World AIDS Day 2018 provides a timely moment to reflect on just how much change – and progress – has been made in the 30 years since the inaugural World Aids Day in 1988.
The idea back then was a simple one: to raise awareness and encourage people worldwide to unite in the fight against AIDS and HIV.
This was just five years after the virus was first identified in 1983, and a year after Princess Diana made international headlines by shaking the hand of a person living with HIV.
Since then huge scientific advances have been made in HIV treatment. We understand so much more about the disease and governments, non-governmental organisations (NGOs), campaigners and celebrities have worked together to break down stigma and negative associations.
But this important milestone reminds us that there remains much to do to achieve the United Nations goal of eliminating the virus by 2030: There are 36.9 million people living with HIV globally and 1.8 people million were infected in 2017.
Lesotho, the small, landlocked nation in Sub-Saharan Africa, is one of the places still disproportionately affected by HIV and AIDS – data suggests that as many as one in four of the population have the virus and it’s the leading cause of death in the country.
However, the Lesotho government has been making inroads, and there’s a lot to be learnt from their approach.
The Vodafone Foundation first started working with the Lesotho Ministry of Health in 2015 and we partnered on an innovative new approach to HIV testing and treatment, bringing together 10 funding and implementing partners.
Data available to us in 2015 suggested that only 15% of children with the HIV virus in Lesotho were diagnosed and receiving treatment – and children who are born with HIV and don’t receive treatment are likely to die before the age of two.
One of the biggest barriers we faced was reaching women and children to offer testing and referral for treatment where applicable, as Lesotho is a mountainous country, with scattered rural communities.
We had to design a programme that would reach paediatric and adolescent populations through a range of different initiatives, including community football events and mobile outreach clinics.
The approach incorporated the use of low-cost 4x4 vehicles to take specialist HIV and community nurses out to some of Lesotho’s more rural communities to offer primary health services and HIV testing, a mobile management app (linking patients, health workers and clinics) and vouchers on M-Pesa, Vodafone’s mobile money transfer service, to cover costs of transport to treatment for those patients who needed it.
Scale and sustainability
Today, 64% of HIV positive children in Lesotho are receiving treatment – the result of a long-term multi-partner approach.
Last month, we officially handed over the programme to the Lesotho government, which will replicate and extend the programme with an additional fleet of vehicles - expanding the reach of the programme even further. This will increase the number of people that can receive primary healthcare by an estimated 15,000 to 45,000 people each year, and HIV testing and counselling by 12,000 to 36,000 people.
Overall through the course of the programme 164,263 people (close to 10% of the Basotho population) have been tested for HIV. Of this number, 68% were children and adolescents under 14 years.
In total, 3,364 HIV positive children, adolescents and adults (including pregnant women) were identified and linked to life-saving care and treatment.
60% of patients who tested positive were registered for M-Pesa mobile money service and were provided with free transport to care facilities, meaning that patients can access treatment far more quickly.
The smartphone app, developed by the Vodacom Lesotho Foundation, is used by health workers not only to enable M-Pesa payments, but also to track critical data to ensure that patients are registered and monitored – helping to overcome one of the country’s major challenges, and transform the healthcare system.
It is hard not to be moved by the some of the people we met and stories we were told during our time in Lesotho. They are also a reminder of the very real challenges that are faced, especially by people living in rural areas.
One mother we spoke to, Maboe, previously had to walk for most of the day, and stay overnight to take her six year-old HIV positive son to the clinic for treatment each month. But the programme enabled her to visit a mobile clinic much closer to home - she told us: “The Nurses have really helped by coming nearer to us. Now we don’t need to travel so far.” – before telling us that her greatest wish for her son is for him to grow up and be healthy.
It is clear that a combination of committed partners for both funding and implementation, dedicated healthcare staff, mobile technology and transport saves lives.
In Lesotho, this model has transformed the delivery of HIV testing and treatment, and shows that a sophisticated, targeted approach is needed if we are to eradicate the virus globally – and HIV and primary care can be combined to find, treat and care for children who would otherwise be missed.
Crucially, our model offered a cost-effective and sustainable way for the Ministry of Health to connect some of Lesotho’s remote, rural communities to primary healthcare. It has also shown what can be achieved by working in partnership in the fight against the global HIV epidemic.
Andrew Dunnett has been Director of the Vodafone Foundation since 2006. Andrew is also a Trustee of the M-Pesa Foundation (Kenya) and a Board member of the M-Health Alliance (USA). He has 15 years' experience in corporate responsibility, community investment and public affairs, including advising organisations such as, BTEC, the BBC, the Commission for Racial Equality the Sustainable Development unit at the UK Department of Trade and Industry and Thames Water.
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