HIV epidemic in Lesotho - HIV treatment and monitoring of patients on antiretroviral therapy 2014-2024.

This study evaluates progress in expanding access to antiretroviral therapy (ART) and HIV viral load (VL) monitoring in Lesotho using programmatic data 2014-2024. As a lower middle-income country in Southern Africa, Lesotho maintains the world's second highest HIV prevalence (25.6%).Retrospective, countrywide data from 2014-2024 were assessed, including the cumulative number of people living with HIV receiving ART, the proportion of ART patients who had a VL test within the prior 12 months, the percentage of VL tests indicating viral suppression (<1,000 copies/mL) and the turnaround time (TAT) from specimen collection to result return.From 2014 to 2024, the number of PLHIV on ART more than doubled, rising from 111,322-242,438. VL coverage progressed from 6% in 2014 to 93% in 2024. VL suppression improved from 75% in 2015 to 99% in 2024. Mean TAT declined from 56 to 8 days over the study period.Lesotho achieved substantial expansion of ART coverage, VL testing, and timely result reporting during the study period 2014-2024. This report documents Lesotho's achievement to reach the third UNAIDS "95" goal that 95% of persons on ART are virally suppressed. These findings underscore the feasibility of scaling up HIV service delivery, achieving high levels of viral suppression and strengthening laboratory systems in high-prevalence, resource limited countries.