Title : The Lesotho nursing council taking a lead in HIV prevention through the nurse –midwifery led VMMC delivery model
Lesotho has the high prevalence rate of HIV infection estimated at 25% since 2009 (LDHS, 2014). Therefore, Lesotho came up with strategies to curb the HIV infection; amongst which Voluntary Medical Male Circumcision (VMMC) was initiated by the MOH Development Partners in order to reduce HIV infection. It was established that VMMC reduces men’s risk of acquiring HIV through heterosexual intercourse by approximately 60%. The Ministry of Health (MOH) has been scaling-up VMMC since February 2012, using a doctor-led model and achieving 27% at the end of 2014. The pace of scale-up is key to achieving the impact of HIV prevention intervention as the World Health Organization (WHO) also recommended scaling up accessibility of VMMC services through use of nurse-midwives and other providers to perform the procedure. Lesotho has low circumcision prevalence and limited human resources for health, but has not yet implemented a policy on task sharing of VMMC. Also, Doctors are not available at all levels of care, yet services for VMMC ought to be accessible at all levels.
Lesotho Nursing Council (LNC), after being approached by Jhpiego as one of the MoH partners, initiated to conduct a pilot study to assess performance of nurse-midwives trained to perform the VMMC procedures, in order to make an informed decision on task-sharing of VMMC procedures in Lesotho; and also to determine whether it is safe for nurse-midwives to perform the procedure. The information gathered would inform an extension on the nurses’ scope of practice. The project was supported by Jhpiego technically and financially. Forty nurse-midwives were trained to perform VMMC procedures. LNC Task Team was engaged to monitor trainings and procedures performed to assess the participants’ competence after trainings. It was discovered that acquisition of knowledge and skills to participants differed, and it was shorter to those that received training before. There were various stakeholder meetings held for Nursing and Midwifery leaders in order to get their buy-in, share project findings and get their inputs. A study tour was undertaken to Tanzania to learn their approaches and strategies used towards a nurse led VMMC model.
At the end of the project, a final report was presented to stakeholders who agreed that it is safe for nurses-midwives to perform the procedure, and should be included in the pre-service curriculum and in-service trainings for nurses and midwives. Participation of LNC in the development of task-sharing approach for VMMC will allow a key pillar in the prevention strategy.
Audience Take Away:
• Lesotho’s HIV and AIDS prevalence rates.
• Sharing the country’s initiatives, strategies, challenges encountered, and achievements in reducing the high HIV and AIDS prevalence rates in Lesotho.
• Sharing experiences on how Lesotho adopted the nurse-led VMMC models.
• Learn how the four pillars of Nursing and Midwifery collaboratively worked to improve nursing and midwifery services in Lesotho.
• The countries will learn and realize the importance of nurse led VMMC services on quality improvement and public protection; make informed decisions based on the Lesotho project findings to determine the safety of nurses to perform such services. They will then be in a position to advice themselves whether to extend the nurses’ scope of practice in order to contribute towards reduction of high HIV prevalence rates, and also develop the Task-Sharing policy in order to engage in the task sharing approach.
• VMMC is one of the strategies that reduce men’s risk of acquiring HIV through heterosexual intercourse by approximately 60%