Rapid scale-up of Antiretroviral program in the Lesotho Apparel Industry

1. 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

2. 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 Background

3. 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

4. Results • Of the 4382 patients enrolled since May 2006 –May 2009, 956 with advanced HIV disease have been initiated on ART. The median follow up time is 13month and Median CD4 gain among ART patients was 119 cells/mL Initial regimens include stavudine-lamivudine-nevirapine, 30%; stavudine-lamivudine-efavirenz, 19%; zidovudine-lamivudine-nevirapine, 10%; zidovudine-lamivudine-efavirenz, 22%; tenofovir-lamivudine-efavirenz, 16%; tenofovir-lamivudine-nevirapine, 3%). • The probability of death was 0.03 and probability of being lost to follow up was 0.1 Patients without factory based services were 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.

5. 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