Lesotho’s HIV prevalence among pregnant women is 28%. In 2013, Lesotho’s Prevention of Mother to Child Transmission (PMTCT) program adopted Option B+ and revitalized the village health worker (VHW) program to strengthen community level PMTCT. The national goal was to test 95% of HIV-exposed infants (HEI) at 2 and 18 months and reduce transmission rates to <5% by 2016.
We reviewed routinely collected PMTCT data of infants aged <18 months registered for Under 5 services from July 2013-July 2014 in 111 facilities in 4 high HIV burden districts prioritized for the Accelerating Children on Treatment (ACT) initiative. Two districts (Berea, Leribe) used an Enhanced VHW Model in which women and HEI were accompanied to care visits and 2 districts (Maseru, Mafeteng) used a Standard VHW Model (no accompaniment). This analysis examined HEI positivity, 18-month retention, VHW Care Models effects, and progress to PMTCT targets. Statistical analyses utilized generalized linear mixed models with a random effect to account for facility clustering.
A total of 4,354 HEI registered for care were included. Of 3,612 HEI registered by 2 months of age, 77% (2,748) received 2-month DNA PCR testing on time; of these, 2.5% (70) tested HIV(+), 88% (2,408) tested HIV(-) and 10% (270) had no recorded result. By 18 months of age, overall 2.9% (128/4,354) were HIV(+) [including those who tested HIV(+) prior to 18 months], 27% (1,158) were discharged as HIV(-), while 70% (3,068) did not have a final HIV status, of whom 76% had at least 1 prior HIV(-) test. At both 2 and 18 months, males were less likely to test HIV(+) compared to females (1.9% vs 3.2%, 2.4% vs 3.7%; both p=0.04). HEI in the Enhanced VHW Model were less likely to have an HIV(+) (2.2% vs 3.5%) and missing status (66% vs 74%) at 18 months compared to those in the Standard VHW Model (both p=0.001). HIV(+) infants in the Enhanced VHW Model were less likely to be retained on treatment at 18 months than those in the Standard VHW Model (26% vs 48%, p=0.05).
Overall, HIV positivity among HEI was <5%; however, most HEI were missing a final HIV status at 18 months. Opportunities were missed to provide HIV testing, retain HEI until final status was confirmed at 18 months, and retain HIV(+) infants on treatment. Strengthening interventions, including the Enhanced VHW Model, to identify, link and retain HEI in care are critical to achieve elimination of mother to child transmission.