Landmark Achievements in Lesotho’s Fight to End AIDS

Amid the deep disruptions COVID-19 caused to the global AIDS response in the past year, there is a bright spot: Lesotho, a small country in southern Africa that has faced one of the most acute HIV epidemics in the world, reached the ambitious 2020 targets established by the global health community in the fight to end HIV/AIDS. 

These five-year targets dubbed “90-90-90” were launched by UNAIDS in 2015 to drive momentum towards ending the AIDS epidemic by 2030.  

• 90% of all people living with HIV will know their status 
• 90% of people living will HIV are receiving life-saving antiretroviral therapy (ART) 
• 90% of people on treatment will have controlled the virus, achieving viral suppression.   

Over the last 5 years, EGPAF, working closely with the Ministry of Health, and with support from PEPFAR, USAID, and CDC, has led major health service adaptations and scale-up of innovations to propel Lesotho forward.

This year’s national HIV survey (LePHIA 2020) shows that Lesotho reached and surpassed the 90-90-90 targets with 90% of the population aware of their HIV status, 97% of those diagnosed with HIV on treatment, and 92% of those on treatment virally suppressed. 

Through EGPAF’s programs in Lesotho, we have learned a great deal about building an effective HIV response. Perhaps the biggest lesson of all, and the real key to Lesotho’s success, is the emphasis on patient-centered services. The importance of meeting people where they are with what they need cannot be overstated.

Differentiated service delivery, community ART distribution, and multi-month dispensing have proven to be game-changers for retention and treatment adherence. Providing access to tailored services designed with youth input such as Adolescent Corners has underscored the value of bringing age-friendly information and a community of supportive peers. These services empower young people to take control of their health – a key priority as HIV continues to be a leading cause of death for adolescents across sub-Saharan Africa. 

Finally, the scale-up of testing and treatment innovations has given us a new arsenal of tools to deploy. Lesotho was among the first countries to implement WHO’s “treatment for all” guidelines in 2016, and since then, EGPAF-Lesotho has also rolled out transformational point-of-care early infant diagnosis (POC EID), which enables efficient, affordable testing of HIV-exposed infants. This project has been successfully handed over to the Ministry and also incorporates viral load monitoring for pregnant women. These results remind us how imperative it is that new technologies and approaches reach the people in most urgent need. 

Getting to 90-90-90 was not easy. This landmark achievement would not have been possible without many donors and strong partners including the Ministry of Health, PEPFAR, CDC, USAID, The Global Fund, Unitaid, Johnson & Johnson, Cepheid, and UNICEF. Furthermore, we applaud Lesotho’s health workers and HIV advocates, who have courageously persevered in the face of incredible challenges in order to strengthen their communities and save lives.  

COVID has provided a stark reminder that progress cannot be taken for granted; it is not guaranteed. And despite this significant advancement, HIV-related illness is still the leading cause of death in Lesotho.   

At EGPAF we are driven to see a world where no mother, child, or family is devastated by HIV—and we know that this means getting prevention and treatment services to all people, through every stage of life. Together, we can create an AIDS-free generation in Lesotho and around the world. 

For more on this topic, please watch our webinar recording below. To receive emails about future webinars on similar topics, sign up at pedaids.org/egpafimpact.