March 2023

On the Front Lines

A Doctor's Commitment to End Inequities for Children in Lesotho

When Dr. Cecilia Ntsere heard that the 2022 World AIDS Day theme was “Equalize” she thought back to when she was working in a hard-to-reach district of Qacha’s Nek in Lesotho, where access to health services remains a challenge. She says that in these hard-to-reach areas, there is no public transport, roads, electricity, or clean water.

UNAIDS has warned that the global HIV response is in danger as there has been faltering progress with approximately 1.5 million new HIV infections occurring in 2021, which is more than 1 million more than the global targets, yet resources for supporting HIV programs have been shrinking. The world is not on track to end AIDS by 2030 as planned because new infections are still reported daily, as are AIDS-related deaths. But through dedication and cooperation, the world can get back on track.

“I have witnessed the inequalities on HIV services,” says Dr. Ntsere, “especially those children in the mountainous districts who live far from the facilities with no means of transport. Those children must walk to facilities, crossing rivers with no bridges and climbing mountains, to access health and HIV services. Some places are only reached by horses, so if the child is left with a granny who cannot ride a horse, it is becomes a problem.”

“Deep in these mountains in the Kingdom of Lesotho, we met this young 6-year-old girl who has been abandoned by her biological mother and left under the care of a grandmother who regularly forgets to give the child the ARV [antiretroviral] treatment that she so desperately needs. Therefore, the child ended- up with high viral load due to sub optimal adherence,” recalls Dr. Ntsere.

To reach these communities that struggled with access to health services, community outreaches assist in bridging the gap.

“To support the 6-year-old child we, had to form a multidisciplinary team consisting of a doctor, nurse, and social worker to deliver services in a health post nearer to them,” says Dr. Ntsere.

“We had to cross the Senqu river and take a hike to Lebakeng, where we met up with her and her grandparent from a long hour walk to the facility.”

The village health worker from the area was involved to offer treatment support to the child. During this visit by the health team, the daily medication time for the child was changed from evening to morning to allow the village health worker to visit her on daily basis to give her medication. The family was further supported with food packages through social support to encourage treatment adherence. Then the clinic delivered the child’s treatment at home, to help granny not to walk long hours and focus on treatment adherence for the child without forgetting.

Several months after this intervention, the child’s general health had improved substantially, and blood was tested for viral load. The results came back as suppressed, indicated that the treatment had worked, and her immune system was strong.

Dr Ntsere says that geography and age contributed to the inequalities that this child faced. The solution applied was to implement a multi-disciplinary intervention, whereby a doctor, nurse, social workers and village health worker all work together to address this challenge. The team further used multi sectoral intervention where different partners from non-government organizations and government ministries, as well as community, intervened to save the life of the child.

“This young girl will grow up to be a healthy strong woman because from that day, the team succeeded in returning and retaining her to care and she is now on treatment and virally suppressed,” says Dr Ntsere. “Until no child dies of AIDS, we shall continue to be on the front line to advocate for children’s rights to HIV services. Even if it means climbing down a mountain at 7 p.m. in the dark, crossing the Senqu River, and arriving home late from work!

“Together we can fight for an AIDS free generation,” says Dr Ntsere.