CDC Celebrates 15 Years in Lesotho

CDC Celebrates 15 Years in Lesotho image
AMB Brewer and CDC Lesotho staff plants a peach tree in honor of CDC 15-year Anniversary
Front Row L to R: Senate Moshoeshoe, DSc; AMB Maria Brewer, MS; Puleng Ramphalla, MSc; Kamohelo Mokhesi, BA Back Row L to R: Maletsatsi Motebang, MPH; Fred Asiimwe, MD; Sherene Cora, MPH; Hlapase Morojele, BA; Sekake Nako, BA; Mamorapeli Ts’oeu, BSN

In 2022, the U.S. Centers for Disease Control and Prevention (CDC) marked 15 years of partnership with the Government of Lesotho through the Ministry of Health (MOH). This significant milestone demonstrates CDC’s ongoing commitment to supporting the people of Lesotho in addressing public health threats, meeting public health goals, and ultimately saving lives.

CDC in Lesotho

CDC opened its office in Lesotho in 2007 to help strengthen the MOH’s capacity to treat HIV/AIDS. More than 90 percent of CDC’s support to the government is through the President’s Emergency Plan for AIDS Relief (PEPFAR). To date, CDC Lesotho supports integrated services for HIV and tuberculosis (TB), including improvements in public health policies, prevention, treatment, health management information systems, and laboratory capacity. In addition, CDC provides technical assistance and administrative leadership in these program areas in close partnership with the MOH and implementing partners. In the last 15 years, through continued support, CDC has helped the Government of Lesotho achieve remarkable progress toward ending HIV and TB.

Success by the Numbers

CDC works with partners, including host countries, local implementing partners, faith-based organizations, and other community-based organizations, to measure the impact of HIV treatment and prevention programs using Population-Based HIV Impact Assessments (PHIAs) surveys. These household surveys provide data insights that CDC and partners use to make timely adjustments to programs, leading to increased efficiencies and positive outcomes for community members, including people living with HIV.

Since 2017, CDC has supported the Government of Lesotho in completing two PHIAs, with the most recent being conducted in 2020. According to the results, Lesotho has surpassed the UNAIDS’ 90-90-90 target:

  • 90 percent of adults living with HIV are aware of their HIV status;
  • 97 percent of all people living with HIV (PLHIV) know their HIV status and are on treatment;
  • and 92 percent of those on treatment have achieved viral suppression.

CDC’s treatment support services remain focused on supporting Lesotho to attain and sustain equitable HIV epidemic control across all age and sex groups – ensuring all patients, adults and children alike, are on an optimized antiretroviral therapy (ART) regimen. Toward this objective, CDC supports activities to eliminate mother-to-child HIV transmission while providing routine cervical cancer screenings for women. These efforts have helped reduce mother-to-child transmission and improve early infant diagnosis coverage from 74 percent in 2020 to 86 percent in 2022. In addition, it has led to a 98 percent linkage to treatment for infants newly diagnosed with HIV.

With support from PEPFAR, CDC assists the MOH with HIV Testing Services and technical assistance to improve the quality, cost-effectiveness, and expansion of testing services to reach every person who does not know their HIV status. To assist Lesotho in achieving targets for ending its HIV epidemic, CDC supported developing and implementing of evidence-informed risk screening tools. Introduced in 2019 in 201 health facilities and community testing points, the risk screening tools and HIV self-testing kits have helped reduce the number of annual HIV tests by over 750 percent, allowing for focused efforts. The impacts of the evidence-based approach have ensured that those who need a test receive it, as HIV positivity test rates have increased by 150 percent from FY17 to FY22.

Strengthening Lab Capacity

Through CDC support, an effective and efficient specimen transportation system was established to improve access to rapid HIV testing services. The system cut turnaround time in half – dropping from 4 to 2 weeks in 201 health facilities nationwide. CDC technical assistance also improved the quality and coverage of viral load (VL) testing by 75 percent in just four years. This improvement was achieved through the procurement of VL tests, early infant diagnosis laboratory reagents, and TB test supplies for the national HIV program and was supported by the complete migration to an electronic lab information management system.

Improving Tuberculosis Outcomes

At 62 percent, Lesotho has one of the highest TB/HIV co-infection rates in the world. However, through CDC support, the uptake of ART among those living with HIV and infected with TB has improved significantly. In addition, through strong advocacy and partnership with the Global Fund, TB case finding and treatment with chest x-rays, computer-aided diagnostics, and shorter TB treatment regimens have all helped to improve TB outcomes. With support from CDC, Lesotho also adopted and implemented its first TB Preventive Therapy (TPT) guidelines, improving the management of TB/HIV co-infected patients and increasing TPT completion rates by 233 percent from 2017 to 2019.

Data Leading the Way

To provide accurate data and timely information on new infections, CDC Lesotho established HIV-1 Recent Infection Surveillance using Point-of-Care Tests in 2019. The data gives insights into those newly diagnosed with HIV in over 200 PEPFAR-supported sites informing HIV prevention and treatment strategies.

The same year, CDC supported the Violence Against Children and Youth Survey, which provided critical data on efforts to reduce violence against children. Results from the survey will inform data-driven violence prevention strategies in Lesotho. CDC also provided funding for developing and implementing an electronic medical record system, eRegister, in 183 facilities across the country. eRegister is a client-level electronic register that captures all services provided to clients from the point of testing to treatment and continuation of treatment. Recording all services provided, the system can track viral load testing and results, antiretroviral regimens and doses, appointments, and TB screening. An electronic system improves the data quality and alleviates the written documentation burden previously faced by healthcare workers.

Achieving Results Amidst a Pandemic

The COVID-19 pandemic introduced new challenges in Lesotho’s HIV response and threatened hard-won gains. Restriction to movement and other measures implemented to mitigate the spread of COVID-19 posed a challenge for HIV testing, treatment, and prevention services offered in healthcare settings. For many PLHIV, this meant a potential disruption of access to ART. Retaining PLHIV on treatment during the pandemic remained a key focus for CDC Lesotho and partners who worked hard to prevent a decline in the uptake of critical services. Together with in-country partners, CDC supported continued HIV and TB service delivery, ensured strategic HIV testing, and retained HIV and TB clients on treatment through rapid scale-up of multi-month dispensing of HIV and TB medications. Multi-month dispensing provides PLHIV with uninterrupted access to medications (for 3 to 6 months) and decreases the frequency of visits to healthcare facilities. As a result, more than 75 percent of PLHIV on ART received a 6-month supply of medication at every visit.

CDC’s continued efforts with the Ministry of Health and other local partners have prevented the spread of COVID-19 across borders and within health facilities. Leveraging global vaccination resources, CDC Lesotho focused on vaccination uptake among adolescents, men, and other underserved populations. As a result, the vaccine rate increased from 2 percent in 2021 to 46.5 percent by the end of 2022.

Through 20 years of PEPFAR, foundational health systems around the world continue to be strengthened. And through these partnerships, CDC continues to support Lesotho’s emergency operations, promote uptake of the COVID-19 vaccine, enhance laboratory diagnostics, disease surveillance, and workforce capacities – helping to save countless lives.