Setting

Lesotho is a small, mountainous country surrounded by South Africa. With a population of about 2.3 million, it is classified as a lower-middle-income country and has one of the world’s highest HIV prevalence rates—18.5% among adults.

As of 2023, approximately 270,000 people were living with HIV in Lesotho, with 4,800 new acquisitions that year. Most of the population resides in rural areas, where access to health services is limited. Roughly 22% of rural households are more than three hours’ walk from a health facility, and 38% are one to three hours away. These challenges are compounded by a severe shortage of health professionals, with only 4.7 doctors and 32.6 nurses and midwives per 10,000 people.

The VICONEL cohort currently operates in three districts in northern Lesotho—Butha-Buthe, Mokhotlong, and Leribe—home to a combined population of around 550,000. These regions are among the country’s most remote, and VICONEL plays a key role in improving access to HIV monitoring and strengthening healthcare infrastructure where it is needed most.