Lesotho lags in juvenile TB, HIV targets



  • As existing HIV response fails to meet the needs of children
  • CSOs agree to improve collaboration and coordination



MASERU – Despite scoring 90-97-92 to surpass the UNAIDS 90-90-90 HIV/Aids treatment target by 2020, Lesotho still lags behind in meeting TB and HIV targets among children and adolescents. It is estimated that about 13 000 children from ages 0 to 14 years of age and 306 000 adults above 15 years of age are currently living with HIV in Lesotho.

On the other hand, TB case incidence is 654 per 100 000 people, while HIV prevalence is 22.7 percent. HIV and TB co-infection continues to pose challenges of adherence to both anti-tubercular medication and antiretroviral therapy (ART), while ART coverage among adolescents and young people remains low, and viral load suppression among children is sub-standard. This emerged at the 2022 International AIDS Society Conference Discussion that took place on July 31.

Key outcomes of the discussions included, among others, sharing perspectives of how diverse partnerships can elevate pediatrics in the HIV and TB responses, and articulating policy priorities identified at the country level to ensure inclusion of children and adolescents in national responses.  Acting programmes manager Mosonngoa Motseko of the National AIDS Commission Lesotho, noted that the country still has pregnant mothers with high viral loads which increases chances of infection to infants, which was at five percent in a year 2021. She said the risk of progression to TB disease is higher if infection occurs before adolescence, in the 0-4 age group and in those who are immunocompromised.

Similarly, EGPAF chief executive officer and president, Chip Lyons, also highlighted that approximately 160 000 children were newly infected with HIV in 2021, an unconscionable rate equivalent to 430 new pediatric infections daily. Nearly 85 percent of these new vertical infections occurred in sub-Saharan Africa. Lyons said the data also shows that while children make up to four percent of all people living with HIV in 2021, they accounted for 15 percent of all AIDS related deaths globally.

To end HIV in children, Lyons said it is everybody’s responsibility to ensure that mothers and pregnant women living with HIV can safely and regularly access care services. According to reports, almost half of new HIV infections in children are due to HV positive mothers not receiving access to HIV testing services and ART, and yet ART coverage for pregnant women living with HIV has not meaningfully improved since 2014. “Engaging pregnant women in care is a foundational first step to reduce the likelihood of transmitting HIV to their babies, while also protecting their own health,” Lyons further noted.

According to Lyons, the existing HIV response is failing to meet the needs of children. Globally, only 52 percent of children who became infected with HIV are accessing HIV treatment services whereas the same treatment coverage for adults is at 76 percent, a gap that has continued to grow. “It is incumbent upon the global health community to step up to this achievable challenge and save the lives of kids impacted by HIV and AIDS. “If we are truly guaranteed an AIDS-free generation, the global AIDS response must be focused on addressing these unacceptable inequities by taking deliberate action that prioritises the life of every child at risk or living with HIV,” Lyons noted.

Various literature reports on a high incidence of HIV among adolescents owing to early sexual debut among girls and boys, discordancy, gender-based violence, and gender inequalities among adolescent girls and young women, intergenerational sexual relationships between girls and older men that create challenges in negotiating for condom use, safer sex, and power dynamics, and low levels of knowledge that hinder behaviour change and demand creation on voluntary medical male circumcision (VMMC), condoms, and test-and-treat services.

To address the existing TB and HIV gaps, poor TB case identification in children, high HIV incidence among adolescents and gender-based violence, Civil Society Organisations (CSOs) agreed on improving collaboration and coordination among themselves with at least 40 percent of the TB/HIV response in community-led and sustainable by 2023, strengthening and sustain advocacy, communication, and social mobilisation, involving private and voluntary health care providers, economic analysis, and financial planning, and operational research.

CSOs acknowledge that the integration of TB/HIV services beyond health care facility levels remains crucial not only for the early identification of cases but for their immediate linkage to care. This also has the positive potential to identify clients lost to follow-up care and possibilities of coinfections. According to Lesotho CSOs Priority Charter on Children and Adolescents in Response to TB/HIV 2021, immediate linkages to care from a community perspective will also improve treatment support and care and ensure uninterrupted treatment.

This can be achieved through community awareness and demand creation on TB services such as screening and HIV testing, index testing and partner notification, provider-initiated testing and counselling HIV self-testing, HIV case finding, TB screening and contact tracing. It can also be achieved through presumptive TB testing for outpatients and inpatients or during integrated outreach activities, Village Health Worker treatment support and linkage to care. These can be rolled out, not only in health care facilities, but also in primary, secondary, and high schools, higher education institutions, and in villages where the clients live.

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