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Progress toward HIV epidemic control in Lesotho

Thin, Kyawa; Frederix, Koenb; McCracken, Stephenc; Letsie, Mosilinyanea; Low, Andread; Patel, Hetalc; Parekh, Bharatc; Motsoane, Tsietsoa; Ahmed, Nahimad; Justman, Jessicad; Callaghan, Larkind; Tembo, Susane; Schwitters, Ameef

doi: 10.1097/QAD.0000000000002351
Epidemiology and Social

Objective: The Lesotho Population-based HIV Impact Assessment survey was conducted nationally and designed to measure HIV prevalence, incidence, and viral load suppression (VLS).

Design: A nationally representative sample of 9403 eligible households was surveyed between November 2016 and May 2017; analyses account for study design. Consenting participants provided blood samples, socio-demographic, and behavioral information.

Methods: Blood samples were tested using the national rapid HIV testing algorithm. HIV-seropositive results were confirmed with Geenius supplemental assay. Screening for detectable concentrations of antiretroviral analytes was conducted on dried blood specimens from all HIV-positive adults using high-resolution liquid chromatography coupled with tandem mass spectrometry. Self-reported and/or antiretroviral biomarker data were used to classify individuals as HIV-positive and on treatment. Viral load testing was performed on all HIV-positive samples at central labs. VLS was defined as HIV RNA below 1000 copies/ml.

Results: Overall, 25.6% of adults aged 15–59 years were HIV-positive. Among seropositive adults, 81.0% (male 76.6%, female 84.0%) reported knowing their HIV status, 91.8% of people living with HIV (male 91.6%, female 92.0%) who reported knowing their status reporting taking antiretrovirals, and 87.7% (male and female 87.7%) of these had VLS. Younger age was significantly associated with being less likely to be aware of HIV status for both sexes.

Conclusions: Findings from this population-based survey provide encouraging data in terms of HIV testing and treatment uptake and coverage. Specific attention to reaching youth to engage them in HIV-related interventions are critical to achieving epidemic control.

aLesotho Ministry of Health

bICAP at Columbia University in Lesotho, Maseru, Lesotho

cCenters for Disease Control and Prevention, Atlanta

dICAP at Columbia University, New York, USA

eWorld Health Organization in Lesotho

fCenters for Disease Control and Prevention in Lesotho, Maseru, Lesotho.

Correspondence to Amee Schwitters, US Centers for Disease Control, Division of Global HIV & TB, 1600 Clifton Road, NE, Atlanta, GA 30329, USA. Tel: +1 404 718 8583; e-mail:

Received 14 May, 2019

Revised 23 July, 2019

Accepted 26 July, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.