December 2020

HIV Services for Factory Workers in Lesotho

Pop-up factory clinic, 2017

Lesotho is a tiny nation entirely surrounded by South Africa. With the second highest prevalence of HIV in the world, nearly one-quarter of Basotho are living with HIV at a prevalence rate of 25.6% amongst the adult population age between 15-49 (LePHIA 2017).

Poverty is also high, with half of people living in poverty at a rate of 49.7% while 24.1% living in extreme poverty (Bureau of Statistics 2017/18) and unemployment rate of 23.48% (BOS 2019). Lesotho’s textile and apparel industry provides over 80% of Lesotho’s manufacturing employment and is key to Lesotho’s sustainable economic development.

Workers in the textile industry form a sub-group in the country that is at increased risk of HIV, with a prevalence rate as high as 43% (ALAFA 2012 KAP study). Young women form a large population in these factories. Factory workers have proven persistently reluctant to leave work for a day to seek health services in the public sector as this will result in loss of income. In the absence of health services at the workplace, these workers too frequently do not seek treatment when ill, often dying as a result.1 Those on treatment tend to default.

Pop-up factory clinic, 2017

In response, the Ministry of Health has partnered with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to provide workplace clinics on the grounds of the factories.
Lesotho, like the rest of the world, faced the outbreak of COVID-19 earlier this year. In order to save jobs, the factories remained opened using 24-hour rotational shifts to reduce overcrowding and maintain social distancing. The workplace clinics also remained open to continue the fight against HIV while integrating screening and testing of COVID-19 among factories workers—with one big difference. Before COVID-19, all clients living with HIV were given monthly drugs refills. Now they are giving out a three- to six-month supply to eligible patients.

Multiple-month dispensing (MMD) is a strategy that has been rolled out in many countries, including Lesotho, in response to COVID-19. MMD means that people living with HIV only having to refill their antiretroviral (ARV) medicine every three or six months as opposed to every month. MMD has long been regarded the best solution to retain clients living with HIV in care, having been recommended by the World Health Organization for stable clients since 2016. While many countries, including Lesotho, were slow to adopt this practice, the onset of COVID-19 made this practice imperative.

Pop-up factory clinic, 2017

Mateboho Mokobocho, an EGPAF counsellor working at C&Y textile factory in Maseru, says that the 289 workers in this factory living with HIV have enthusiastically accepted MMD, saying it was long overdue.

“Only 31 patients have not been supplied [with MMD]—due to unsuppressed viral loads, limited supply of some regimens, and those whohave less than six months on antiretroviral treatment,” she explains.

Makobocho says that prior to implementation of MMD in this factory, HIV patients were not adhering well to their medication. For many patients, attending their clinical appointments to get their refills meant taking time away from work, sacrificing their hourly work targets. Factory productivity as a whole has seen an improvement as well, as workers need take only a third of the time off their jobs for clinic visits.

MMD has also benefited the clinic. Mokobocho says that the strategy decongests the clinic and reduces workload, providing them enough time to conduct more thorough clinical assessments and examinations for each patient, as well as enough time for cervical cancer screenings.

Makobocho mentioned that the MMD strategy included the halt of appointment notification via loudspeakers, which reduces concern surrounding involuntary disclosure. This strategy reduces long queues, attracting workers with unknown HIV statuses to come for HIV testing and TB screening.

Pop-up factory clinic, 2017

“We believe that adherence to care and treatment will improve drastically through MMD, and this will improve retention of our patients to care,” Mokobocho said.


1Common health challenges included unsafe abortions from unplanned pregnancies, high HIV prevalence, low utilization or absence of HIV prevention measures, poor retention to HIV care and treatment services, undiagnosed tuberculosis (TB), HIV-positive babies from HIV-positive mothers due to late HIV diagnosis, poor adherence on antiretroviral therapy (ART) and poor retention to care and treatment services.

Created by:

Team EGPAF

Country:

Lesotho

Topics:

Community Mobilization; COVID-19; HIV Treatment Optimization