Lesotho Civil Society Organizations’ HIV and TB Priority Charter for Children and Adolescents
Overview
Background
Despite Lesotho’s achievement of 90-90-90 targets at 90-97-92,1 the country still lags in meeting TB and HIV targets among children and adolescents. It is estimated that about 13,000 children from ages 0 to 14 years old and 306,000 adults above 15 years of age are currently living with HIV in Lesotho.2 TB case incidence is 654 per 100,000 people,3 while HIV prevalence is 22.7%.1 HIV and TB coinfection continues to pose challenges of adherence to both antitubercular medication and antiretroviral therapy (ART). ART coverage among adolescents and young people remains low, while viral load suppression among children is sub-standard.4 For instance, in EGPAF-supported sites in the eight districts of Lesotho, viral load suppression among children below 1 year old and below 5 years old was 69% and 76% respectively, while for the age group above 15 years old it was 97%.5 The risk of progression to TB disease is higher if infection occurs before adolescence, in the very young (0-4 years old), and in those who are immunocompromised.6 Additionally, extrapulmonary TB is more prevalent in children, young adults, and in cases of HIV- associated TB. Therefore, it remains imperative to accord children and adolescents special consideration owing to their cultural, social, and economic and biological vulnerability.
Aim of this Charter
The overall goal of this priority charter is to identify existing gaps in TB and HIV screening and management among children and adolescents in Lesotho. The objective is for CSOs to advocate for resources to enhance the delivery of programs targeting TB and HIV among children and adolescents. This charter will guide coordination, fund mobilization, ensure effective program implementation, and assist CSOs to speak with one voice using evidence-based gaps.
Methodology
An informative desk review of literature was initially conducted to understand the context in which CSOs were providing TB and HIV services among children and adolescents in Lesotho. This was followed by a baseline assessment to identify gaps in the provision of TB and HIV services among children and adolescents. During this process, a framework on which the priorities charter would be founded was also developed. Data was collected using three questionnaires. Questionnaire 1 elicited information on the interventions on TB and HIV among children and adolescents. Questionnaire 2 elicited information on advocacy activities undertaken by CSOs. Questionnaire 3 elicited information on the support provided by other key stakeholders such as government ministries and international organizations. Results of the baseline assessment were presented to stakeholders at a virtual participatory dialogue meeting during which they also identified priority strategies to be included in the charter. Finally, the charter document was validated and adopted at another virtual participatory dialogue meeting held in July 2021.
Adolescent Identification, Care & Treatment; Pediatric HIV Diagnosis, Care & Treatment; Tuberculosis