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.