Towards 90-90-90 in Lesotho

The Swiss TPH initiated ‘Towards 90-90-90’ research consortium involves units of the Ministry of Health of Lesotho, the District Health Management Team of Butha-Buthe, the Swiss not-for-profit organization SolidarMed, and the Molecular Virology Group of the Department of Biomedicine of the University of Basel. In Butha-Buthe district, the main implementation partners are the District Health Management Team of Butha-Buthe and SolidarMed (www.solidarmed.ch).

The ‘Towards 90-90-90’ consortium initiates and conducts development and research projects along the lines of the UNAIDS 90-90-90 targets for 2020, which try to achieve the following:

  • 90% of individuals know their HIV status
  • 90% of HIV infected individuals receive life-saving treatment
  • 90% of those who receive treatment achieve viral suppression (no free virus detectable in their blood)

In Lesotho, one out of four people are infected with HIV

Lesotho, a small, impoverished and landlocked country surrounded by South Africa has, with 25% of the adult population, the second-highest HIV rate in the world. The ‘Towards 90-90-90’ project is based in the Butha-Buthe District of Northern Lesotho. Here the great majority of the approximately 130’000 inhabitants lives in remote villages and depends on subsidence farming or migratory work in neighbouring South Africa.

Niklaus Labhardt
Project Leader
n.labhardtunibas.ch

Clinical Research Unit

The CASCADE trial

Recruitment for this open-label randomized controlled trial was completed in July 2016. The trial is planned to run until October 2017, when the primary outcome will be assessed. The CASCADE trial recruited all consenting adults, who tested HIV-positive during a home-based testing campaign. The trial will test, if in the arm of same-day home-based start of antiretroviral therapy is superior for improving subsequent linkage to HIV care and viral suppression compared to the referral after testing for the clinic-based start of antiretroviral therapy (standard of care).

Cascade-Trial on Visible Impact

 

Improving Molecular HIV Diagnostics in Rural Lesotho

All individuals infected with HIV, who take antiretroviral therapy, need up-to-date state-of-the-art laboratory monitoring to ensure continuously successful therapy. For this the World Health Organization recommends regular viral load monitoring (to determine if HIV is fully controlled) in all individuals who take antiretroviral therapy. This project makes such virus monitoring available to all patients who receive HIV-treatment in Butha-Buthe district. 

The SAVIR trial

Good adherence to therapy – consistently taking medication as prescribed– is the key to the success of antiretroviral therapy. This stepped wedge cluster randomized trial will start in November 2016 and tests the effect of a structured adherence intervention in individuals with unsuppressed viral load. 

The SESOTHO trial

This randomized controlled trial is planned to start in 2017. For patients who do not reach virus suppression on first-line antiretroviral therapy the SESOTHO trial assesses new criteria for switching patients to second-line therapy using a lower threshold for viral load.

Comorbidities and virologic outcomes among patients on antiretroviral therapy

CART-1 was the first study assessing comorbidities and virologic outcomes among patients taking antiretroviral therapy in Lesotho. The study was conducted between May 2014 and December 2015. Amongst other aspects it assessed how many patients achieved full viral suppression in their blood and how many failed therapy. This was the first study providing genotypic resistance data from a large number of patients with therapy failure in Lesotho. Furthermore, it assessed comorbidities, such as metabolic disorder, hepatitis B and C co-infection, and mental health. 

Link to Project 

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Selected projects at this location:
  • Swiss National Science Foundation (SNF)
  • Gottfried und Julia Bangerter-Rhyner Stiftung
  • Stiftung für Infektiologie beider Basel
  • Forschungsfonds Universität Basel
  • Swiss Foundation for Excellence and Talent in Biomedical Research