Lesotho has the second highest HIV prevalence in the world. In 2013 the country became one of the first African countries to implement Option B+ nationwide. However Lesotho does not have reliable data on HIV prevalence in children, previously relying on estimates modeled from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed, among other objectives, to determine HIV prevalence among children 0-14 years in order to assess the efficacy of the prevention of mother to child transmission (PMTCT) program and guide future policy.
A nationally representative sample of children under 15 years underwent household-based, two-stage rapid HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using DNA PCR. Parents or legal guardians provided information on children’s clinical history. Children aged 10-14 years also answered a questionnaire which included socio-demographic and behavioral questions. National weighted pediatric prevalence was estimated accounting for complex survey design, with Jackknife replication to calculate 95% confidence intervals (CI). We used bivariate statistics to compare characteristics across demographic groups.
A total of 3,966 children were tested for HIV, and 1,601 10-14 year olds completed interviews. Overall, HIV prevalence was 2.1% (95% CI: 1.5-2.6%), corresponding to roughly 13,300 children living with HIV. Prevalence varied across districts, with the highest prevalence in Mokhotlong (4.8%, 95% CI: 2.2-7.3%), and the lowest in Berea (0.5%; 95%CI: 0-1.2%). Prevalence in 10-14 year olds (3.2%; 95% CI: 2.1%, 4.2%) was significantly greater compared to 0-4 year olds (1.0%; 95% CI: 0.5%, 1.6%). Sexual activity was reported in 9.3% (95%CI: 7.3-11.3%) of 10-14 year olds but there was no association with HIV infection. Overall HIV prevalence in females and males was 2.6% (95% CI: 1.8% – 3.3%) and 1.5% (95% CI: 1.0% – 2.1%), respectively.
Substantial progress has been made in the reduction of vertical transmission in Lesotho. But despite the early roll-out of Option B+ in Lesotho, pediatric HIV prevalence remains high, with girls disproportionately affected. Further research is required to understand the greater prevalence among girls, barriers to PMTCT and the possible contribution of horizontal transmission in older children.