Lesotho is "struggling to contain" the spread of tuberculosis in the face of its HIV/AIDS epidemic, IRIN News reports. In 2006, the country reported 12,000 new TB cases, but TB expert Peter Saranchuk of Medecins Sans Frontieres said the actual number of cases likely is much higher.
In addition, Saranchuk estimates that there are "vast" numbers of undiagnosed TB cases because roughly 85% to 92% of HIV-positive people in the country also have TB. The capacity to perform culture testing to diagnose TB among HIV-positive people is limited in Lesotho, and sputum samples must be sent to South Africa. Results typically are not returned for six weeks. Although TB also can be diagnosed among HIV-positive people using X-rays and clinical assessments, the strategy is relatively new, and Lesotho's department of health and social development still is training health workers in how to manage the two diseases, according to IRIN News. Coordination between Lesotho's TB and HIV/AIDS programs has not been common until recently, IRIN News reports. TB and HIV treatments previously were available at different sites, and few health professionals working on the two diseases collaborated. To address the issue, the department of health and social development established a strategy to control the two diseases that includes training health workers and counselors in both diseases; routinely offering HIV testing to people with TB; screening HIV-positive people for TB; and providing treatment for both diseases at the same site. Michael Sekokomala -- head of Lesotho's largest TB outpatient clinic at Botsabelo Hospital in the capital, Maseru -- said more work needs to be done to implement the strategy. There is a shortage of counselors at the clinic to provide HIV testing to all patients, and people who have both diseases are required to make separate appointments to receive antiretroviral drugs at a nearby HIV/AIDS clinic. In addition, different strategies are used to ensure that patients adhere to their TB and HIV/AIDS treatment regimens. The DOTS strategy is used for people with TB, while HIV-positive people receive adherence counseling to ensure that they understand the importance of following their daily treatment regimens on their own. Shoeshoe Matsoele, deputy manager of Lesotho's TB control program, said that the DOTS strategy can be adapted to cover adherence to antiretroviral drugs. Matsoele added that volunteers trained in DOTS also can be trained to monitor adherence to antiretrovirals.