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
We reviewed routinely collected PMTCT data of infants aged
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