GH16-005, LESOTHO, PROVIDE MINER-FRIENDLY SERVICES FOR INTEGRATED TB/HIV CARE (PROMISE)

PROJECT SUMMARY With one of the world's most severe HIV and TB epidemics and an economy dependent upon labormigration to South African mines, Lesotho is an optimal setting to study the effectiveness of TB/HIV integrationstrategies. HIV prevalence in Lesotho is 23%, the world's second highest; the TB incidence rate of 852 per100,000 is the world's highest; 72% of TB patients are HIV positive. Basotho migrant miners, who travelbetween their homes in Lesotho and work in South African mines, and their families are among those withelevated risk of HIV and TB. We found that 32% of miners and miners' family members tested for HIV in threeTEBA mining employment offices in Lesotho in 2014-15 were newly diagnosed with HIV; an additional 7%were known to be HIV positive. The TB incidence rate in South African miners is estimated at 3,000-7,000 per100,000 per year, several-fold higher than that in the populations from which they originate. Testing, linkage,and retention of miners and their families along the TB/HIV care continuum are suboptimal, and TB treatmentoutcomes are also poor compared with the general population. Implementation science research is urgentlyneeded to determine an effective strategy for improving early detection of HIV and early initiation ofantiretroviral therapy (ART) and isoniazid preventive therapy (IPT) among migrant miners and their families. The PROvide MIner-friendly SErvices for Integrated TB/HIV Care (PROMISE) Study aims to evaluate theeffectiveness, feasibility and acceptability of integrated TB/HIV services for migrant miners and their familymembers provided in miner-friendly service venues (MF). A prospective cohort study design will be used tocompare the effectiveness of the MF intervention, which includes provision of family-focused, integratedTB/HIV diagnosis, care and treatment services at TEBA offices six days per week, to public sector healthfacilities, which deliver usual integrated care for TB and HIV. Additionally, we will assess HIV testing yield toidentify PLHIV with CD4 count >500 cells/µl, time spent accessing ART and IPT services, and costs associatedwith delivery of the MF intervention. We will also explore patients' and providers' perceived barriers, facilitatorsand preferences to understand how they impact uptake and delivery of the MF intervention. The study will leverage long-standing collaborations between ICAP, the Lesotho Ministry of Health,National University of Lesotho and TEBA and a well-trained, highly productive team with substantialexperience in implementation science research in sub-Saharan Africa to identify an effective, feasible andacceptable TB/HIV service delivery model for migrant miners and their families that addresses barriers toimplementation of early ART and IPT. The ultimate goals of the project are to 1) improve health outcomesamong migrant miners and their families, a hard-to-reach population that represents a hotspot of TB/HIVtransmission, in Lesotho and in PEPFAR programs more broadly; and 2) strengthen the implementationscience research capacity of national and local institutions.