To strengthen the quality of Human immunodeficiency virus (HIV) testing services, Lesotho is transitioning to the World Health Organisation’s (WHO) recommended Three HIV Test Strategy. The Three Test Strategy is an HIV testing strategy in which a person is diagnosed with HIV after three consecutive reactive tests.

HIV testing is essential to achieving “the first 95” of the UN “95-95-95” targets aimed at ensuring at least 95% of people living with HIV know their HIV status by 2025 thereby contributing to ending the HIV epidemic.

Lesotho has one of the highest HIV prevalence rates globally, with approximately 21.1% of the population living with HIV. About 280,000 people are living with HIV with approximately 4,790 new HIV infections and around 4,700 deaths attributed to AIDS annually. The high prevalence, incidence, and mortality calls for the urgency of prevention and early detection to avert most of the new infections and deaths prevented with timely diagnosis and treatment through timely and accurate diagnosis.

With the evolving HIV epidemic in Lesotho, updated HIV guidelines are essential for improving diagnosis, supporting treatment initiation, preventing new infections, ensuring continuity of care, maintaining quality, and aligning with global standards and national healthcare objectives.

In response to changes in the HIV epidemic, in November 2019, WHO recommended countries use three consecutive reactive tests to provide an HIV-positive diagnosis. Moving from a two-test to a three HIV testing strategy is essential to ensure an accurate HIV diagnosis in the face of declining HIV prevalence in countries. The Three Test Strategy uses three consecutive HIV- reactive tests to provide an HIV- positive diagnosis.

In line with these developments, Lesotho embarked on steps to transition from the older two-test HIV algorithm to the new three-HIV test strategy in line with the latest WHO recommendations to minimize false HIV-positive results. Besides updating its national HIV testing strategies, the Ministry of Health is also adopting dual HIV syphilis testing in ANC services.

WHO is providing ongoing technical guidance to the Ministry of Health by facilitating consultations among the HIV Testing Services (HTS) Technical Working Group and stakeholders in the reviewing and updating of the 2019 national HTS guidelines.

Currently, the WHO team is supporting the Ministry of Health in the write-up of the new national HTS Guideline in line with the latest WHO guidelines.

The updated HTS guidelines encompass the three test algorithms, dual HIV-syphilis testing for pregnant women, and a strategic mix of HIV testing services to achieve the greatest impact and efficiency ranging from those in facility and community settings, as well as partner notification and self-testing approaches.

The plan is to finalize the updated HTS guideline by the end of August 2024 for implementation.