Introduction: The six-month course of isoniazid preventive therapy (IPT) has been demonstrated to have significant benefits in mitigating the occurrence of tuberculosis (TB), particularly in high TB burden settings. However, its implementation in Sub-Saharan countries remains subdued for obscure reasons. This study investigated the factors inhibiting IPT uptake in the sub-Saharan country of Lesotho, which has one of the highest rates of TB incidences globally. Material and methods: Data were obtained from 46 healthcare workers, key informants at the Ministry of Health of Lesotho, and representatives of partner organizations, who were purposively selected for their roles in IPT implementation. Data were coded to identify themes, and the emerging themes were benchmarked to previous typologies for evaluating the implementation of best practices in health interventions, namely effectiveness, reach, sustainability, and adaptation. Each major theme was further linked to the World Health Organization's 'six building blocks of a health system'. Results: Challenges affecting the implementation of IPT were as follows: ineffective TB screening due to challenged decentralization of human immunodeficiency virus (HIV)/TB services, late detection of side effects linked to weak monitoring systems, and inefficient health information systems. Further challenges in the health system included interrupted supply chains due to insufficient health system financing, while inadequate healthcare workers' education on IPT implementation was also noted. Conclusions: These findings indicate that a wide spectrum of challenges has affected the implementation of IPT in Lesotho, and this indicates the need for 'health systems approach' to the implementation of IPT in Lesotho and other countries with similar challenges.

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BackgroundGiven the well documented undesired impacts of HIV/AIDS globally, there is a need to create a statistical inventory of research output on HIV/AIDS. This need is particularly important for a country such as Lesotho, whose HIV/AIDS prevalence is one of the highest globally. Research on HIV/AIDS in sub-Saharan Africa continues to trail behind that of other regions, especially those of the developed countries. Lesotho, a sub-Saharan country, is a developing country with lower research output in this area when longitudinally compared to other countries. This study reviewed the volume and scope of the general research output on HIV/AIDS in Lesotho and assessed the coverage of the national research agenda on HIV/AIDS, making recourse to statistical principles.MethodsA bibliometric review of studies on HIV/AIDS retrieved from the SCOPUS and PubMed databases, published within the 30-year period between 1985 and 2016, was conducted. The focus of each of the studies was analysed and the studies were cross-matched with the national research agenda in accordance with bibliometric methodologies.ResultsIn total, 1280 studies comprising 1181 (92.3%) journal articles, 91 (7.1%) books and 8 (0.6%) conference proceedings were retrieved. By proportion, estimation of burden of infection (40.7%) had the highest research volume, while basic (5.5%) and preventive measures (24.4%) and national planning (29.4%) had the lowest. Out of the total studies retrieved, only 516 (40.3%) matched the national research agenda. Research on maternal and child health quality of care, viral load point-of-care devices, and infant point-of-care diagnosis had hardly any publications in the high priority research category of the agenda.ConclusionNotwithstanding a considerable research output on HIV/AIDS for Lesotho, there is insufficient coverage of the national research agenda in this research area. The major research gaps on general research output are in basic and preventive measures as well as national planning. There is also a need to increase targeted funding for HIV/AIDS research to appropriately address the most compelling gaps and national needs.

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Background: Tuberculosis (TB) remains a public health problem, particularly in people living with human immunodeficiency virus (PLHIV). Yet, efforts to reduce TB incidence using isoniazid preventive therapy (IPT) have been curtailed by poor uptake of this intervention. This study reviewed the rate of IPT initiation in the sub-Saharan country of Lesotho, which has one of the highest TB incidences in the world.Methods: Time to IPT initiation in randomly sampled medical records of PLHIV was analysed using Cox’s proportional hazards regression. Differences in the periods of enrolment into Human immunodeficiency virus (HIV) care were controlled for by considering the year IPT was launched (2011) as the base year and stratifying the medical records into the 2004–2010 cohort (before the launch of IPT) and the 2011–2016 cohort (after the launch).Results: Out of 2955 patients included in the final analysis, 68.8% had received IPT by the study exit time. However, the overall rate of IPT initiation was 20.6 per 100 person-years, with 135 (6.6%) treatment interruptions. Compared to the 2004–2010 cohort, the 2011–2016 had a significantly (p 0.05) higher rate of initiation (15.8 vs. 27.0 per 100 person-years, respectively). Age group, district category and duration of antiretroviral therapy emerged as the most significant predictors of IPT initiation, while district category and gender significantly predicted IPT therapy interruption.Conclusion: These findings indicate a high uptake of IPT with a slow rate of implementation. Significant factors associated with disparities in the initiation and interruption of IPT therapy in this study are important for policy review.

The southern African country of Lesotho introduced an old age pension scheme in 2004 with the aim of enhancing the quality of life (QoL) of the nation's elderly population. This study is the first to assess the physical, psychological, social, and environmental aspects of the health-related QoL of the elderly in Lesotho since the pension scheme was adopted. Data for this study were gathered using the World Health Organization QoL-BREF questionnaire. Mean QoL scores were compared across demographic, socioeconomic, and clinical variables using analysis of variance, t test, and regression analysis. Findings indicate that respondents were least satisfied with the environmental and physical domains of QoL. They also indicate that the overall QoL of the elderly in Lesotho was mainly affected by marital status, level of education, type of housing, source of income, and level of satisfaction with income. These factors should thus be taken into account when developing interventions aimed at improving the QoL of the elderly in Lesotho.

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Background: Plants are important sources of medicines. Herbal medicines in Lesotho are exposed to excessive exploitation and habitat destruction. Comprehensive information to promote proper use and conservation of these herbal medicines is lacking. This study described the uses of medicinal plants in Lesotho with comparative reference between practice and the literature, highlighting important ethno-medicinal information and conservation status of the plants. Additionally, the study established a repository and monograph for the herbal medicines in Lesotho. Materials and Methods:Medicinal plant samples and information on their uses were obtained from herbalists in four districts of Lesotho between January and May 2014 through questionnaire-based interviews. Samples consisted of roots, bark, stems or leaves and/or combinations. Voucher samples were processed into powders, labelled, and stored in a repository. Information on the uses, plant parts used, geographical distribution, known phytochemical components and conservation status of each plant was recorded in a Microsoft Access database. Results: Seventy-eight local herbalists were interviewed and men (about 84%) dominated the practice of traditional medicine. Fifty-four herbal medicine samples were collected and stored in a recently established Lesotho Herbal Medicines Repository (LHMR). The herbal medicines were from 54 medicinal plant species and 46 genera belonging to 29 plant families. Asteraceae (about 20%) was the most common plant family. Overall, 46% (n=54) of the prescriptions by local herbalists were similar to prescriptions in the literature at least in part. However, traditional medicinal uses for 9% of the plant samples could not be confirmed from the literature. Local herbalists use different parts of medicinal plants with roots being the most frequently (57%) used part. Twenty percent of the plants were threatened with extinction while the conservation status of 7% of the plants was undocumented. Conclusion: Training of local herbalists on sustainable harvesting and safe use of medicinal plants is recommended. The repository and monograph is a useful reference and source of herbal medicine samples for researchers, which need to be expanded to include more medicinal plants in Lesotho. Local herbalists in Lesotho have valuable indigenous information on medicinal plants that needs to be documented.