Test and start policy doubles numbers initiating treatment at PEPFAR Lesotho sites

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MMWR reports preliminary results of Lesotho’s adoption of WHO universal treatment guidelines

The first country in sub-Saharan Africa to adopt World Health Organization guidelines recommending all people with HIV have immediate access to the antiretroviral medicine that prevents illness and transmission saw the average number of patients starting treatment of the virus increase by nearly 80 percent in the 9 months that  followed, according to data released last week.

The data, from the five districts across Lesotho where the U.S. President’s Emergency Plan for AIDS Relief supports treatment services, and that are home to about 75 percent of people living with HIV in the country, was reported in the August 4 U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

It shows that while over each of the eight months preceding the adoption of the WHO guidelines as policy the numbers of people starting treatment for HIV hovered around 2,000, more than 5,000 people with HIV started treatment in June 2016, the month the new policy went into effect. Prior to adoption of the policy, known as “Test and Start,” evidence that the virus had already caused damage to patients’ immune systems was a prerequisite for treatment.

Over the months that followed, from 3,000 to 3,500 people with HIV started treatment for HIV, raising treatment coverage for men by 80 percent, and treatment coverage for women by 79 percent. Treatment coverage for children living with the virus rose by 72 percent, for teenagers and young adults aged 15 to 24 by 84 percent, and for people 25 and older by 79 percent. Not included in the data is a breakdown of how many of the people initiating treatment were newly diagnosed, and how many had been diagnosed earlier, but under previous guidelines were not sick enough to qualify for treatment.

For Lesotho, where  about one of every four people between the ages of 15 and 49 was living with HIV in 2014, where the virus is the leading cause of death, and is the reason the country was home to the shortest life expectancy at birth of 195 nations and territories, the gains in the number of people receiving treatment is significant, the report notes. Under the terms of a budget plan proposed by the Trump administration, Lesotho however, is one of the countries in southern Africa where PEPFAR would no longer support treatment expansion,

In the meantime, a UNAIDS/IAPAC pre-IAS conference audience in July, former Lesotho Minister of Health Molotsi Monyamane also summed up the stakes for the small and mountainous country surrounded by South Africa.

“We have only human capita,” he said. “No Diamonds, no minerals. For Lesotho, fighting HIV is a matter of survival.”

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