The state of the pediatric HIV epidemic in Lesotho: results from a population-based survey.

OBJECTIVE: Lesotho does not have reliable data on HIV prevalence in children, relying on estimates generated from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed to determine HIV prevalence among children 0-14 years to assess the effectiveness of the prevention of mother to child transmission (PMTCT) program and guide future policy.

METHODS: A nationally representative sample of children under 15 years underwent household-based, two-stage HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using total nucleic acid (TNA) PCR. Parents (61.1%) or legal guardians (38.9%) provided information on children's clinical history. Children aged 10-14 years also answered a questionnaire on knowledge and behaviors.

RESULTS: HIV prevalence was 2.1% (95% CI: 1.5-2.6%). 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%). HIV prevalence in girls and boys was 2.6% (95% CI: 1.8% - 3.3%) and 1.5% (95% CI: 1.0% - 2.1%), respectively. Based on reported status and/or the presence of detectable antiretrovirals, 81.1% (95% CI: 71.7-90.4%) of HIV-positive children were aware of their status, 98.2% (95% CI: 90.7 - 100.0%) of those aware were on ART and 73.9% (95% CI: 62.1-85.8%) of those on ART were virally suppressed.

CONCLUSIONS: Despite the roll-out of Option B+ in Lesotho in 2013, pediatric HIV prevalence remains high. Further research is required to understand the greater prevalence among girls, barriers to PMTCT, and how to better achieve viral suppression in children living with HIV.