A year of accomplishments for Lesotho's national multidrug-resistant TB program

By Sadie Richards

Strains of tuberculosis that cannot be treated with traditional approaches and drug regimens pose an ever-growing threat to global health. Just one year ago, patients in Lesotho infected with multi-drug resistant tuberculosis (MDR-TB) faced almost certain death. Today they and their families have reason to hope for a better prognosis.

Partners In Health Lesotho’s (PIHL’s) MDR-TB Program Director, Dr. Hind Satti, recently reflected on the accomplishments of - and challenges still facing - the national program she helped spearhead last July.

	A treatment supporter, PIHL record book in hand, descends into a village to visit one of her patients.

PIHL worked hand-in-hand with the Ministry of Health and Social Welfare (MOHSW) and other partners (including the Foundation for Innovative New Diagnostics and the World Health Organization) over the past 12 months to build up the basic infrastructure, expertise and technical support needed to test and treat patients for MDR-TB. The national program now encompasses a state of the art MDR-TB hospital, laboratory and pharmacy, all of which are fully staffed and complemented by a team of treatment supporters who provide personalized, in-home patient care.

Satti attributes PIHL’s achievements largely to the organization’s community-based model of care and its collaboration with the MOHSW from the start. PIHL’s approach involves building local capacity from the ground up, within a framework that offers staff financial incentives, personal protective equipment, and continual training. High staff and patient retention has also resulted.

PIHL’s MDR-TB program currently treats 155 patients living in all ten districts of the country. This number is growing rapidly and is expected to reach 280 by the end of the year, and 450 by the end of 2009. Most of these patients receive treatment in their homes. Community health workers (a.k.a. treatment supporters) visit each patient twice daily to administer medication, provide psychosocial support, screen and counsel family members and/or accompany extremely sick patients to the hospital in Botsabelo.

	Dr. Hind Satti with five young MDR-TB patients, most of whom are orphans.

The youngest of nine children who are part of the program is only three years old. Of these young patients, three are sick enough to be in-patients at the 20-bed hospital. One young boy, however, is well enough to attend school. With the comprehensive PIHL package of medical care, food supplementation and financial support, the others may soon join him.

PIHL also trains “expert patients” who become an integral part of the community-based model. These are out-patients who have often returned to health from the brink of death to take on roles similar to those of the treatment supporters. They identify new potential patients, combat stigma associated with the disease and seeking treatment, visit patients at home, provide health education on TB, HIV and sexually transmitted infections, and provide psychosocial support to other patients and their families. As Satti attests, they are “the living, breathing example of the success that can be reached in treating MDR-TB” through community-based programs.

To stave off the spread of drug resistant strains of the disease, and for effective programmatic scale up to continue successfully, more funding – for treatment, prevention and research – will be necessary. Satti specifically calls for increased investment in research that will give rise to evidence-based policies and procedures. Since more than three quarters of Lesotho’s MDR TB patients also have HIV, Satti is convinced that lessons from Lesotho can inform disease treatment and prevention in other resource-poor countries struggling with a high burden of MDR-TB and HIV co-infection.

[published July 2008]