1. Family Health Days: An innovative approach to providing integrated health services for HIV and non- communicable diseases among adults and children in hard-to-reach areas of Lesotho A. Tiam, J. Khonyana, O. Oyebanji, A. Ahimbisibwe, R. Pakela, A. Isavwa, L. Buhendwa, M. Mokone, M. Putsoane, M. Foso, M. Tsoeu, M. Nyabela. MOAE0102

2. Kingdom of Lesotho

3. Lesotho Demographic Information Population1.9 million 2006: Census HIV prevalence - adults23.7% 2009: LDHS HIV prevalence - pregnant women 27.7% 2009: Sentinel Surveillance Hypertension prevalence37.6% 2001: MOHSW Survey Report Maternal mortality ratio1,155/100,000 2009: LDHS Infant mortality ratio91/1,000 2009: LDHS Fertility rate3.4 per woman 2006: Census

4. Demographic Information Continued ANC attendance91.8% (first visit) 2009: LDHS Deliveries in health Facilities 69.8% 2009: MOHSW HIV test uptake at ANC95% Program data PMTCT coverage81% 2010 Cumulative Health Facility Data

5. Background In Lesotho, considerable resources have been allocated to the HIV/AIDS response, while resource allocation for non-communicable diseases has lagged. Due to geographic location and weak transportation and infrastructure, a number of clients find access to health care facilities challenging. The Family Health Day (FHD) campaign is a national mobile health program, which brings integrated health services to communities and families.

6. Goals and Objectives FHD aims to make integrated health services accessible to communities in Lesotho through use of mobile clinics, and use of multi-disciplinary teams and family-centered approaches Objectives: Test all HIV-exposed children Increase early infant diagnosis of HIV and timely enrollment into care and treatment Increase adult access to HIV care and treatment services Increase screening for hypertension, diabetes, malnutrition, and TB Increase access to integrated family services

7. Methods EGPAF supported Lesotho’s Ministry of Health (MOH) to assemble a multidisciplinary team, composed of medical doctors, nurses, and nutritionists, pharmacists, mental health officers, social workers, counsellors. EGPAF provided logistics support to the MOH, technical support for the monitoring and evaluation component, and worked with other service delivery partners to strengthen the campaign.

8. Services Provided at FHD Population groupChronic disease services provided HIV-, STI- and TB-related services provided All adults  Screening: hypertension, diabetes, malnutrition, outpatient care  Screening: HIV testing and counseling, TB screening, STI screening Pregnant women  ANC services  HIV testing and counseling, STI Children and infants  Vitamin A  De-worming  Immunizations  Growth monitoring  Malnutrition screening  HIV testing and counseling, including DBS for infants  NVP initiation/administration for HIV- exposed children HIV-positive individuals  CD4 blood draw  Clinical staging  Co-trimoxazole  Adherence counseling Other services  Ophthalmic  Social welfare  Mental observation/therapy  Condom distribution  Family planning Table 2: Services

9. Results Between October 17 and November 25, 2011, 10 rounds of FHDs were carried out in the 10 districts of Lesotho. Of the 8,396 adults tested for HIV, 7% were positive. Of HIV-positive individuals, 68.5% received CD4 testing and 36.6% were enrolled into HIV care 324 defaulters were linked back to care 990 children were immunized Of the 4,454 adults screened for hypertension, 24.2% had elevated blood pressure * 3.1% of 3.045 adults had elevated blood sugar, and all were linked to care** *JNC7 report. See table 3 for details. ** hypertension. ADA. I. Classification and Diagnosis. Diabetes Care 2011;34 (suppl 1):S13. Table 2. defined as random plasma glucose ≥200 mg/dl (11.1 mmol/l) according to national guidelines

10. Distribution of Blood Pressure by Age Group FemaleMale Age groupMSBPMDBPRangeMSBPMDBPRange 20-29149103143-158 93-108 152100146-162 95-117 30-39155101142-164 91-111 153123145-163 102-131 40-49159100158-174 97-109 Incomplete data 155-160 100-104 50-59162103148-189 102-137 177115156-202 95-127 60-69162104145-193 97-147 171106150-202 99-124 ≥70174100151-213 91-132 164108149-183 94-121

11. Discussion HIV screening HIV prevalence was quite low compared to national prevalence High number of treatment defaulters identified; this provided an opportunity to link defaulters back to HIV care and treatment services Enthusiasm about knowing HIV status Non-communicable diseases FHD gave first opportunity in Lesotho to carry out hypertension screening in hard- to-reach communities The mean blood pressure seemed to be quite high; selection bias is one hypothesis

12. Patients queuing for services at different work stations

13. Pharmacy unit in a converted car boot

14. Thank you!