In 2006, in collaboration with Partners In Health, the FXB Center launched a project to provide HIV & TB care and treatment in the mountains of the southern African country of Lesotho . Simultaneously, the project staff will research factors associated with good clinical outcomes in patients receiving HIV & TB care in rural Africa , and how successful clinical programs can be scaled-up effectively in high HIV prevalence, resource poor settings in Africa .

Approximately one-quarter of Lesotho 's adult population is HIV-positive and life expectancy in the tiny mountain kingdom has plummeted to less than 35 years. In addition, the Basotho people are being ravaged by a second epidemic - Lesotho 's TB rate is the 4th highest in the world, and TB is both more infectious and more deadly in this tiny, immunocompromised nation.

In order to address this issue, the FXB Center, in collaboration with Partners In Health and Brigham and Women’s Hospital, began working with the Ministry of Health and Social Welfare, the Lesotho Flying Doctors Service, the Mission Aviation Fellowship, and the Clinton HIV/AIDS Initiative (CHAI) to build a program for improved testing and treatment for HIV & TB in the remote mountain regions of Lesotho. Significant funding for the clinical portions of the project is provided by the Irish Government.

The project – known as Bo-Mphato Litsebeletsong tsa Bophelo in the national language, Sesotho – began with a focus on bringing HIV and TB care and treatment to poor, rural communities that have largely been neglected by other AIDS programs and non-governmental organizations. In the case of Lesotho , that means remote villages high in the mountains that are often accessible only by single-engine propeller aircraft or on horseback. The first project site in the mountain village of Nohana is less than 70 miles from the nearest hospital in Mohale's Hoek. But the terrain is so rough and the road in such ill repair that it takes eight hours to reach the clinic by car.

Since June 2006, the project has been providing clinical support, training for nurses and village health workers, and medications for treatment of HIV/AIDS and tuberculosis. The project also offers outreach and treatment for prevention of mother-to-child transmission of HIV and conducts home visits and educational meetings in villages served by the mountain health centers. With assistance from the World Food Program, the project provides nutritional support for HIV and TB patients, malnourished children and others who show clinical signs of malnutrition. In 2007, PIH began working at additional mountain health centers in Bobete, Nkau, and Lebakeng.

The primary focus of the research will be on understanding factors associated with treatment success of patients with HIV living in rural regions of the African nation of Lesotho , and on the factors associated with treatment success among HIV and TB co-infected patients in Lesotho . The overall goal is to better understand ways to improve clinical outcomes among patients with such diseases, and to successfully scale-up therapy in similar resource poor settings. Once preliminary studies have been carried out, the goal is to design interventions to improve treatment that can be tested in larger-scale trials. The research work will take place in several phases over a period of years.

A small office in the capital of Maseru coordinates logistics, procurement and communications for what will become a network of ten community health centers by late 2008, serving a combined population of more than 300,000 people. Transport of people and supplies is provided through partnerships with the Lesotho Flying Doctors Service (supported by the Ministry of Health and Social Welfare) and Mission Aviation Fellowship.

The project’s achievements during the first 15 months in Lesotho are breathtaking, as are the mountains and other obstacles that had to be surmounted to get there. By October 2007, the list of accomplishments included:

• more than 7,300 people tested for HIV
• approximately 2,500 HIV and tuberculosis patients diagnosed, monitored and receiving care and treatment
• over 1,000 AIDS patients enrolled on antiretroviral therapy, including 61 children under the age of 14
• nearly 450 TB patients diagnosed, 82% co-infected with HIV
• four clinics, each staffed with a doctor in residence and frequent visits from other physicians, at clinics formerly staffed exclusively (and somewhat sporadically) by a nurse and nursing assistant
• improved clinic facilities at each site, including new waiting rooms constructed for patients who previously had to wait outdoors, often after traveling several hours on foot to reach the clinic
• over 400 village health workers have been trained in the management of HIV and AIDS and management of opportunistic infections
• 17 lay counselors from the surrounding areas have been trained in record documentation, patient adherence counseling and patient support. They have also been trained to measure vital signs and to record initial baseline patient information
• with the collaboration of CHAI, 14 new nurses have been hired and placed in the rural health centers
• 800 patients receive monthly food supplements for themselves and 4 family members
• 72 infants enrolled in a breast milk substation programs at Nohana, Bobete and Nkau

For more information, visit the website of Partners In Health.