A recent national evaluation of Lesotho’s Prevention of Mother-to-Child Transmission (PMTCT) program has revealed alarmingly high rates of HIV infection and mortality among infants born to HIV-positive mothers, despite the country’s success in achieving the UNAIDS 90-90-90 targets and high PMTCT program coverage.
The study, conducted by researchers from ICAP at Columbia University (New York and Lesotho) and the US Centers for Disease Control and Prevention in Lesotho, analysed data from approximately 200 health facilities across the country.
It focused on infants born between October 2020 and September 2021.
Of the 10,659 HIV-exposed infants (HEI) enrolled in care, a promising 95.6 percent (10,187) were tested for HIV by 12 months of age.
However, 1.2 percent (123 infants) were diagnosed with HIV by that time. More concerningly, only 74.8 percent (92) of those diagnosed had initiated Antiretroviral Therapy (ART) within their first year.
By 18 months, a total of 183 infants had died, translating to an overall mortality rate of 1.7 percent among the cohort, highlighting gaps in follow-up and care for HIV-exposed children.
The evaluation identified critical weaknesses across the continuum of care, including inconsistent HIV testing and retesting for mothers during pregnancy, labour, delivery, and postpartum and gaps in initiation and continuation of Pre-Exposure Prophylaxis (PrEP) for pregnant and postpartum women
It also identified delayed treatment initiation and retention challenges for HIV-positive infants.
The study concludes that more intensive follow-up of HIV-exposed infants is urgently needed to curb paediatric HIV infections. It also calls for better integration of childhood illness management to improve survival in a high HIV burden setting.
A recent national evaluation of Lesotho’s Prevention of Mother-to-Child The findings, based on data collected from infants born between October 2020 and September 2021, highlight significant gaps in the continuum of care for HIV-Exposed Infants (HEI).
Of the 10,659 HEI registered during the observation period, and a high percentage 95.6 percent (10, 187) were tested for HIV by 12 months, and a total of 1.2 percent (123 infants) were diagnosed with HIV by 12 months.
Furthermore, the study revealed challenges in ensuring timely treatment initiation and retention in care for those infants who tested positive.
Among the 123 infants diagnosed with HIV by 12 months, only 74.8 percent (92) initiated Antiretroviral Therapy (ART) by that time.
Alarmingly, by 18 months, among the entire cohort of 10,659 HEI, an additional 173 had died, yielding an overall death rate of 1.7 percent (183).
According to the study, this underscores the critical need to improve follow-up and care for these vulnerable children.
The researchers identified several key areas contributing to these persistent challenges, including gaps in HIV testing and retesting during pregnancy, labor and delivery, and the postpartum period for mothers, initiation and continuation of Pre-Exposure Prophylaxis (PrEP) among pregnant and postpartum women and HIV testing and treatment initiation and continuation among HIV-exposed infants.
The study’s conclusion emphasises the urgent need for intensive follow-up of HIV-exposed infants to reduce pediatric HIV infections. Additionally, the researchers call for enhanced integrated management of childhood illnesses to improve overall survival rates in this high HIV burden environment.
These findings were spotlighted during the 13th National Health Forum held on Wednesday under the theme “Strengthening Research and Innovation for Resilient Health Systems and Universal Health Coverage.”
Minister of Health Selibe Mochoboroane welcomed the research, stating it reaffirms the country’s commitment to strengthening health systems through evidence and innovation.
“Research is the backbone of informed decision-making,” Mochoboroane said. “It helps us identify what works and measure progress, from HIV and TB to maternal health, non-communicable diseases, and primary healthcare,” he added.
Ntsoaki Motaung is an award-winning health journalist from Lesotho, specializing in community health stories with a focus on sexual and reproductive health and rights, as well as HIV. She has contributed to platforms like “Be in the KNOW,” highlighting issues such as the exclusion of people with disabilities from HIV prevention efforts in Lesotho.
In addition to her journalism, Ntsoaki serves as the Country Coordinator for the Regional Media Action Plan Support Network (REMAPSEN). She is also a 2023 CPHIA Journalism Fellow.
