Progress toward HIV epidemic control in Lesotho

• Published in: AIDS (London) Vol. 33; no. 15; pp. 2393 - 2401
• Main Authors: Thin, Kyaw, Frederix, Koen, McCracken, Stephen, Letsie, Mosilinyane, Low, Andrea, Patel, Hetal, Parekh, Bharat, Motsoane, Tsietso, Ahmed, Nahima, Justman, Jessica, Callaghan, Larkin, Tembo, Susan, Schwitters, Amee
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc 01.12.2019
• Subjects: Adolescent; Adult; Anti-Retroviral Agents - therapeutic use; Epidemics; Family Characteristics; Female; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; Incidence; Lesotho - epidemiology; Logistic Models; Male; Mass Screening; Middle Aged; Prevalence; Sampling Studies; Surveys and Questionnaires; Viral Load; Young Adult; Lesotho
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000002351

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.