Country Spotlight: Lesotho
Our Work in Lesotho
EGPAF is a global advocate for public policies benefitting women, children, and families living with and affected by HIV and AIDS. Together with other partners, EGPAF/Lesotho has successfully advocated for free HIV services. In addition, the Government of Lesotho is offering all maternal and child health services for free, thereby giving an opportunity to Basotho women and children to have access to quality services in public health facilities at no cost.
The Strengthening Clinical Services (SCS) Project is made possible through support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID). Under SCS, EGPAF supports the Lesotho MOH to provide a comprehensive service package of PMTCT services, adult and pediatric HIV/AIDS chronic care and support services, and adult and pediatric antiretroviral treatment (ART). The objectives of the five-year project are as follows:
- 100 percent of facilities offering comprehensive PMTCT services by the end of 2011;
- 100 percent of facilities offering care and support for adults and children by the end of 2013; and
- 90 percent of facilities offering treatment initiation for adults and children by the end of 2013.
Key project strategies include:
- Technical assistance (TA) at each level of the national health system on the provision of quality integrated, comprehensive, and family-centered HIV/AIDS prevention, care and treatment services;
- Capacity building at the district, facility, and community levels through the training of healthcare workers (HCW) and community representatives;
- Community mobilization for increased uptake and adherence to HIV/AIDS services; and
- Strengthening health systems through supportive supervision and mentorship, addressing human resource (HR) challenges, supporting updated guidelines and materials, participation in national technical advisory committees (TACs) and technical working groups (TWGs), and monitoring and evaluation (M&E) activities.
From EGPAF’s central office in Maseru, senior staff members provide national-level TA and supportive supervision to the district level. Additionally, EGPAF staffs ART/MCH integration nurses at 17 hospitals nationwide to address HR shortages. These nurses provide direct MCH/ART integration services, serving as mentors for other hospital staff on EGPAF’s model of PMTCT, ART, MCH, and pediatric HIV service integration.
Cervical cancer is the most common cancer in Lesotho, and the leading cause of cancer death among women in Lesotho. Women infected with HIV have a higher prevalence of infection with human papilloma virus (HPV) and are more likely to develop persistent HPV infection – and possibly a more rapid progression to and a higher incidence of cervical cancer. EGPAF/Lesotho is supporting the MOH to create a comprehensive and cost-effective national cervical cancer screening program using evidence-based strategies for early detection and treatment of pre-cancers at the Senkatana Center at Botshabello Hospital in Maseru.
The USAID-funded Lesotho Together against HIV and AIDS Partnership (LETLAMA) project, primed by Population Services International (PSI), seeks to reduce HIV incidence among youth and adults by increasing the adoption of protective behaviors and supporting healthy social norms. EGPAF serves as one of the project’s lead implementers of HIV clinical services programming. EGPAF is working to build the capacity of Basotho institutions’ HIV prevention services; engage communities to adapt social and cultural norms and attitudes that reduce vulnerability to HIV; and motivate Basotho youth and adults to change their behavior through increased knowledge, risk perception, skills and access to HIV prevention services. In addition, EGPAF is working with the Ministry of Health and Social Welfare (MOHSW) to revitalize and scale-up post-exposure prophylaxis (PEP) activities in all health facilities while strengthening integration of sexually transmitted disease management and HIV services in Lesotho.
As of March 31, 2013, EGPAF-supported programs in Lesotho had:
- Provided nearly 151,000 women with PMTCT services.
- Tested nearly 122,000 pregnant women for HIV.
- Enrolled nearly 201,000 people into HIV care and support programs, including more than 12,000 children under the age of 15.
- Started more than 95,000 people on antiretroviral therapy (ART) for HIV, including more than 5,300 children under the age of 15.
(*All data cumulative from program start through September 30, 2012 with the exception of Care and Treatment data [current as of June 30, 2012])
Key Projects in Lesotho
System Development and Mentoring for Integration of Active Case-Finding for TB (ACF) and Isoniazid Preventive Therapy (IPT) with Prevention of Mother-to-Child Transmission of HIV Services (PMTCT) in Lesotho (Johns Hopkins University: 2010-2013)
Tuberculosis (TB) is a leading cause of death among women worldwide. An estimated 342,900 women died from maternal causes in 2008, compared to an estimated 700,000 from TB in the same year. TB in women of reproductive age impacts their own health, their pregnancies, and the health of their children. TB may be vertically transmitted in utero, intrapartum, and post-partum – and even in the absence of transmission, may negatively affect fetal and neonatal health by causing premature birth, intrauterine growth retardation, low birth weight, and increased mortality. TB/HIV co-infection in pregnant women also has been shown to increase the transmission of HIV from mother to child.
Lesotho has drafted guidelines for active case-finding (ACF) of TB by clinical symptom screening and provision of isoniazid preventive therapy (IPT) that are based on the WHO guidelines. Implementation of the Lesotho Ministry of Health and Social Welfare’s TB guidelines will consist of ACF for TB using a clinical screening tool to identify individuals at risk for active TB, and providing IPT to HIV-infected persons who do not have signs and/or symptoms of active TB. The Lesotho Ministry of Health and Social Welfare (MoHSW) began to implement these guidelines at hospital-based clinics serving HIV-infected persons. The focus of this systems development and mentoring project is to conduct operations research on ACF and IPT in the antenatal clinic context. This project will assess the progressive roll-out of ACF among HIV-positive and HIV-negative pregnant women, and measure the uptake of IPT among women in whom active TB has been excluded. Study findings and documentation of implementation challenges during the initial roll-out of the program will be used to guide the expansion of ACF and IPT in antenatal clinics throughout Lesotho, and will add to the evidence base in support of the global implementation of integrated TB/HIV service delivery.
Expediting Access to Antiretroviral Treatment for more Infants and Young Children (ViiV Healthcare: 2010-2013)
This project, launched in 11 countries including Lesotho, sought to expedite access to testing, care, and antiretroviral treatment (ART) for infants and young children. This partnership enabled EGPAF to fill critical gaps that limit access by focusing on three key objectives:
- Increase early detection and initiation of ART for HIV-positive infants and young children;
- Strengthen government leadership;
- Use strategic information to understand what works, and to apply this understanding to improve programs.
By project end, there were significant improvements in key indicators, including more HIV-exposed infants tested within eight weeks of birth; more HIV-exposed infants that tested positive receiving their results within eight weeks of testing; and more HIV-exposed infants and young children (IYC) that tested positive being initiated on ART. In addition, linkages between health facilities and communities were strengthened via new partnerships with community-based organizations and the engagement of village health workers. Technical advocacy aimed at addressing barriers to testing and treating IYC was successful in a number of areas, including the ability for nurses to prescribe ART and the development of a new national pediatric counseling and testing curriculum in Swaziland. Also, 40 HIV/AIDS Technical Leaders from 16 countries were provided critical training on how to implement the new WHO Guidelines on Pediatric ART. In Lesotho specifically, the first-ever training on psychosocial support counseling for HIV-positive children and caregivers was held – and proved very successful. The training focused on frontline healthcare workers, and they are implementing the skills learned across the entire country. In addition, the proportion of HIV-exposed infants and young children tested and initiated on ART increased, and this project has enabled the Lesotho team to pilot and update the under-five register (which includes EID information and longitudinal follow-up of HIV-exposed children).
Strengthening Clinical Services (SCS) Project (USAID/PEPFAR: 2010-2015)
Strengthening Clinical Services (SCS) Project (USAID/PEPFAR: 2010–2015) EGPAF is supporting and expanding prevention of mother-to-child transmission of HIV (PMTCT) and care and treatment services in Lesotho through the USAID-funded Strengthening Clinical Services (SCS) project. The five-year project has a goal to reach 100% PMTCT and HIV care services coverage nationwide by 2011, which is in line with the Ministry of Health’s (MOH) goal, and to achieve 90% facility coverage for the initiation of HIV treatment of adults and children. The SCS project’s specific objectives are:
- Sustained, high-quality, comprehensive, integrated, client‐centered HIV/AIDS care and treatment services at health facilities;
- Strengthened and increased roll-out of family-centered HIV/AIDS care and treatment services at all points of contact;
- Universal access to PMTCT, including expanded delivery of services;
- A strengthened national health system in accordance with MOH’s plan;
MOH’s policy, protocols and guidelines for care and treatment services reviewed and improved on a regular basis Activities are being implemented by EGPAF and four key sub-grantee partners: Baylor Pediatric AIDS Initiative, mothers2mothers (M2M), the Apparel Lesotho Alliance to Fight AIDS (ALAFA), and the Lesotho Network of AIDS Service Organizations (LENASO). All activities are planned and implemented in concert with the MOH to ensure that efforts under this project fit within the national framework of priorities and enhance the leadership role of the government.
As the MOH’s key implementing partner for HIV/AIDS clinical services in Lesotho, EGPAF also plays a key technical assistance role nationally. EGPAF participates in all relevant national technical working groups and technical advisory committees, and serves as co-lead of the PMTCT national technical working group. EGPAF supports the MOH by leading and participating in the drafting and revision of national guidelines, training materials, standard operating procedures, and policies.
In 2011, Lesotho achieved the first of its primary SCS goals: scaling up PMTCT services to all public and private facilities nationwide. Looking ahead, EGPAF is working to establish universal access to adult and pediatric HIV/AIDS care services, as well as 90% facility coverage for adult and pediatric ART services, by 2015. EGPAF has supported the MOH to successfully integrate HIV/AIDS services with maternal and child health services at every health facility across the country. This has increased uptake and availability of critical HIV/AIDS prevention, care, and treatment services for pregnant women, partners, and children from birth to two years of age. EGPAF is also supporting the creation of a national cervical cancer screening program at the Senkatana Center at Botshabello Hospital in Maseru.
Pilot Test of HIV and Infant Feeding Indicators (WHO: 2011-2012)
Breastfeeding is a direct route of HIV transmission from HIV-infected mothers to infants. Yet currently, there is no standardized indicator on the infant feeding practices of HIV-exposed infants. While population-based surveys collect information on infant feeding practices, disaggregated data by HIV serostatus/exposure is only available in a small number of countries including Lesotho, where the 2009 Demographic and Health Survey (DHS) was not disaggregated by HIV serostatus.
In the absence of such routine information on the breastfeeding status of HIV-infected mothers, prevention of mother-to-child transmission (PMTCT) services may not be able to respond to all the needs of HIV-infected women, and HIV-infected women may not have access to interventions and support that facilitate infant feeding practices to promote the HIV-free survival of their infant.
The lack of regular data makes it difficult for local and national program managers to monitor the patterns of infant feeding among HIV-infected mothers in order to assess counseling approaches and project future needs. At present, no consistent indicator on infant feeding among HIV-infected mothers is collected on a global scale. In order to obtain information on feeding practices of HIV-exposed infants, an indicator has been proposed, and EGPAF has received funding from the World Health Organization (WHO) to conduct a pilot evaluation of the following infant feeding indicators within the context of maternal and child health (MCH) postnatal services in select sites in Lesotho:
- Percentage of HIV-exposed infants who are exclusively breastfeeding at three months of age;
- Percentage of HIV-exposed infants who are replacement feeding at three months of age;
- Percentage of HIV-exposed infants who are mixed feeding at three months of age.
The objective of the pilot evaluation is to determine whether the proposed indicators are feasible to collect routinely at primary health care facilities, and also whether they reflect the actual feeding practices of HIV-exposed infants. The newly revised under-five registers for use in Lesotho MCH clinics includes a line item identifying the method of infant feeding as exclusive breast feeding (EBF), exclusive formula feeding (EFF) or mixed feeding (MF) collected monthly in the first six months of life. These registers are in the process of being rolled out in all MCH clinics; therefore, this evaluation is timely for informing the Ministry of Health and Social Welfare (MOHSW) of the accuracy of this new infant feeding indicator, as well as providing information about the validity as a global indicator. The pilot test will compare the determination of infant feeding method captured during routine program activities and recorded on the under-five register by MCH staff with study-specific exit interviews that contain more direct questioning of the mother or caregiver to determine the accuracy of the infant feeding practices indicator and provide information on the quality of services. In addition, data on the use of antiretroviral therapy during breastfeeding will also be collected.
Strengthen M&E of PMTCT (UNICEF: 2011-2013)
With support from UNICEF, EGPAF is providing targeted technical assistance to improve systems for monitoring and evaluation (M&E) of prevention of mother-to-child transmission of HIV (PMTCT) programs in Cameroon, Lesotho, and Zambia. In Lesotho, EGPAF will continue to support the Ministry of Health (MOH) and other stakeholders by training health staff on the standard operating procedures for antenatal care and labor and delivery registers. In addition, the EGPAF/Lesotho team is working with the MOH to strengthen the timely and accurate transfer of PMTCT data from the districts to the central level (MOH) through the use of 3G internet technology.
The Partnership for Management Development (J&J and PEPFAR/USAID: 2012-2013)
The Partnership for Management Development (PMD) is a program designed by the University of Cape Town (UCT) Graduate Business School faculty for the Lesotho Ministry of Health (MOH) and implemented with the support of EGPAF. The program aims to address an identified gap in health services and accelerate the elimination of mother-to-child transmission (MTCT) of HIV by developing the management capacity of African healthcare leaders. The PMD program is funded through a public-private partnership between PEPFAR/USAID and Johnson & Johnson, and EGPAF/Lesotho is the implementing partner. Based on an initial gap analysis done, four major topic areas for improvement were identified:
- Improve team-based leadership;
- Increase facility-based deliveries/births;
- Reduce stock-outs of supplies and drugs;
- Use data to support managerial approaches
Mother Baby Pack (UNICEF: 2012-2013)
With support from UNICEF, EGPAF is conducting an evaluation of the Mother-Baby Pack (MBP) program in Lesotho to document the experience with the distribution and implementation of the packs to determine the feasibility, acceptability, and lessons learned through use of the packs, and to identify barriers or potential harms associated with their use. Results from the MBP evaluation will have significant implications for the prevention of mother-to-child transmission of HIV (PMTCT) program in Lesotho as well as globally, as other countries consider implementation of this innovative approach for PMTCT drug distribution.
Scaling up Adolescent Health Services Through Family Health Days (UNICEF: 2012-2013)
The goal of this project is to provide integrated health services and make them accessible to the community through the use of mobile clinics and a family- centered approach. With the support of UNICEF-Lesotho, EGPAF will conduct family health day (FHD) campaigns in two identified districts (Berea and Qacha’s Nek), with a targeted and expanded focus on adolescents. Specific objectives of the UNICEF/EGPAF collaboration on FHD are to:
- Integrate adolescent reproductive health (ARH) into FHD;
- Provide HIV testing and counseling (HTC) to adolescents;
- Identify and support adolescents living with HIV;
- Promote early screening for hypertension, diabetes, malnutrition, and TB;
- Promote child survival through the provision of comprehensive and integrated family-centered services;
- Promote early infant diagnosis (EID) and timely enrollment into care and treatment for HIV-positive children;
- Test all eligible children who have not been tested via routine testing;
- Provide HTC to adults and enroll those testing positive into HIV care and treatment services.
To Prevent the Spread of HIV/AIDS and Mitigate the Impact of HIV/AIDS among Orphans and Vulnerable Children in Lesotho Global Fund to Fight AIDS, Tuberculosis and Malaria (2013-2014)
Pivoting around the “National Strategic Plan for Elimination of MTCT and for Pediatric HIV Care and Treatment (2011-2016)”, this project aims to prevent the spread of HIV and mitigate the impact of AIDS among orphans and vulnerable children (OVC) in Lesotho. It is funded through Single Stream of Funding (SSF) from Global Fund Rounds 7 and 9, and EGPAF is Technical Agency to the Ministry of Health (MOH).
EGPAF’s scope under the Global Fund project consists of training 1,800 village health workers to strengthen community-level support for PMTCT services, building community engagement on health seeking behavior, including male involvement in PMTCT interventions, coordinating MOH community activities, conducting PMTCT supervisory visits to ensure service quality, conducting data verification visits, and training district teams on data quality management. EGPAF’s role in revitalizing the national village health worker program and providing technical assistance on PMTCT and data quality will support increased service utilization and quality towards elimination of pediatric HIV in Lesotho.
Call to Action (USAID/PEPFAR: 2004-2010)
With funding from the United States Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), EGPAF implemented the eight‐year global Call to Action (CTA) project in 12 countries, including Lesotho (from 2004 through March 2010). Through the CTA project in Lesotho, EGPAF has significantly contributed to national prevention of mother-to-child transmission of HIV (PMTCT) achievements. EGPAF’s work in Lesotho has been based around four areas:
- Expanding coverage of HIV/AIDS services;
- Ensuring high-quality services;
- Building community support for program sustainability;
- Providing support at the national level
Over the course of more than five years, EGPAF assisted the MOH in establishing and enhancing PMTCT service provision at 103 health facilities in six districts (Berea, Butha‐Buthe, Leribe, Maseru, Mokhotlong, and Thaba‐Tseka). In the five districts where EGPAF was the only PEPFAR clinical services partner, coverage was successfully increased to 100% for PMTCT, providing more than 55,000 pregnant women with HIV testing and counseling (HTC) services since 2006. Approximately 17,000 women were provided prophylaxis for PMTCT, including 4,000 who were initiated on Highly Active Antiretroviral Therapy (HAART), and nearly 15,000 infants received drugs to help keep them free of HIV. More than 6,000 HIV‐exposed infants received cotrimoxazole (CTX) prophylaxis, and almost 8,000 were tested for HIV using deoxyribonucleic acid/polymerase chain reaction (DNA/PCR) testing.
Prevention of Mother-to-Child Transmission of HIV Partnership (Johnson & Johnson: 2008-2011)
The EGPAF-J&J partnership was designed to expand coverage and improve the quality of prevention of mother-to-child transmission of HIV (PMTCT) services, as well as demonstrate global leadership in PMTCT by replicating and documenting best practices in six country programs including Lesotho. By project end, EGPAF succeeded in:
- Integrating PMTCT into routine maternal and child health (MCH) services by training health personnel and developing tools and job aides;
- Assisting sites to provide additional services for HIV-positive women, including early infant diagnosis, TB screening and treatment, infant cotrimoxazole and maternal antiretroviral (ARV) prophylaxis for PMTCT, and infant feeding education;
- Strengthening linkages between health centers and communities by selecting and training lay counselors and expert patients to serve as site-level community and counseling Focal Persons who organized monthly meetings of CHWs and volunteers, collected reports of activities, gave supportive peer counseling, and participated in the performance assessment of CHWs and volunteers;
- Providing technical leadership and support to the Ministry of Health (MOH) to support national monitoring and evaluation (M&E) data quality and accuracy;
- Serving on the national PMTCT and Pediatric Technical Working Group, which helped make and inform policy decisions
Promoting Good Health for Mothers and Babies (UNICEF: 2010-2011)
With support from UNICEF, this project sought to support the Ministry of Health (MOH) to improve quality of services offered to pregnant women at maternal and child health (MCH) clinics, including nutrition support, by integrating prevention of mother-to-child transmission of HIV (PMTCT) into MCH services and also scaling up pediatric HIV care and treatment. Project successes include:
- More than 1,110 infants initiated on cotrimoxazole prophylaxis during the project period;
- 57 nurses trained on comprehensive pediatric care and treatment, and 17 nurses trained on the new WHO PMTCT guidelines;
- On-site mentoring provided, with health care workers focusing on monitoring and evaluation, presumptive diagnosis of severe HIV disease in young children less than 18 months, and infant and young child feeding (IYCF);
- 375 health care workers trained on IYCF counseling and support as well as Plumpy’nut usage and distribution;
- “Child Health Days” introduced in 10 districts nationwide that offered HIV testing and counseling services, including early infant diagnosis, TB screening, nutrition assessments, and distribution of vitamin A; these campaigns reached more than 11,559 children;
- Psychosocial support through monthly family support group meetings; as of 2011, there were 81 active family support groups.
The Impact of HIV Test Results on Subsequent Antenatal Care Attendance by Women in Rural Hospitals in Lesotho (2010-2011)
Regular antenatal care (ANC) visits beginning early in pregnancy promote safe motherhood, particularly for HIV-positive women. While many factors affecting ANC attendance have been documented, the aim of this study was to explore the impact of a positive or negative HIV test result at a woman’s first ANC visit on her subsequent ANC attendance, for which existing research was limited. The study utilized a retrospective cohort design. Women’s ANC records in three rural hospitals in Lesotho in December 2009-May 2010 were reviewed. Information collected from the registers included the number of ANC visits, gestational age at first visit, HIV status, maternal age, gravidity, parity, and CD4 count and the receipt of ARV prophylaxis or ART for HIV-positive women. The distribution of gestational age (GA) and number of visits between HIV status and knowledge of HIV status subgroups was analyzed using statistical tests.
Neither number of subsequent visits nor GA at first visit differed for women receiving a positive or negative HIV test result. However, women who knew their status before their first visit had significantly more subsequent visits than women of unknown status (2.1 vs. 1.6 visits, P=0.014) and attended ANC earlier (19.6 vs. 22.9 weeks, P<0.001). Of those with known status, HIV-positive women attended ANC nearly six weeks earlier than HIV-negative women, though results were not statistically significant.
Results describe the similarities and differences in ANC attendance among women with positive and negative HIV test results, as well as among women who knew and did not know their HIV status. Findings from this study were accepted for a poster presentation by the International AIDS Conference, which took place in Washington, D.C. in July 2012. A manuscript to be submitted to a peer-reviewed journal also is being prepared. With a limited amount of funding, the study team was able to use existing data routinely collected at facilities to answer a research question that informs the PMTCT program in Lesotho. Moreover, this research will contribute to the growing evidence in maternal and child health on factors that facilitate or hinder access to ANC services for women and the completion of what is commonly referred to as the PMTCT “cascade”: HIV counseling, testing, receipt of test results, and if positive, ARV prophylaxis (or ART) for the mother and infant.
Lesotho Together Against HIV and AIDS Partnership (LETLAMA) (USAID/PEPFAR: 2011-2013)
This USAID/PEPFAR-funded project, led by Population Services International (PSI), seeks to reduce HIV incidence among youth and adults by increasing the adoption of protective behaviors and supporting healthy social norms. EGPAF serves as one of the project’s lead implementers of HIV clinical services programming. EGPAF is working to:
- Build the capacity of Basotho institutions’ HIV prevention services;
- Engage communities to adapt social and cultural norms and attitudes that reduce vulnerability to HIV;
- Motivate Basotho youth and adults to change their behavior through increased knowledge, risk perception, skills, and access to HIV prevention services;
- Collaborate with the Ministry of Health to revitalize and scale up post-exposure prophylaxis (PEP) activities in all health facilities in Lesotho, while integrating HIV and sexually transmitted diseases in HIV clinics as a strategy for prevention with positives.
The Community Initiative Program (Gilead Foundation: 2012)
Through the generous support of the Gilead Foundation, EGPAF/Lesotho carried out three key activities, all of which supported EGPAF’s goal of the virtual elimination of pediatric HIV in Lesotho by 2016. First, EGPAF worked to build the human resource capacity for community-clinic linkages by facilitating training with the Lesotho Network of AIDS Service Organizations (LENASO), an umbrella organization for all local groups implementing HIV/AIDS services at the community level nationwide. This integrated five-day training on PMTCT, HIV care and treatment, and community linkages was attended by all 10 LENASO District Community Coordinators, and emphasized strategies to improve maternal health while concurrently providing maximum protection against HIV infection of infants.
The project also worked to improve the patient referral system through mobile technology. With funding from Gilead, EGPAF purchased BlackBerry Mobile phone devices, which are being used to strengthen client referral follow-up and tracking systems in each district. Finally, the project strengthened community-based client tracking systems through the distribution of community tracking tools, designed to immediately trace any HIV-exposed infant testing positive for HIV in order to facilitate them coming back to the facility and starting antiretroviral therapy (ART) within one week of the availability of test results.
Towards Getting More HIV-Positive Infants on Lifesaving Treatment: Measuring HIV Test Turnaround Times and Early Effectiveness of HIV Mother-to-Child Prevention Programs Using Early Infant Diagnosis Records (Private: 2012)
Despite advances made in the field of prevention of mother-to-child transmission (PMTCT) of HIV, the average age of initiation of treatment for HIV-positive children is approximately five years. Only 23% of eligible children younger than 15 years (out of an estimated 2.02 million) are receiving antiretroviral therapy (ART). Though there are multiple reasons, poor access to infant HIV testing and diagnosis is one key barrier to initiating treatment. While early infant diagnosis (EID) access has improved – with some limited-resource countries reaching greater than 50% of exposed infants getting tested – globally only 15% of HIV-exposed infants receive an HIV test. Early diagnosis and treatment are critically important, because without them, one third of perinatally HIV-infected children will not see their first birthdays, and almost one half will die before two years of age. In Lesotho, 37,000 children are living with HIV, and only 38% of these are currently receiving lifesaving treatment. Historically, there have been gaps in coverage for EID/Early Infant Treatment (EIT) services in Lesotho, especially in rural areas, with long turn-around-times (TATs) identified as a significant challenge for the EGPAF program in-country.
The aim of this study is to describe the current EID process, early MTCT infection rates, and the PMTCT services received by HIV-positive mothers and their infants who had an HIV test at six to eight weeks in selected sites in Lesotho in order to determine necessary steps to improve early initiation of HIV-positive infants into antiretroviral (ARV) treatment programs. This will be accomplished with two main objectives:
- To identify delays in the EID process from the time the six-to-eight week HIV specimen is collected to the time when caregivers receive the results and HIV-infected infants are initiated on ART at study sites;
- To measure the perinatal HIV infection rate among HIV-exposed infants who were tested for HIV at six to eight weeks of age, as well as PMTCT-related services received among these infants and their mothers at study sites within a one-year period
The study employed a retrospective cohort design in which existing facility records of women registered in the PMTCT program in 25 sites from 10 districts during 2011 were linked to data on HIV testing, and subsequent test results of their HIV-exposed infants contained in a central laboratory database. Primary study outcomes included time to ART initiation in infants identified as HIV-infected; MTCT HIV infection rate for infants around six weeks of age at the selected sites; and utilization of services among pairs of mothers and HIV-exposed infants. Data was collected in March and April of 2012, with data entry and cleaning in May and analysis ongoing in June and July. Preliminary findings from a total of 1,187 records extracted are that ~90% of EID records could be linked to the mother’s antenatal record with 4.0% (47/1187) of infants tested HIV+ at six to eight weeks, and 37 initiated on ART (five did not, five unknown).
Findings from this study could ultimately lead to an increased number of eligible children receiving treatment by measuring TATs and identifying barriers from HIV testing through treatment initiation.
Country adaptation of the 2010 World Health Organization recommendations for the prevention of mother-to-child transmission of HIV: Download PDF
Using Data to Understand and Address Gaps in the Treatment Cascade for HIV-Positive Infants and Young Children: Experiences from Lesotho, Malawi, and Swaziland: Download PDF