Ndobe, Mario Brondani, and Denise M. Laronde. "Oral Health Status and Patterns of Dental Service Utilization of Adolescents in Lesotho, Southern Africa." Children 8, no. 2 (February 7, 2021): 120. http://dx.doi.org/10.3390/children8020120.

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This study aimed to characterize the best predictors for unmet dental treatment needs and patterns of dental service utilization by adolescents in the Kingdom of Lesotho, Southern Africa. A self-reported 40-item oral health survey was administered, and clinical oral examinations were conducted in public schools in Maseru from August 10 to August 25, 2016. Associations between psychosocial factors with oral health status and dental service utilization were evaluated using simple, bivariate, and multivariate regressions. Five hundred and twenty-six survey responses and examinations were gathered. The mean age of student participants was 16.4 years of age, with a range between 12 and 19 years of age. More than two thirds (68%; n = 355) of participants were female. The majority reported their quality of life (84%) and general health to be good/excellent (81%). While 95% reported that oral health was very important, only 11% reported their personal dental health as excellent. Three percent reported having a regular family dentist, with the majority (85%) receiving dental care in a hospital or medical clinic setting; only 14% had seen a dental professional within the previous two years. The majority of participants did not have dental insurance (78%). Clinical examination revealed tooth decay on 30% of mandibular and maxillary molars; 65% had some form of gingivitis. In multivariate analysis, not having dental education and access to a regular dentist were the strongest predictors of not visiting a dentist within the last year. Our results suggest that access to oral health care is limited in Lesotho. Further patient oral health education and regular dental care may make an impact on this population.

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Logie, Carmen H., Lisa V. Dias, Jesse Jenkinson, Peter A. Newman, Rachel K. MacKenzie, Tampose Mothopeng, Veli Madau, Amelia Ranotsi, Winnie Nhlengethwa, and Stefan D. Baral. "Exploring the Potential of Participatory Theatre to Reduce Stigma and Promote Health Equity for Lesbian, Gay, Bisexual, and Transgender (LGBT) People in Swaziland and Lesotho." Health Education & Behavior 46, no. 1 (March 28, 2018): 146–56. http://dx.doi.org/10.1177/1090198118760682.

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Stigma and discrimination affecting lesbian, gay, bisexual, and transgender (LGBT) people compromise health and human rights and exacerbate the HIV epidemic. Scant research has explored effective LGBT stigma reduction strategies in low- and middle-income countries. We developed and pilot-tested a participatory theatre intervention (PTI) to reduce LGBT stigma in Swaziland and Lesotho, countries with the world’s highest HIV prevalence. We collected preliminary data from in-depth interviews with LGBT people in Lesotho and Swaziland to enhance understanding of LGBT stigma. Local LGBT and theatre groups worked with these data to create a 2-hour PTI composed of three skits on LGBT stigma in health care, family, and community settings in Swaziland (Manzini) and Lesotho (Maseru, Mapoteng). Participants ( n = 106; nursing students, health care providers, educators, community members) completed 12 focus groups following the PTI. We conducted thematic analysis to understand reactions to the PTI. Focus groups revealed the PTI increased understanding of LGBT persons and issues, increased empathy, and fostered self-reflection of personal biases. Increased understanding included enhanced awareness of the negative impacts of LGBT stigma, and of LGBT people’s lived experiences and issues. Participants discussed changes in attitude and perspective through self-reflection and learning. The format of the theatre performance was described as conducive to learning and preferred over more conventional educational methods. Findings indicate changed attitudes and awareness toward LGBT persons and issues following a PTI in Swaziland and Lesotho. Stigma reduction interventions may help mitigate barriers to HIV prevention, treatment, and care in these settings with a high burden of HIV.

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Mabaleha, Mohale B., Pieter C. Zietsman, Anke Wilhelm, and Susan L. Bonnet. "Ethnobotanical Survey of Medicinal Plants Used to Treat Mental Illnesses in the Berea, Leribe, and Maseru Districts of Lesotho." Natural Product Communications 14, no. 7 (July 2019): 1934578X1986421. http://dx.doi.org/10.1177/1934578x19864215.

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Mental illnesses (MIs) such as anxiety, epilepsy, major depression, schizophrenia, sleep disorder, and pain influence the quality of life severely. According to the World Health Organization Atlas for Mental Health (2014), the formal health sector in Lesotho has only 13.7 mental health workers per 100 000 of the population, which breaks down to 0.1 psychiatrist and other medical doctors, 0.3 psychologists, 4.7 nurses, and 5.2 social workers. Traditional health practitioners (THPs) have always played a significant role in the prevention and treatment of MIs, via utilization of Lesotho’s vast diversity of plants. This investigation aims to determine which medicinal plants are used for the treatment of MIs in the Berea, Leribe, and Maseru districts of Lesotho. A combination of unstructured and semistructured one-on-one interviews were conducted with 27 THPs. They were interviewed about the status of MIs in Lesotho, diagnostic methods, medicinal plants used, and preparation and administration of the herbal remedies in the treatment of MIs. A total of 43 different plant species (indigenous and exotic) were indicated by the THPs as commonly used to treat neurological disorders. With the exception of one unidentified plant, the plants represented 26 families and 42 genera. The most common families are the Asteraceae (9 species), Fabaceae (5 species), and Rosaceae (3 species). The most cited plant species were Morella serrata (Myricaceae) (26%), followed by Xysmalobium undulatum (Asclepiadaceae) (22%), and Afroaster hispidus (Asteraceae) (15%). This survey provides, for the first time, a database of Lesotho’s medicinal plants that are used to treat MIs.

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Mugomeri, Eltony, Palesa Khama, Polo C. Seshea, Bisrat Bekele, Selatela Mojai, Charles Maibvise, and Champion N. Nyoni. "The occurrence and quality of care of non-communicable diseases in people living with HIV in Maseru, Lesotho: a mixed-methods study." HIV & AIDS Review 3 (2017): 155–62. http://dx.doi.org/10.5114/hivar.2017.67788.

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Madiba, Sphiwe, and Mamorapeli Putsoane. "Testing Positive and Disclosing in Pregnancy: A Phenomenological Study of the Experiences of Adolescents and Young Women in Maseru, Lesotho." AIDS Research and Treatment 2020 (February 12, 2020): 1–8. http://dx.doi.org/10.1155/2020/6126210.

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The routine antenatal screening through the prevention of mother to child transmission of HIV (PMTCT) services results in pregnancy being often the point at which an HIV diagnosis is made. Disclosure to partners presents particular complexities during pregnancy. However, research on the pattern and experiences of disclosure in pregnancy is limited in Lesotho, despite the high prevalence of HIV among pregnant women. The aim of this study was to explore and describe the disclosure experiences of adolescent girls and young women (AGYW) after receiving a positive HIV test result during pregnancy. Methods. Descriptive phenomenology using semistructured in-depth interview was used to collect data from AGYM sampled purposively from PMTCT sites located in urban areas of Maseru, Lesotho. Data analysis was inductive and followed the thematic approach. Findings. There were 15 AGYW involved in this study with the mean age of 20 years. Fourteen reported being pregnant with their first child and perceived HIV testing in antenatal care as compulsory. Ten AGYM disclosed their HIV status in the immediate posttesting period to protect their partners from HIV infection. The narratives revealed that the AGYM hoped that after disclosing, the partner would be tested for HIV. Furthermore, the AGYM disclosed because they wanted freedom to take their medication. Their experience of disclosure was relief, as they did not have to hide their HIV status. The AGYM reported being supported to adhere to medication and clinic attendance by their partners who also provided emotional support to them to deal with being HIV positive and pregnant. Conclusion. The AGYM recounted an overall positive experience of disclosure to their partners who agreed to test for HIV and adopted safe sex practices. This has positive implications for the PMTCT programme and the involvement of men in reproductive health. Therefore, there is need to integrate disclosure and partner testing interventions in the cascade of services in PMTCT programmes.

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Moteetee, A., and B. E. Van Wyk. "The medical ethnobotany of Lesotho: a review." Bothalia 41, no. 1 (December 13, 2011): 209–28. http://dx.doi.org/10.4102/abc.v41i1.52.

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Traditional healing in Lesotho is reviewed, focusing on four aspects: 1, cultural practices; 2, traditional health care practitioners; 3, dosage forms; 4, the materia medica. Cultural practices are strongly associated with the belief that intangible forces are responsible for human happiness and misery. A total of 303 plant species are used medicinally (including 25 alien species), representing eight pteridophyte and 75 angiosperm families, of which the most important are Asteraceae, Fabaceae, Hyacinthaceae, Apocynaceae, Scrophulariaceae, Lamiaceae and Poaceae. Dicoma anomala (used mainly for digestive ailments) and Artemisia afra (used mainly for respiratory ailments) appear to be the best known and most widely used medicinal plants amongst a total of 37 species that have been cited four or more times in the literature. About 50 species are variously employed for magic and sorcery. There are no new species records but 36 new uses are reported. Our conclusion is that the medicinal plants of Lesotho are relatively well recorded and that this review will allow detailed comparisons with other African healing cultures.

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Furin, Jennifer, Mike Shutts, and Salmaan Keshavjee. "Aviation and the Delivery of Medical Care in Remote Regions: The Lesotho HIV Experience." Aviation, Space, and Environmental Medicine 79, no. 2 (February 1, 2008): 136–38. http://dx.doi.org/10.3357/asem.2134.2008.

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Thabane, Motlatsi. "Public mental health care in colonial Lesotho: themes emerging from archival material, 1918–35." History of Psychiatry 32, no. 2 (February 18, 2021): 146–61. http://dx.doi.org/10.1177/0957154x21989176.

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This paper identifies some of the themes that emerge from a study of official archival records from 1918 to 1934 on the subject of mental health in colonial Lesotho. They include: difficulties experienced by colonial medical doctors in diagnosing and treating mental illnesses, given the state of medical knowledge in the nineteenth and early twentieth centuries; impact of shortage of financial and other resources on the establishment and operation of medical services, especially mental health care; convergence of social order, financial and medical concerns as influences on colonial approaches to mental health care; and the question of whether Basotho colonial society saw institutionalization of their relatives as ‘hospitalization’ or ‘imprisonment’. Two case studies are presented as preliminary explorations of some of the themes.

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Gill, Michelle M., Rhoderick Machekano, Anthony Isavwa, Allan Ahimsibwe, Oyebola Oyebanji, Oluwasanmi L. Akintade, and Appolinaire Tiam. "The Association Between HIV Status and Antenatal Care Attendance Among Pregnant Women in Rural Hospitals in Lesotho." JAIDS Journal of Acquired Immune Deficiency Syndromes 68, no. 3 (March 2015): e33-e38. http://dx.doi.org/10.1097/qai.0000000000000481.

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Macneal, Kenneth, Vincent Tukei, Emma Sacks, Mafusi Mokone, Lehlohonolo Makoti, Esther Tumbare, Tebello Samosamo, Tsietso Mots'oane, Jean-Francois Lemaire, and Jennifer Cohn. "Use of Point-of-Care Nucleic Acid Tests Beyond Early Infant Diagnosis of HIV: A Retrospective Case Review in Lesotho." JAIDS Journal of Acquired Immune Deficiency Syndromes 84, no. 1 (July 1, 2020): S78—S83. http://dx.doi.org/10.1097/qai.0000000000002381.

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Hollifield, Michael, Wayne Katon, and Neo Morojele. "Anxiety and Depression in an Outpatient Clinic in Lesotho, Africa." International Journal of Psychiatry in Medicine 24, no. 2 (June 1994): 179–88. http://dx.doi.org/10.2190/x3xa-lpjb-c3kw-amly.

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Objective: Past studies of psychiatric disorders in primary care in developing countries have utilized measures to determine conspicuous psychiatric morbidity (CPM) rather than diagnoses. Our goal was to determine the prevalence of DSM-III major depression (DEP), panic disorder (PD), and generalized anxiety disorder (GAD) in an outpatient clinic in Lesotho, Africa. Methods: As part of a larger community study, we utilized a translated version of the N.I.M.H. Diagnostic Interview Schedule to determine the prevalence of DEP, PD, and GAD in 126 randomly selected outpatients (response rate = 77%) attending a general hospital clinic. We compared these data to information about demographics and symptom presentation. Results: We found twenty-nine (23%) patients with DEP, thirty (24%) with PD, and thirty-six (29%) with GAD. Forty-six (36%) had either DEP or PD, with thirteen (45%) having concurrent illness. Patients with DEP and/or PD presented with a significantly higher number of physical symptoms, and a higher percentage of symptoms that were pain or autonomic nervous system related than patients with no disorder ever. Conclusion: There is significant psychiatric morbidity of common diagnoses in outpatient clinic in Lesotho, and patients present primarily with somatic symptoms, as in developed countries. There is a need for better elucidation of cross-cultural phenomenology, medical co-morbidity as a con-founder, and help-seeking and treatment patterns in the developing world.

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Amstutz, Alain, Jennifer Anne Brown, Isaac Ringera, Josephine Muhairwe, Thabo Ishmael Lejone, Thomas Klimkait, Tracy Renée Glass, and Niklaus Daniel Labhardt. "Engagement in Care, Viral Suppression, Drug Resistance, and Reasons for Nonengagement After Home-Based Same-Day Antiretroviral Therapy Initiation in Lesotho: A Two-Year Follow-up of the CASCADE Trial." Clinical Infectious Diseases 71, no. 10 (November 29, 2019): 2608–14. http://dx.doi.org/10.1093/cid/ciz1126.

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Abstract Background The CASCADE trial showed that compared with usual care (UC), offering same-day (SD) antiretroviral therapy (ART) during home-based human immunodeficiency virus testing improved engagement in care and viral suppression 12 months after diagnosis. However, questions remain regarding long-term outcomes and the risk of propagating drug resistance. Methods After completion of the primary endpoint at 12 months, participants not in care in both arms were traced and encouraged to access care. At 24 months, the following outcomes were assessed in both arms: engagement in care, viral suppression, and reasons for nonengagement. Furthermore, we explored the acquisition of drug resistance mutations (DRMs) among SD arm nonlinkers. Results At 24 months, 64% (88/137) in the SD arm vs 59% (81/137) in the UC arm were in care (absolute difference [AD], 5%; 95% confidence interval [CI], −6 to16; P = .38) and 57% (78/137) vs 54% (74/137) had documented viral suppression (AD, 3%; 95% CI, −9 to 15; P = .28). Among 36 participants alive and not in care at 24 months with ascertained status, the majority rejected contact with the health system or were unwilling to take ART. Among 8 interviewed SD arm nonlinkers, 6 had not initiated ART upon enrollment, and no acquired DRMs were detected. Two had taken the initial 30-day ART supply and acquired DRMs. Conclusions SD ART resulted in higher rates of engagement in care and viral suppression at 12 months but not at 24 months. Leveling off between both arms was driven by linkage beyond 12 months in the UC arm. We did not observe compensatory long-term disengagement in the SD arm. These long-term results endorse SD ART initiation policies. Clinical Trials Registration NCT02692027.

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Low, Andrea, Chloe Teasdale, Kristin Brown, Danielle T. Barradas, Owen Mugurungi, Karam Sachathep, Harriet Nuwagaba-Biribonwoha, et al. "Human Immunodeficiency Virus Infection in Adolescents and Mode of Transmission in Southern Africa: A Multinational Analysis of Population-Based Survey Data." Clinical Infectious Diseases 73, no. 4 (April 29, 2021): 594–604. http://dx.doi.org/10.1093/cid/ciab031.

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Abstract Background Adolescents aged 10–19 years living with human immunodeficiency virus (HIV) (ALHIV), both perinatally infected adolescents (APHIV) and behaviorally infected adolescents (ABHIV), are a growing population with distinct care needs. We characterized the epidemiology of HIV in adolescents included in Population-based HIV Impact Assessments (2015–2017) in Zimbabwe, Malawi, Zambia, Eswatini, and Lesotho. Methods Adolescents were tested for HIV using national rapid testing algorithms. Viral load (VL) suppression (VLS) was defined as VL <1000 copies/mL, and undetectable VL (UVL) as VL <50 copies/mL. Recent infection (within 6 months) was measured using a limiting antigen avidity assay, excluding adolescents with VLS or with detectable antiretrovirals (ARVs) in blood. To determine the most likely mode of infection, we used a risk algorithm incorporating recency, maternal HIV and vital status, history of sexual activity, and age at diagnosis. Results HIV prevalence ranged from 1.6% in Zambia to 4.8% in Eswatini. Of 707 ALHIV, 60.9% (95% confidence interval, 55.3%–66.6%) had HIV previously diagnosed, and 47.1% (41.9%–52.3%) had VLS. Our algorithm estimated that 72.6% of ALHIV (485 of 707) were APHIV, with HIV diagnosed previously in 69.5% of APHIV and 39.4% of ABHIV, and with 65.3% of APHIV and 33.5% of ABHIV receiving ARV treatment. Only 67.2% of APHIV and 60.5% of ABHIV receiving ARVs had UVL. Conclusions These findings suggest that two-thirds of ALHIV were perinatally infected, with many unaware of their status. The low prevalence of VLS and UVL in those receiving treatment raises concerns around treatment effectiveness. Expansion of opportunities for HIV diagnoses and the optimization of treatment are imperative.

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Taniguchi, Cullen M., Anuja Jhingran, Shane Richard Stecklein, Adam Melancon, Laurence Court, Jared Ohrt, Michael Elliot Kupferman, and Susan Citonje Msadabwe. "A pilot course of intensive training in radiation biology and physics for oncologists in sub-Saharan Africa." Journal of Global Oncology 5, suppl (October 7, 2019): 24. http://dx.doi.org/10.1200/jgo.2019.5.suppl.24.

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24 Background: Radiation therapy is an essential component of cancer care used for palliative and curative treatments access a wide spectrum of disease, but many low- and middle-income countries do not have equitable access to this technology or training in the radiation sciences. Towards this end, we launched a pilot program to teach the principles of radiation biology and radiation physics that are a basic component of training and credentialing of radiation oncologists in the United States. Methods: We designed a 5 days curriculum for radiation biology and radiation physics that were similar in depth and scope to the courses taught to residents at MD Anderson. Medical oncologists, medical students and radiation therapists from Zambia, Tanzania, Lesotho, as well as Papua New Guinea attended the course. All have experience with direct patient care in oncology, but no formal training in radiation biology or physics. A pre-test of 50 multiple choice questions for radiation biology and 40 multiple choice questions for radiation physics was administered to all students prior any instruction on the first day of the course, and the same test was given on the last day. Each question stem had 4 possible choices. Instructions consisted of lectures and problems sets with an emphasis on practical applications of radiation biology and physics. Results: The students (N = 22) scored a mean of 30.6±13.5% correct on the radiation biology pre-test and this improved to a mean of 57.7±13.1% after 5 days of instruction (P < 0.0001). Similarly, the students who took the medical physics exam (N = 22) had a mean 33.0±8.8% correct at baseline, which improved to 61.7±18.1% on the post-test (P < 0.0001). Conclusions: Despite almost no prior exposure to these complicated concepts, students exhibited nearly a two-fold increase in scores on a standardized test of radiation biology and medical physics. This pilot study demonstrates a proof-of-concept that this material can be taught effectively in a short time frame. Further refinement of this material may allow similar in-person intensive courses, teleconferencing, or archived videos to improve the education of radiation therapists in low- and middle-income countries.

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Murye, AF, and SM Mohale. "Health care waste management in the Maseru district of Lesotho." UNISWA Research Journal of Agriculture, Science and Technology 8, no. 2 (August 25, 2006). http://dx.doi.org/10.4314/uniswa-rjast.v8i2.4752.

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Ntlale, Matsola E., and Sinegugu E. Duma. "The costs and benefits of nurse migration on families: A Lesotho experience." Curationis 34, no. 1 (September 27, 2011). http://dx.doi.org/10.4102/curationis.v34i1.13.

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The present day migration of nurses from developing countries, to more developed countries,depletes these countries of this vital human resource, which is necessary to provide optimum quality nursing care to their populations. If nurse migration persists, the health systems of these countries face collapse.It is important that a nurse understands the costs and benefits of migration to their families, whom they leave behind. This is not only to curb the problems that may occur, but to help the migrant nurses to realise how migration affects their families, especially their children and spouses, before they decide to leave their home countries to work in foreign lands.The purpose of this study, which was exploratory, descriptive and qualitative, was to investigate and describe the experiences of family members, of migrant nurses, from the Maseru district of Lesotho, about the costs and benefits of nurse migration. The objectives were to explore and describe the disadvantageous costs and the benefits gained by the families of migrant nurses. These were explored through the research question ’What are the experiences of family members of migrating nurses with regard to the costs and benefits of nurse migration?’The target population of the study was families of migrant nurses from Lesotho. Using purposive sampling the families of two migrant nurses, who were colleagues of the researcher, were identified and approached to participate in the study. Snowball sampling was next utilised to recruit the remainder of the participants. In total, six families were identified and included in the study.The semi-structured interviews and field notes were the two data collection methods that were implemented. The Giorgi’s (1970) steps for data analysis, as outlined in (Burns & Grove 2001:610), were followed and seven themes were discovered as findings. The themes that relate to the costs of nurse migration are: emotional instability, weaker family connections and increased responsibility. The themes that relate to the benefits of nurse migration for their families are: better household income, improved quality of life, essential skills development and travelling opportunities.The use of communication technology is recommended to increase contact across borders in order to reduce the emotional costs of nurse migration on the families of migrant nurses. The article provides a balanced view of the costs and benefits of nurse migration on their families.

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Bryden, Benjamin, Mariel Bryden, Jonathan Steer-Massaro, and Sebaka Malope. "Family Medicine Training in Lesotho: A Strategy of Decentralized Training for Rural Physician Workforce Development." Frontiers in Medicine 7 (January 14, 2021). http://dx.doi.org/10.3389/fmed.2020.582130.

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Family medicine is a relatively new but rapidly expanding medical discipline in Sub-Saharan Africa. Specialization in family medicine is an effective means for building and retaining a highly skilled rural physician workforce in low- and middle-income countries. The Lesotho Boston Health Alliance Family Medicine Specialty Training Program is the first and only postgraduate family medicine program and the only accredited postgraduate training program in the Kingdom of Lesotho. Lesotho has unique challenges as a small mountainous enclave of South Africa with one of the lowest physician-to-patient ratios in the world. Most health professionals are based in the capital city, and the kingdom faces challenging health problems such as high human immunodeficiency virus prevalence, high maternal mortality, and malnutrition, as well as increasing burdens of non-communicable diseases such as hypertension, diabetes, and obesity. In response to these health crises and the severe shortage of health professionals, Lesotho Boston Health Alliance partnered with the Lesotho Ministry of Health in 2008 to introduce family medicine as a new specialty in order to recruit home and retain Basotho doctors. Family medicine training in Lesotho uses a unique decentralized, non-university-based model with trainees posted at rural district hospitals throughout the country. While family medicine in Lesotho is still in the early stages of development, this model of decentralized training demonstrates an effective strategy to develop the rural health workforce in Lesotho, has the potential to change the physician workforce and health care system of Lesotho, and can be a model for physician training in similar environments.

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Leyenaar, JoAnna K., Paul M. Novosad, Katheleen T. Ferrer, Lineo K. Thahane, Edith Q. Mohapi, Gordon E. Schutze, and Mark W. Kline. "Early Clinical Outcomes in Children Enrolled in Human Immunodeficiency Virus Infection Care and Treatment in Lesotho." Pediatric Infectious Disease Journal, December 2009, 1. http://dx.doi.org/10.1097/inf.0b013e3181bf8ecb.

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Mataka, Anafi, Esther A. J. Tumbare, Tsietso Motsoane, David Holtzman, Monkoe Leqheka, Kolisang Phatsoane, Emma Sacks, Anthony Isavwa, and Appolinaire Tiam. "Strategic site selection for placement of HIV early infant diagnosis point-of-care technology within a national diagnostic network in Lesotho." African Journal of Laboratory Medicine 10, no. 1 (August 24, 2021). http://dx.doi.org/10.4102/ajlm.v10i1.1156.

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Ballif, Marie, Benedikt Christ, Nanina Anderegg, Frédérique Chammartin, Josephine Muhairwe, Laura Jefferys, Jonas Hector, et al. "Tracing People Living With Human Immunodeficiency Virus Who Are Lost to Follow-up at Antiretroviral Therapy Programs in Southern Africa: A Sampling-Based Cohort Study in 6 Countries." Clinical Infectious Diseases, May 16, 2021. http://dx.doi.org/10.1093/cid/ciab428.

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Abstract Background Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with human immunodeficiency virus (PLHIV) who were lost to follow-up (LTFU) during 2014–2017 at ART programs in Southern Africa. Methods We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in 8 ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, 2017–2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting. Results Among 3256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2294 PLHIV (71%) by phone calls, home visits, or both: 768 (34% of 2294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1323 (41% of 3256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, and higher in PLHIV who had been on ART <1 year or LTFU ≥1 year and those living farther from the clinic or in rural areas. Results were heterogeneous across sites. Conclusions Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.

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Mapesi, Herry, Ravi Gupta, Herieth Ismael Wilson, Blaise Lukau, Alain Amstutz, Aza Lyimo, Josephine Muhairwe, et al. "The coArtHA trial—identifying the most effective treatment strategies to control arterial hypertension in sub-Saharan Africa: study protocol for a randomized controlled trial." Trials 22, no. 1 (January 21, 2021). http://dx.doi.org/10.1186/s13063-021-05023-z.

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Abstract Background Arterial hypertension is the most prevalent risk factor for cardiovascular disease in sub-Saharan Africa. Only a few and mostly small randomized trials have studied antihypertensive treatments in people of African descent living in sub-Saharan Africa. Methods In this open-label, three-arm, parallel randomized controlled trial conducted at two rural hospitals in Lesotho and Tanzania, we compare the efficacy and cost-effectiveness of three antihypertensive treatment strategies among participants aged ≥ 18 years. The study includes patients with untreated uncomplicated arterial hypertension diagnosed by a standardized office blood pressure ≥ 140/90 mmHg. The trial encompasses a superiority comparison between a triple low-dose antihypertensive drug combination versus the current standard of care (monotherapy followed by dual treatment), as well as a non-inferiority comparison for a dual drug combination versus standard of care with optional dose titration after 4 and 8 weeks for participants not reaching the target blood pressure. The sample size is 1268 participants with parallel allocation and a randomization ratio of 2:1:2 for the dual, triple and control arms, respectively. The primary endpoint is the proportion of participants reaching a target blood pressure at 12 weeks of ≤ 130/80 mmHg and ≤ 140/90 mmHg among those aged < 65 years and ≥ 65 years, respectively. Clinical manifestations of end-organ damage and cost-effectiveness at 6 months are secondary endpoints. Discussion This trial will help to identify the most effective and cost-effective treatment strategies for uncomplicated arterial hypertension among people of African descent living in rural sub-Saharan Africa and inform future clinical guidelines on antihypertensive management in the region. Trial registration Clinicaltrials.govNCT04129840. Registered on 17 October 2019 (https://www.clinicaltrials.gov/).

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Mugomeri, Eltony, Dedré Olivier, and Wilhelmiena M. J. Van den Heever. "Tracking the rate of initiation and retention on isoniazid preventive therapy in a high human immunodeficiency virus and tuberculosis burden setting of Lesotho." Southern African Journal of Infectious Diseases 34, no. 1 (November 25, 2019). http://dx.doi.org/10.4102/sajid.v34i1.10.

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Background: Tuberculosis (TB) remains a public health problem, particularly in people living with human immunodeficiency virus (PLHIV). Yet, efforts to reduce TB incidence using isoniazid preventive therapy (IPT) have been curtailed by poor uptake of this intervention. This study reviewed the rate of IPT initiation in the sub-Saharan country of Lesotho, which has one of the highest TB incidences in the world.Methods: Time to IPT initiation in randomly sampled medical records of PLHIV was analysed using Cox’s proportional hazards regression. Differences in the periods of enrolment into Human immunodeficiency virus (HIV) care were controlled for by considering the year IPT was launched (2011) as the base year and stratifying the medical records into the 2004–2010 cohort (before the launch of IPT) and the 2011–2016 cohort (after the launch).Results: Out of 2955 patients included in the final analysis, 68.8% had received IPT by the study exit time. However, the overall rate of IPT initiation was 20.6 per 100 person-years, with 135 (6.6%) treatment interruptions. Compared to the 2004–2010 cohort, the 2011–2016 had a significantly (p 0.05) higher rate of initiation (15.8 vs. 27.0 per 100 person-years, respectively). Age group, district category and duration of antiretroviral therapy emerged as the most significant predictors of IPT initiation, while district category and gender significantly predicted IPT therapy interruption.Conclusion: These findings indicate a high uptake of IPT with a slow rate of implementation. Significant factors associated with disparities in the initiation and interruption of IPT therapy in this study are important for policy review.

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Journal articles on the topic 'Maseru (Lesotho) – Medical care'

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