1. H Bygrave L Triviño L Makakole Medecins sans Frontieres Lesotho Scott Hospital Morija TB/HIV Integration Lessons learned from implementation of a TB/HIV “One Stop Service” at primary health care clinics in rural Lesotho

2. “ I’ve just been told I have TB and HIV. The nurse gave me some tablets for the TB but I have to go to the hospital to get treatment for my HIV”

3. What does this really mean ? A four hour bumpy and breathless ride to the hospital Waiting to save up the money for the transport fees An important delay in a life saving treatment

4. Background- Lesotho Mountainous country landlocked by South Africa Fifth Highest burden TB (637/100,000) 3 rd Highest prevalence of HIV (23%) TB/HIV Co-infection Rate 76% HIV/ TB program supported by MSF since 2006 Nurse based programme HIV and TB care decentralised to primary health care level 14 Primary health care sites and one district hospital OPD

5. What do we mean by “One Stop Service” Both diseases treated at PHC level or at OPD Same day Same room Same clinician Same counsellor Same folder Same drug delivery point

6. What did we do to provide a “One Stop TB/HIV Service ” in Lesotho? What was the impact?

7. Training on both TB and HIV Nurses and Lay counsellors

8. Diagnosis Specimen Collection Training on Smear Negative Algorithm

9. TB and HIV drugs available at clinic level

10. Task shifting to TB/HIV lay counsellors Intensified Case Finding and Adherence support for TB and HIV

11. Documentation in same folder HIV indicators in TB register

12. Infection Control

13. Integrated TB/HIV ( PHC) Supervision

14. What was the impact?

15. Increase in the Proportion of Smear Negative Diagnoses

16. Impact: Indicators of TB/HIV Integration

17. How does this compare to other sites?

18. Outcomes in Co-infected Patients According to concurrent ART therapy

19. Mortality in co-infected:15%LTFU in co- infected: 6%

20. What was the difference for Joseph? “I was grateful I didn’t have to travel to the hospital, I was worried about paying for the transport and taking extra time off work. Seeing the same nurse and counsellor was good as I got to know them and them me. I felt they were treating me and not just the disease”

21. Acknowledgements People living with HIV in Lesotho Scott Hospital and clinic staff Ministry of Health and Social Welfare Lesotho Christian Health Authority of Lesotho MSF team Morija and Capetown