Supporting Lesotho on the way towards the UNAIDS 90-90-90 targets: Operational and clinical research addressing HIV/AIDS care in resource-limited settings

Concerted global efforts in scaling up HIV services in the past two decades have led to substantial progress in curbing the HIV/AIDS epidemic. In 2015, the United Nations Programme on HIV/AIDS (UNAIDS) launched a strategy with the ambitious goal to end the HIV/AIDS epidemic by 2030. The strategy formulated targets to reach until 2020 (the “90-90-90 targets”) and is based on the evidence that antiretroviral therapy (ART) does not only hinder individual disease progression but prevents transmission of the virus. In short, by 2020, 90% of all people living with HIV should be aware of their status; 90% of all people diagnosed should receive therapy; of these, 90% should achieve a suppressed viral load in order to hinder transmission. At the start of my thesis, UNAIDS estimated that Lesotho achieved 72%-53%-53% along the three treatment cascade targets.
The overall aim of this thesis was to generate evidence on how to achieve the cascade targets in a high-prevalence resource-limited setting such as Lesotho. I investigated several interventions along the cascade: HIV self-testing, same-day home-based ART initiation, community ART delivery, preference-based peer-led differentiated service delivery for adolescents and alternative clinical management of low-level viremia. All research projects had a strong focus on informing current World Health Organization (WHO) guidelines to maximize impact beyond Lesotho.