March 2021

How Lesotho Reached 90-90-90 Treatment Targets to Control the AIDS Epidemic

Evidence to Action Webinar

In 2015, UNAIDS launched final targets to drive progress towards the concluding chapter of the AIDS epidemic. By 2020, 90% of all individuals living with HIV would have knowledge of their HIV status; by 2020, all individuals with confirmed HIV status would be receiving lifelong, sustained antiretroviral therapy; and, by 2020, 90% of all people receiving antiretroviral therapy will be experiencing viral suppression.

We learned over the last 5 years that HIV programs faced insurmountable challenges achieving high rates of HIV testing and treatment to optimize health and to reduce transmission. However, a few countries came out of 2020 accomplishing the milestone. The most recent Lesotho Population-based HIV Impact Assessment showed that Lesotho reached the UNAIDS 90-90-90 targets by 2020, with 90% of the population aware of their HIV status, 97% of those aware of their HIV status on treatment, and 92% of those on treatment virally suppressed.

In this E2A webinar, we focused on these results and the key components needed to achieve such progress in epidemic control. This discussion featured:

  • Opening Remarks, from EGPAF’s CEO and President, Chip Lyons
  • How Support from Donors and Partners was Instrumental, from Ts’epang Mohlomi, EGPAF-Lesotho Country Director, and Ian Membe, USAID Deputy Country Director
  • Interventions which Drove Success, from Dr. Esther Tumbare, EGPAF-Lesotho Technical Director, and Dr. Mamello Sekese, EGPAF-Lesotho Project Director
  • How the Ministry of Health saw this through, from Dr. Lucy Mapota, Director General of Health Service a.i., Lesotho Ministry of Health
  • Perspective from Kindy, a beneficiary of this work
  • Discussion, where we encourage all to join and discover more about how we can earn these goals in every high HIV-burden country.

This event took place Thursday, March 4 at 9 am EST (3pm CET).

The Discussion Continued…

As we expected, there was so much interest in learning more about what worked, what challenges were encountered in reaching these targets, etc. Unfortunately, the 60-minute format of the webinar did not offer enough time to get to the many questions. This engagement is important to us and EGPAF’s Lesotho team is answering them here.

Question: How are you planning to sustain and maintain this work?

Response: EGPAF has always and will continue to always move the world toward a common goal and although we’re reaching closer to witnessing an entire generation free of HIV, we’re not yet at the finish line. Our teams are currently working closely with PEPFAR and Lesotho’s Ministry of Health (MOH) to determine the ideal human resources for health capacity needed for the health system to maintain and sustain epidemic control once it is attained.

Question: How can we ensure that 97% will have continued access to ART?

Response: Looking at the program landscape, 97% of patients being on treatment necessitates further scale-up of standardized differentiated models of care. Our team is currently working on the validation of a national DSD model, which will guide all facilities in providing quality care to patients while decongesting facilities. Collaboration with other community implementing partners to ensure continuity of care (e.g. programs for orphans and vulnerable children) will be strengthened to better treatment needs of higher-risk individuals.

Question: Now that we have reached the 90/90/90 target does it mean it is the end of “test and treat?” 

Response: Achieving the 90-90-90 targets is a critical step toward progress, but it is not the final step and it certainly would not be prudent to remove a policy, which broadened access to treatment. Lesotho’s MOH continues to work toward the achievement of the 95-95-95 targets by 2030. The country will continue to implement Test and Treat, as there are more benefits to the patients for starting treatment early.

Question: On improved access to treatment, a big lesson around how we handle migrant populations on ART during the COVID lockdown was learned. An obvious outcry was heard when these populations couldn’t access treatment. Any concrete arrangement going forward? 

Response: Many Basotho work in South Africa and are continuously moving across Lesotho borders into South Africa for employment purposes. COVID-19 highlighted the need to strengthen services for individuals who work in South Africa. The program has been able to scale-up six-month multi-month dispensing (or longer, if needed and discussed with health providers) for this population, enabling our migrant clients to have enough stock supply to last throughout their work in South Africa, until their next return visit home. We’ve collaborated with other local organizations to offer differentiated drug delivery, wherein e-lockers are placed at malls, community sites, outside clinics allowing deposited ARVs to be collected by patients on arrival in country at any hour, of any day. In addition, the Lesotho government is collaborating with the South African government to ensure Basotho can access treatment at South Africa-based public health facilities when they are away from home, and that they are tracked in care.

For more questions and answers, email publications@pedaids.org

Country:

Lesotho

Topics:

HIV Treatment Optimization; Strengthening Local Capacity