History

In Lesotho, viral load monitoring was initiated shortly after the World Health Organization recommended it as the preferred method for monitoring HIV treatment outcomes in 2013. Initially, testing was centralized in the capital, Maseru and access for people living in rural areas was severely restricted due to limited laboratory capacity, long-distance transport requirements for samples, and delays associated with paper-based reporting systems.

To address these barriers, a consortium led by the Ministry of Health of Lesotho, the District Health Management Team of Butha-Buthe, SolidarMed, the Swiss Tropical and Public Health Institute, and the University of Basel launched the country’s first decentralized viral load testing platform in the District Laboratory of Butha-Buthe Government Hospital in north-eastern Lesotho. The platform became operational in December 2015 and was officially inaugurated by the Minister of Health in June 2016.

Following a six-month pilot at Butha-Buthe Government Hospital, viral load testing was gradually expanded to all clinics within Butha-Buthe District and, from 2018, extended to neighboring Mokhotlong District. In parallel, the Viral Load Cohort North-East Lesotho (VICONEL) was established to systematically monitor treatment outcomes among people living with HIV in the catchment area. In 2025, the cohort further expanded to include a third district, Leribe, supporting broader data collection and service provision across northern Lesotho.