Expanding role of village health workers in Lesotho: from supporting HIV patients to COVID-19 contact tracing

BACKGROUND: The COVID-19 globally has strained health systems, particularly in developing countries like Lesotho, which have experienced a shortage of health workers during the pandemic. Since 2006, Partners In Health Lesotho (PIHL) has been supporting comprehensive HIV services at seven health centers in hard-to-reach areas of Lesotho. Prior to the pandemic, PIH had engaged and trained two village health workers (VHW) in each village, one who is dedicated to providing services to HIV patients and the second who is dedicated to maternal and child health.
DESCRIPTION: PIHL collaborated with the Ministry of Health of Lesotho to expand the scope of the work of the VHWs who support HIV patients to include COVID-19 screening and contact tracing. Through this intervention, 938 VHWs were trained on COVID-19 symptoms, infection prevention and control measures, contact tracing and case reporting. The VHWs received three day in-person training and personal protective equipment (PPE), including face masks, face shields and hand sanitizers. The VHW coordinator and health facility staff supervised and coached the VHWs to undertake COVID-19 related activities in addition to HIV patients'' care at the community level.
LESSONS LEARNED: From May 2020 to December 2021, 87,634 people were screened for COVID-19, 430 clients were diagnosed with COVID-19, and 444 were contacts traced and isolated with the help of VHWs. During this time, VHWs continued to support 5,279 HIV patients, which was comparable to a pre-pandemic patient load (N=5168). Between January 2020-December 2021, we completed 10,684 viral load tests, which was only a 7% reduction from the 11,533 tests performed during the two previous years (Jan 2018-December 2019). However, average testing coverage during the pandemic remained greater than one test per patient per year. From January 2020 to December 2021, 9,737 viral loads tests (91%) were virally suppressed (<1,000 copies/ml), which was a higher proportion than observed during the previous two years (January 2018 to December 2019, N=9,048, 78.5%).
CONCLUSIONS: Providing VHWs with PPE and training to integrate COVID-19 infection services into their routine HIV prevention and care activities was an effective strategy to staff COVID-19 prevention and control programs without sacrificing high-quality HIV care.