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					                                                       Abstract no.




Rapid scale-up of Antiretroviral
   program in the Lesotho
       Apparel Industry
  F. Asiimwe1, L.Phatsoane1, M. Mokone1, M. Letsie1,
  M. Ramangoaela1, T. Nthejane1, D.Hanisch1,
  B.Vander Plaetse1.
  1Apparel Lesotho Alliance to Fight AIDS (ALAFA) ,

  Lesotho
                                  Background
   Kingdom of Lesotho is a mountainous and land locked with a population of 1.8 million people

   National HIV prevalence rate of 23.2% , 3rd highest in the world.

   Lesotho apparel industry is the largest private employer and HIV prevalence in the apparel

    industry is estimated at 43.2%

   Lesotho government has made significant strides in the fight against HIV and AIDS and is rapidly

    scaling up its ART .

   Through innovative private public partnership HIV and AIDS treatment is being implemented in

    the workplace .

   ALAFA ‘s goal is to expand access to HIV related services to the entire apparel industry in

    Lesotho in support of the Lesotho Government’s HIV and AIDS Strategic Plan, 2006-2011.

Rationale

•   This program provides a unique opportunity to assess program patient retention, rates of loss to

    follow up, immunological failure and mortality in a private public implementation model
                            Methods
 Care is provided by private doctors accredited by government

 Currently 25 factory based Clinics and 15 private doctors

 Free ARV drugs, TB and other OI drugs provided by Government
   of Lesotho

 ALAFA core staff ensuring care is provided according established
   Lesotho National ART guidelines

 Electronic integrated patient management system with direct
   computer entry of clinical records and transfer of data to central
   database at ALAFA
                                                   Results
Baseline Characteristics of the 956 ART patients
                                                      •   Of the 4382 patients enrolled since May 2006
                                                          –May 2009, 956 with advanced HIV disease
Characteristic                  Value
                                                          have been initiated on ART. The median follow
                                                          up time is 13month and Median CD4 gain
Sex Female                      899 (94%)                 among ART patients was 119 cells/mL Initial
    Male                        57 (6%)
                                                          regimens include stavudine-lamivudine-
Age                             30 [IQR: 24-43]           nevirapine, 30%; stavudine-lamivudine-
                                                          efavirenz, 19%; zidovudine-lamivudine-
Baseline CD4                    173 [ IQR: 78-247]        nevirapine, 10%; zidovudine-lamivudine-
                                                          efavirenz, 22%; tenofovir-lamivudine-efavirenz,

Baseline WHO clinical stage 3   19.1%                     16%; tenofovir-lamivudine-nevirapine, 3%).
and 4)
                                                      •   The probability of death was 0.03 and

Death Crude Mortality rate      3%                        probability of being lost to follow up was 0.1
                                                          Patients without factory based services were

Lost to follow up               9.7%
                                                          more likely to be lost to follow up with a hazard
                                                          ratio of 1.57 and more likely to have
                                                          immunological failure, hazard ratio 1.32.
                                          Conclusion
    This program demonstrates that ART /HIV diseases management can be successfully
     scaled up using service providers from the private sector.

    Patient baseline characteristics and outcomes are typical of those accessing ART in
     other public sector programmes.

    Early HIV diagnosis and timely initiation of ART minimizes loss of skills and improves
     productivity at the workplace

    Private public partnership in ART roll out need to have established patient data
     management systems to ensure data completeness and to allow good ascertainments
     of outcomes and loss to follow up rates.

    With the roll out ART through this model; it will be important to monitor antiretroviral drug
     resistance at treatment failure and this population overtime

    Initial data review provides the program clinicians and policy makers to begin to evaluate
     private public partnership as an alternative to rapidly scale up ART in some unique
     populations



This program is showing significant impact across the industry with excellent initial immunological and clinical outcomes
Emphasis should be placed on early linkage into care through factory based services

				
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