Mobilizing community-based HIV testing for children in Lesotho
In 2015, HIV was the cause of 19 percent of all childhood deaths under the age of five in Lesotho. Previous strategies to identify and treat children who were living with HIV had proven ineffective and Lesotho’s goal to reach 80 percent of children living with HIV had fallen short, with only 30 percent of a total estimated 19,000 children on treatment. In response, CHAI partnered with the government to launch the Mobilizing HIV Identification and Treatment Project, aimed at identifying individuals – especially children – who don’t seek care at health facilities and instead providing them access to HIV testing in their communities.
CHAI evaluated seven community-based testing strategies (discussed in detail in the strategies policy memo) that were being executed by other implementing partners in Lesotho. All children who were identified as HIV-positive from the seven strategies were then enrolled through the online mHealth app to be tracked and followed up with to ensure linkage to care and initiation on treatment. Enrolled individuals also received transportation vouchers through a mobile-money transfer called m-pesa. CHAI followed up with these children for a minimum of three months to determine if they linked to care, initiated and continued treatment (read more in the linkage to care outcomes policy memo).
By the end of the project in 2017, Mobile Outreach Clinics proved to be the most effective community-based testing strategy and CHAI is currently helping the government to scale up these clinics across the country. The clinics are facility-supported primary healthcare outlets located in the community. They provide a broad spectrum of healthcare services to rural, underserved communities, with a special focus on HIV testing services for children and prevention of mother-to-child-transmission. During the project, these clinics were well-received in the community, delivering comprehensive services that people appreciated. They were also able to test and identify more children than any other strategy (more information on Mobile Outreach Clinics can be found in the policy memo).