Country Spotlight: Lesotho

Country Overview

HIV/AIDS is Lesotho’s leading cause of death and almost a quarter of the population is living with this disease. Lesotho also suffers from high prevalence of tuberculosis (TB); TB is the second leading cause of death and is a dangerous opportunistic infection for the many infected with HIV (TB/HIV co-infection rate averages 74%). Women are disproportionally affected by the HIV/AIDS epidemic, with prevalence exceeding those of men in almost every age group under 40 years.

Our Work in Lesotho

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), which seeks to end pediatric HIV/AIDS through implementation of HIV prevention, care and treatment programs, advocacy, and research, began collaborating with Lesotho’s Ministry of Health in 2004. Through leadership from the Government of Lesotho and support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Lesotho significantly scaled up access to comprehensive HIV services. As PEPFAR and the Government of Lesotho’s primary HIV and TB clinical service implementing partner, EGPAF supports comprehensive services at health facilities (through direct provision of health services, skills-building of local staff to implement these services, and infrastructure support) and works collaboratively with district and national government teams to ensure quality programming and up-to-date national policies. EGPAF works with local partner organizations to support more than 125 health facilities across seven districts. In Maseru, Leribe, Berea, Mafeteng and Mohale’s Hoek, EGPAF implements a comprehensive package of services, including HIV counseling and testing, prevention of mother-to-child transmission of HIV (PMTCT), adult and pediatric HIV/TB care and treatment, integrated maternal and child health and HIV services, reproductive health care (including cervical cancer screening and treatment), nutrition support, community engagement, community-clinic linkages, and strategic information and evaluation. EGPAF also actively participates in six national HIV-related technical working groups and advisory committees to develop informed policies supporting all persons affected by HIV. EGPAF-Lesotho is dedicated to advancing basic and operations research to strengthen the effectiveness of the global HIV and AIDS response.  

Key Projects in Lesotho

Providing Universal Services for HIV/AIDS in Lesotho (PUSH) Project (2016-2021)

PUSH is a U.S. Agency for International Development (USAID)-funded, five-year award that will result in sustained reduction in HIVtransmission, morbidity, and mortality. PUSH will capitalize on gains made under the USAID-funded Comprehensive HIV/AIDS Services Expansion project (see archived awards section) by sustaining support of a comprehensive package of HIV services in three districts (74 sites) and operations research at eight additional sites in other districts. Using a district-based approach, PUSH will expand coverage of HIV care and treatment services to 80% of the population of people living with HIV in Maseru (by 2017), and Mohale’s Hoek and Mafeteng (by 2018), while maintaining the quality of clinical services in all three districts using quality assurance and quality improvement approaches.

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Strengthening the TB and AIDS Response in Lesotho (STAR-L) Project (2015 – 2020)

EGPAF supports Lesotho’s Ministry of Health to implement a comprehensive HIV service package in more than 46 sites in Leribe and Berea districts. EGPAF is providing site-level services in 45 sites of these sites, based on the PEPFAR/Government of Lesotho prioritization strategy. The goal of STAR-L is to scale-up effective, sustainable, comprehensive HIV and TB/HIV prevention, care and treatment interventions to reduce HIV transmission, morbidity, and mortality. The package of services offered in these health sites under STAR-L includes HIV counseling and testing, PMTCT services, adult and pediatric TB care, adult and pediatric HIV care and treatment, integrated maternal and child health services and nutrition support, health systems strengthening, community engagement, community-clinic linkages, and strategic information and evaluation. STAR-L is made possible by PEPFAR through the U.S. Centers for Disease Control and Prevention funding.

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UNITAID (2015-2019)

The UNITAID project in Lesotho aims to increase the number of HIV-positive infants whose HIV status is known and facilitate early ART initiation for these children. To accomplish this, EGPAF-Lesotho will work with in-country partners and the Lesotho Ministry of Health to strategically place new-to-market point-of-care early infant HIV diagnosis (EID) platforms (in-line with existing national EID networks) within health facilities. Through UNITAID funding, by the end of 2018, Lesotho will have 29 EID testing sites, most will be placed in “hubs”/high-volume sites, receiving samples from an additional 160 “spoke” sites. Ultimately, this project will achieve reduction in turnaround time between blood sample collection and results receipt by caregiver from the current 30-60 days to zero days at hub sites and seven days at spoke sites, reduce median number of days from receipt of results by caregiver to ART initiation among HIV-infected infants to less than 14 days, and ensure 648 infants (90% of identified infants) are receiving treatment by project end.

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AIDSFree (2014-2019) 

AIDSFree is a five-year cooperative agreement led by JSI Research & Training Institute, Inc., with partners Abt Associates, Inc., EGPAF, EnCompass LLC, IMA World Health, the International HIV/AIDS Alliance, Jhpiego Corporation, and PATH. In Lesotho, AIDSFree is providing technical assistance to help civil society organizations develop their organizational and technical capacity to improve access to PMTCT and pediatric services at the community level; strengthen national-level advocacy and presence; and improve retention for families, including mothers, children, and partners.

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Project Supporting Operational AIDS Research (SOAR) (2014-2019)

Under Project SOAR, and through funding by Population Council from Project SOAR, one research study has been recently complete (see archived project section) and one is ongoing. This second study, entitled “Integrated Management Team to Improve Maternal-Child Outcomes (IMPROVE),” is a prospective, two-arm cluster-randomized study with facilities randomized to receive the IMPROVE intervention or routine services offering the national standard of care. The study will follow a cohort of HIV-positive and HIV-negative pregnant women until their child reaches 24 months of age. The intervention consists of an integrated management team to improve maternal and child outcomes, an early home visit, and provider training and tools focused on improving patient-centered communication. The main objectives are to evaluate the effect of the intervention on retention in HIV care, viral suppression, adherence to ART in HIV-positive women, and HIV retesting in HIV-negative women. Secondary objectives include assessment of the effect of the IMPROVE intervention on general MCH indices including antenatal care attendance, facility delivery, family planning, and immunization coverage. 

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Publications

EGPAF Country Fact Sheet: Lesotho

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Lesotho Program 2013 Annual Report Download PDF download

Pregnant and Postpartum Women’s Experiences and Perspectives on the Acceptability and Feasibility of Copackaged Medicine for Antenatal Care and PMTCT in Lesotho

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