Moshao Makhele

Community Based Chronic Care Lesotho (ComBaCaL) is a collaborative program between Lesotho and Switzerland dedicated to developing, testing, and sharing innovative solutions to enhance chronic disease care in remote settings in low- and middle-income countries.

At the core of ComBaCaL is the concept of Community Health Workers (CHWs) supported by a digital clinical decision support system, enabling them to provide treatment for selected conditions in remote areas with limited access to clinics.

In phase 1, we empowered CHWs to independently prescribe and manage treatment of uncomplicated hypertension and type 2 diabetes. This approach was effective in large cluster-randomised trials.

In the current phase 2, the focus has expanded to integrated care packages addressing a wider range of conditions, including HIV, sexual and reproductive health, and health services for children under five. The aim of this phase is to prepare ComBaCaL for scale.

For detailed information and a comprehensive list of our publications, visit: www.combacal.org.

Research shows that people living with HIV (PLHIV) face a higher risk of non-communicable diseases (NCDs)—particularly cardiovascular disease, cervical cancer, diabetes, and mental health conditions—compared to those without HIV. Cardiovascular disease is a leading cause of non-AIDS-related morbidity and mortality among PLHIV.

With the widespread availability of antiretroviral therapy, life expectancy for PLHIV has increased, exposing them to age-related diseases and NCD risk factors. PRECARIF, implemented in collaboration with SolidarMed in the northern districts of Lesotho, aims to generate evidence on the links between HIV and NCDs, with a primary focus on cardiovascular disease risk factors and related conditions in PLHIV.