1. Dr. Hind E. Satti Partners In Health, Lesotho March, 2008

3. TB SITUATION IN LESOTHO  12,275 TB cases notified in 2007  Estimated prevalence of 544 per 100,000 population  Estimated annual incidence for all cases is 691 per 100,000 population  Estimated incidence of Sputum smear positive cases is 281 per 100,000 population  75% of new TB cases among age-group 15-44 years;  Estimated all TB deaths is 107/100,000 annually  The HIV prevalence rate in Lesotho stands at 23.2% in 2005;  80% of TB cases are HIV positive(NTP 2008);  109MDR-TB cases currently on treatment

4.  May 2007: National guidelines for management of MDR-TB  Collaboration with MOHSW and WHO  Developed from WHO global guidelines.  July 2007: Training of health staff  Training materials for health staff at district level.  Training materials for MDR- TB treatment supporters.

5. Building national lab capacity  Equipment  Staffing  Training and supervision  infrastructure Close relationship with SRL  Culture and DST while national capacity is being built  Proficiency testing Central TB laboratory is now performing culture and first line DST as well as the Rapid RIF testing.

9.  All NTP staff  TB Officers at district hospitals  Health centre nurses providing TB care  Routine HIV screening of MDR-TB patients, partners, family members  Protocol for “medium-risk” and “high-risk”  Sputum sent to national TB laboratory  Initially sent to MRC Pretoria (March 2007)  First-line DST now available in Maseru (Sept 2007)  Screening of household contacts

10.  Outpatient  TB clinics and general outpatient clinics  Treatment supporters  Family members  Inpatient  Cross-infection of patients  Protection of health workers (TB and HIV)

12.  MDR-TB Clinical Teams at all district hospitals  Medical Officer  ART Nurse  TB Officer  TB Coordinator  Empiric treatment for high-risk suspects  Early initiation of ART in all co-infected patients, regardless of CD4  Referral to Maseru for complicated patients

13.  MDR-TB Treatment Supporters  Village Health Worker; community volunteer; KYS counselor  Accepted by the patient  Trained and supervised by District MDR-TB Clinical Team  Incentives

15.  Twice-daily DOT  Injections  Psychosocial support  Screening household contacts  Accompaniment to clinical visits

16.  Very sick patients  Bedridden  Severely wasted  Severe side effects  Severe hypokalemia  Acute renal failure  Severe OIs  Meningitis  Esophageal candidiasis

17.  Started on August 2007  109 patients enrolled.  48 patients pre GLC cohort.  72% HIV co-infection rate  History of multiple failed TB treatments  Average of 8 household contacts per patient

18.  Geography  Advanced HIV disease  Severe malnutrition/wasting  Clinical complications and side effects  Working through the “backlog” quickly