LESOTHO is making significant strides towards controlling the HIV epidemic and is on course to meet the global 90-90-90 targets by 2020.
The first 90 target seeks to ensure that by the year 2020, 90 percent of all people living with HIV know their status. The second target seeks to ensure that 90 percent of all people diagnosed with HIV receive sustained antiretroviral therapy. The third target is to ensure that 90 percent of all people receiving ARVs will have viral suppression by 2020.
The country has already met one of the three global HIV targets set by the joint United Nations Programme on HIV and AIDS (UNAIDS) of having at least 90 percent of all HIV positive people on anti-retroviral treatment (ART) by 2020, with 92 percent of its HIV-positive people on ART by 2017, three years ahead of the 2020 deadline.
This is according to the results of the Lesotho Population- based HIV Impact Assessment (LePHIA) survey that was conducted by the Ministry of Health from November 2016 to May 2017.
The LePHIA survey was supported by the United States of America through the US President’s Plan for Emergency AIDS Relief (PEPFAR), ICAP at Columbia University (ICAP) and the US Centre for Disease Control and Prevention (CDC).
The LePHIA survey measured progress towards the globally recognised UNAIDS 90-90-90 targets to be achieved by 2020.
LePHIA is the first national survey to provide comprehensive information on important HIV/AIDS indicators at national and district levels. It was conducted from November 2016 to May 2017 and included 16 000 randomly selected households.
The survey revealed that Lesotho had achieved 81 percent, 92 percent, 88 percent out of the 90 percent targets.
The LePHIA survey also revealed that the estimated number of people living with HIV remains high at 306 000 with an HIV prevalence of 25, 6 (one in four Basotho, a quarter of the population from the ages of 15 to 59 years are HIV positive). It also revealed an extremely high peak HIV prevalence, 49, 9 percent in females aged 35 to 39 years and 46, 9 percent in males aged 40 to 44 years (translating to nearly half the population of women between the ages 35 to 39 years and men between the ages 40 to 44years are HIV positive).
The incidence of HIV (number of new HIV infections annually was reported to be 1, 1 percent this corresponds to almost 10 000 new cases of HIV infection annually among adults aged 15 to 59 years in the country in 2017.
The LePHIA survey reported an HIV mother to child transmission rate of 2, 8 percent, which has met and surpassed the global standard of 5 percent transmission.
It further revealed that young people are at risk of getting infected with HIV due to high early sexual engagement with limited knowledge about HIV prevention.
The Ministry of Health recently embarked on a district level dissemination campaign following the central dissemination of the survey results in January this year.
The Mohale’s Hoek district had the highest prevalence rate at 29, 3 percent, with Butha-Buthe having the lowest prevalence rate at 17, 8 percent.
Qacha’s Nek and Quthing have the highest number of youths engaging in early sexual intercourse.
According to an HIV and AIDS clinical mentor in the district health management team, ‘Maleiti Pholo, some of the reasons why Mohale’s Hoek has the highest prevalence rate may be due to patients defaulting on taking their medication.
“Many people living in this area work in South Africa and they only come home twice or thrice annually,” Ms Pholo said.
“So, for those who are taking ARVs, this may be a problem because they may run out of medication while in South Africa, undoing the work that had already been done to minimise further spread of HIV.”
She said it may be helpful for Lesotho and South African to have a functional arrangement where patients diagnosed with HIV in Lesotho can easily obtain medication and other related services in South Africa.
Ms Pholo said another possible factor in the district’s high HIV prevalence is lack of knowledge about HIV, which itself is influenced by the difficult topography of the district’s rural areas.
“People in remote areas are likely to engage in risky behaviour due to inadequate knowledge about HIV, caused by challenges of reaching the remote areas around the district,” she added.
Meanwhile, commenting on early sexual intercourse, Qacha’s Nek district health manager Moseme Makhele said this could be as a result of early marriage, which is a common cultural practice in the area.
“You are likely discover that these adolescents that are engaging in early sexual intercourse are actually married, because that is a cultural practice in this part of the country.
“Perhaps a legislation that controls early marriage can play a significant role in addressing this early marriage challenge.” Dr Makhele said.
The HIV and AIDS Programme Manager in the Ministry of Health, Tapiwa Tarumbiswa told the Lesotho Times on the sidelines of the recent district meetings that while the number of people living with HIV has remained stable, the rate of new infections has been gradually coming down over the years. He said this is due to various HIV interventions that the government has embarked on with the support of the US, the Global Fund, UNAIDS, the World Health Organisation (WHO) and other multiple stakeholders.
“The rate of new infections is coming down, for instance in 2010 it was at around 18 000 new infections annually, then in 2017 it came down to just over 10 000 new infections annually,” Dr Tarumbiswa said.
He said the ministry’s interventions which include the Test and Treat Policy which started in 2016 has contributed to an increased ART coverage which has giving life to a lot of people living with HIV. He also indicated that Ministry of Health has worked hard to strengthen the Prevention of Mother to Child Transmission Programme and all prevention services and as a result, these actions have played a significant role in the reduction of the number of new infections annually.
Dr Tarumbiswa said he appreciates that the role the population has played in attaining the “encouraging results”. He indicated that the society’s compliance with the Ministry of Health’s HIV prevention and treatment interventions have played a critical role in the HIV milestones so far, “because without the population’s support all would be in vain”.
The LePHIA survey revealed the prevalence of HIV transmitted drug resistance to be 11, 4 percent and Dr Tarumbiswa said such high levels could result in the complication of the infected people’s medical management.
“The problem with having this many people who are resistant to certain ARVs is that HIV resistance may spread to other people making their medical management complicated.”
Dr Tarumbiswa explained that resistance to ART can be caused by irregularly taking medication or concurrent usage of other drugs that reduce ARV levels in the blood.
He however, indicated that the Ministry of Health has already moved to address the challenge of resistance to Nevirapine- based ARV’s by preparing to switch patient on these ARV’s to more effective, better tolerated and superior ARV’s such as Dolutegravir.
He also said the Ministry of Health recently witnessed strong and positive leadership in the fight against HIV with the Health Principal Secretary (PS) Lefu Manyokole taking a bold stance by issuing clear strategic technical guidance to health care providers on what needs to be done to end HIV epidemic.
“In a memo to health care providers, the PS directed health care workers to scale up efforts in identifying those who still don’t know their HIV positive status, once identified they should be provided lifesaving ARV’s and that quality health services should be delivery so as to retain patients on treatment. This will ultimately reduce new infections, allowing the government to achieve its objective that is to have an AIDs free Lesotho by 2030,” Dr Tarumbiswa said.
The second LePHIA survey is expected to be conducted early 2020 and will be concluded in time to release results for the 2020 World AIDS Day commemoration, where Lesotho is expected to showcase its progress in meeting the 90-90-90 targets.