In the Kingdom in the Sky, Partners Join Forces to End AIDS in Children

In early March 2018, the board of directors of the Elizabeth Glaser Pediatric AIDS Foundation traveled to Lesotho, along with EGPAF senior staff, to witness a remarkable cooperative effort to eliminate AIDS and tuberculosis (TB) in children—and in their families.

Lesotho is a small nation surrounded entirely by South Africa. It is known as the Kingdom in the Sky because of its picturesque mountains and a blue expanse overhead that feels close enough to touch. In the early 19^th century, King Moshoeshoe founded the nation of Lesotho from his mountain fortress of Butha-Buthe and established a proud history of repelling invaders and building strong strategic alliances.

EGPAF board members, EGPAF president Chip Lyons, and a special guest wrap themselves in Basotho blankets and wear the iconic Basotho hat during a meeting with the staff of EGPAF-Lesotho and partners. Photo by Clare Dougherty/EGPAF

Lesotho was struck hard by the HIV pandemic. With more than a quarter of the population in Lesotho living with HIV, only nearby Swaziland has a higher prevalence. TB, a common opportunistic co-infection with HIV, is the second highest cause of death. But the people of Lesotho are fighting back with determination, and they are working with strategic partners to eliminate these deadly threats.

The Lesotho Ministry of Health and EGPAF

In 2017, the Lesotho Ministry of Health strengthened its partnership with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to significantly scale up access to comprehensive HIV and TB services across the country. With the support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and Unitaid, EGPAF delivers HIV and TB services and provides technical assistance to the Ministry of Health.

In this nation of 2 million people, EGPAF has tested more than 904,000 individuals for HIV since 2004, when the organization started partnering with the Lesotho Ministry of Health. EGPAF-Lesotho has provided prevention of mother-to-child HIV transmission (PMTCT) services to more than 235,000 women and has started more than 178,000 individuals on ART—including more than 9,900 children.

EGPAF-Lesotho is led and staffed by public health experts who are primarily Lesotho nationals. The team supports 165 sites in 10 districts.

Point-of-Care Early Infant Diagnosis

In conjunction with a board meeting, the EGPAF board and senior staff traveled to key sites to see innovative, comprehensive approaches for eliminating and treating HIV and AIDS. These included a visit to Mafeteng Hospital to observe the Point-of-Care Early Infant Diagnosis (POC EID) program. POC EID is funded and supported by Unitaid, which aims to diagnose and place on treatment HIV-infected infants before the peak mortality at 2-3 months of age.

Thanks to POC EID technology, health workers are now equipped to test an infant for HIV during routine postnatal visits and provide the parents with the results before they leave the health facility. This means that those infants who test positive for HIV are able to be immediately enrolled on effective treatment. Previously, parents waited as long as three months for test results. EGPAF-Lesotho expects to increase testing of infants by 20 percent in 2018 because of this innovation.

An HIV-positive member of a community ART group is living a healthy life in the Kingdom in the Sky with the support of his peers. Photo by Eric Bond/EGPAF

Community Adherence Groups

Next, the EGPAF board and senior staff visited a pair of community adherence groups, known as CAGs, in Lesotho’s Mafeteng District. CAGs are a key component of EGPAF-Lesotho’s overall approach to differentiating care to suit the individual patient. CAG members rotate the task of picking up antiretroviral treatment for all members. This minimizes the burden of monthly trips to the pharmacy. CAG members also share their experiences with each other to provide mutual support for staying on treatment. Partnering with a civil society organization, the Lesotho Network of AIDS Service Organizations (LENASO), EGPAF has expanded CAGs in high-prevalence districts. As of December 2017, EGPAF supports 4,372 CAGS in Lesotho.

Adolescent Corners

While in Lesotho, the EGPAF visitors also took a short drive to the Berea Hospital to learn more about the experience of adolescents. At Berea Hospital, EGPAF supports an adolescent corner, which provides this young population with health services that are sensitive to their unique needs. As is the case generally throughout sub-Saharan Africa, adolescents in Lesotho are at particular risk for HIV/AIDS: adolescents are often not tested for HIV; those who are tested and diagnosed as HIV-positive are frequently lost to follow-up and are not linked to care or have poor retention rates on antiretroviral medication. At the Berea adolescent corner, EGPAF has provided a special support team that includes youth ambassadors, an adolescent nurse, a psychologist, a social worker, and a peer counselor.

EGPAF President Chip Lyons shares a laugh with adolescents at Berea Hospital. Photo by Justice Kalebe for EGPAF

Men’s Health Corners

EGPAF President Chip Lyons expresses appreciation to Professional HIV Counselor Motlalepula Jacob and HIV Clinical Nurse Montoeli Letlema, who staff a special men’s health corner. Photo by Justice Kalebe for EGPAF.

The EGPAF board and senior staff also visited the Lesotho Defense Force (LDF) health facility outside Maseru to see how men are being reached with HIV and other health services. Men are another target population in the fight to end AIDS in Lesotho because they are generally harder to reach. They are more mobile and less likely to visit health facilities during working hours. In addition, men in Lesotho are often not comfortable sharing the same clinic space with women. The men’s health initiative supported by EGPAF Lesotho is currently being implemented in Berea and Maseru Districts through special men’s health corners. Since opening its doors in June 2017, the LDF men’s corner has tested 9,032 men for HIV and has initiated 1,063 newly diagnosed men on HIV treatment.

Close Cooperation with Partners

At a March 6 reception in Maseru, the capital city, EGPAF President Chip Lyons acknowledged the leadership of the Lesotho government and thanked partners for helping to establish the momentum to end AIDS in Lesotho. EGPAF associates were joined by the organization’s primary partner, the Lesotho Ministry of Health, along with U.S. Ambassador Rebecca E. Gonzales and representatives from the Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID), who provide generous funding for EGPAF programs.

U.S. Ambassador to Lesotho Rebecca E. Gonzales; EGPAF-Lesotho Country Director T’sepang Mohlomi, Honorable Nkaku Kabi, the Lesotho Minister of Health; and EGPAF President Chip Lyons. Photo by Makopano Letastsi/EGPAF

While the HIV prevalence rate remains high in Lesotho, the successes of testing and treatment are actually a main factor in that high percentage: more people are being tested and know their status; more people are enrolling in treatment; more people are surviving. And against that reality, more children are being born HIV-free.

The target of EGPAF’s work is to reach a time when no child will have AIDS. And the strength of EGPAF is largely due to close cooperation with partners. Chip Lyons, EGPAF CEO & President