Setting

Lesotho is a small, mountainous, landlocked country entirely surrounded by South Africa, with a population of approximately 2.3 million (1). Classified as a lower-middle-income country, Lesotho has the second-highest adult HIV prevalence globally, at 18.5%. As of 2023, an estimated 270,000 people were living with HIV, and 4,800 new infections occurred that year (2).

The majority of Lesotho’s population resides in rural areas, where healthcare access is often limited. Around 22% of rural households are located more than three hours’ walking distance from the nearest health facility, and 38% are between one to three hours away (3). The country's healthcare system is further constrained by a critical shortage of trained professionals, with only 4.7 doctors and 32.6 nurses and midwives per 10,000 population (4).

The VICONEL cohort currently operates in three of Lesotho’s ten districts—Butha-Buthe, Mokhotlong, and Leribe.These districts have a combined population of approximately 550,000 people.[JB1] 

 [JB1]Could read as though VICONEL (rather than the 3 districts) has 550,000 people