Nobody left the clinic without knowing

Lesotho is a mountainous country of about 2 million people, surrounded
by South Africa, with an annual income of $1,210 per head and **73% of the
population in rural areas.**

HIV is the leading cause of premature death, and has contributed to Lesotho
having **the shortest life expectancy at birth among 195 countries and
territories.**

The bottleneck

The UNAIDS 90‑90‑90 targets are that 90% know their status, 90% of those
diagnosed are on sustained therapy, and 90% of those on therapy are virally
suppressed.

Progress has been **hampered, in part, by an inability to identify undiagnosed
people.** The first 90 gates the other two: nobody starts treatment without a
diagnosis.

So the approach was to stop waiting for people to come and be tested, and
instead test the people who were already in the building for something else.

Five months of outpatient departments

1 May – 30 September 2017, in PEPFAR-supported facilities:

**389,964 (94.0%) of people attending these outpatient departments knew
their HIV status before leaving the facility.**

Against a national figure of 77.2%.

Two numbers that make the method work

84.5% consented. Offered a test at a visit they were already making, five
in six people said yes — which is a different proposition from being asked to
make a journey to a testing centre in a country where three-quarters of people
live rurally.

5.0% were newly positive. One in twenty of those tested had HIV and did not
know. At that yield, routine offering is not a screening exercise with a low
return; it is finding thousands of people in five months.

**PEPFAR supports testing in 121 facilities — 113 health centres and eight
hospitals — across five of Lesotho's ten districts**, which hold about **75% of
all HIV-positive people in the country.** In the prior fiscal year those
facilities carried out 567,062 of 801,654 supported tests (70.7%).

Source: Centers for Disease Control and Prevention, MMWR.