A cluster of paediatric hydrocephalus in Mohale’s Hoek district of Lesotho, 2013-2016

Background: In 2016, an unusual increase of paediatric hydrocephalus was observed in Mohale’s Hoek (MH) district, Lesotho. This study describes the epidemiology of paediatric hydrocephalus, and review the management of case-patients in MH district. Methods: We defined a case-patient as a child ≤12 years diagnosed with hydrocephalus either radiologically (i.e. by CT or MRI scan) or clinically by a medical officer. We reviewed registries and medical records of children diagnosed or treated with hydrocephalus at national referral hospital in Maseru and in MH district. We also conducted a household survey among case-patients identified in MH. Results: A cumulative total of 75 case-patients with paediatric hydrocephalus were identified in Lesotho, giving an overall prevalence of 87/100,000 live births over the 2-years. Thirty-seven (49.3%) were diagnosed with congenital hydrocephalus, and 5 (6.7%) were acquired hydrocephalus post-meningitis. Overall, 11 case-patients were identified in MH district, giving an overall 4-years prevalence of 211/100,000 live births; case fatality of 4/11 (36.4%). The median age at the time of diagnosis was 3 weeks (range: 1 week - 12 months) and five of the 11 case-patients were diagnosed in 2015. Two (18.2%) were diagnosed with congenital hydrocephalus, 2 (18.2%) with acquired hydrocephalus post meningitis and 7 (63.6%) had hydrocephalus of unspecified origin. Five children had shunts inserted in South Africa with an average delay of about 3 months from diagnosis. All five shunts developed complications that resulted in their removal. Conclusion: Our findings provided an insight into the burden of hydrocephalus in Lesotho and highlight sub-optimal post-surgery follow-up of children treated for hydrocephalus. We recommend that the Lesotho government implement a national surveillance system for congenital abnormalities and strengthen capacity for neurosurgical procedures at the national hospital

Viral suppression by age and drug regimen, among 116 children with VL result after ≥6 months of consecutive drug: Results from 21 health facilities in Lesotho; January 2018-May 2022.

Viral suppression by age and drug regimen, among 116 children with VL result after ≥6 months of consecutive drug: Results from 21 health facilities in Lesotho; January 2018-May 2022.</p

Inclusivity in global research.

IntroductionWe describe transition of HIV-positive children from efavirenz- or nevirapine-based antiretroviral therapy (ART) to optimal dolutegravir (DTG) or lopinavir/ritonavir (LPV/r) (solid formulation)-based ART in Lesotho.MethodsWe followed a cohort of children less than 15 years of age who were initiated on ART on or after January 1, 2018 from 21 selected health facilities in Lesotho. From March 2020 to May 2022, we collected data retrospectively through chart abstraction and prospectively through caregiver interviews to cover a period of 24 months following treatment initiation. We used a structured questionnaire to collect data on demographics, ART regimen, drug formulations and switches, viral suppression, retention, and drug administration challenges. Data were summarized as frequencies and percentages, using SAS ver.9.4.ResultsOf 310 children enrolled in the study, 169 (54.5%) were female, and median age at ART initiation was 5.9 years (IQR 1.1–11.1). During follow-up, 19 (6.1%) children died, 41 (13.2%) were lost to follow-up and 74 (23.9%) transferred to non-study sites. At baseline, 144 (46.4%) children were receiving efavirenz-based ART regimen, 133 (42.9%) LPV/r, 27 (8.7%) DTG, 5 (1.6%) nevirapine; 1 child had incomplete records. By study end, 143 (46.1%) children were receiving LPV/r-based ART regimen, 109 (35.2%) DTG, and 58 (18.7%) were on efavirenz or nevirapine-based regimen. Of 116 children with viral load results after six months or more on a consistent regimen, viral suppression was seen in 35/53 (66.0%) children on LPV/r, 36/38 (94.7%) children on DTG and 19/24 (79.2%) children on efavirenz.ConclusionFollowing optimal ART introduction in Lesotho, most children in the cohort were transitioned and many attained or maintained viral suppression after transition; however, we recommend more robust viral load monitoring and patient tracking to reduce losses and improve outcomes after ART transition.</div

Follow-up outcomes of 310 participants enrolled in 21 study health facilities; January 2018–May 2022.

*LTFU = Loss to follow-up; †Transferred = Participant relocated to non-study site. §Withdrew/Lost interest: participant remained in care but either withdrew from the study or were no longer interested in study follow-up. ǂTerminated = Due to resource constraints, the study was stopped before some participants completed 24 months follow-up.</p

S1 Dataset -

IntroductionWe describe transition of HIV-positive children from efavirenz- or nevirapine-based antiretroviral therapy (ART) to optimal dolutegravir (DTG) or lopinavir/ritonavir (LPV/r) (solid formulation)-based ART in Lesotho.MethodsWe followed a cohort of children less than 15 years of age who were initiated on ART on or after January 1, 2018 from 21 selected health facilities in Lesotho. From March 2020 to May 2022, we collected data retrospectively through chart abstraction and prospectively through caregiver interviews to cover a period of 24 months following treatment initiation. We used a structured questionnaire to collect data on demographics, ART regimen, drug formulations and switches, viral suppression, retention, and drug administration challenges. Data were summarized as frequencies and percentages, using SAS ver.9.4.ResultsOf 310 children enrolled in the study, 169 (54.5%) were female, and median age at ART initiation was 5.9 years (IQR 1.1–11.1). During follow-up, 19 (6.1%) children died, 41 (13.2%) were lost to follow-up and 74 (23.9%) transferred to non-study sites. At baseline, 144 (46.4%) children were receiving efavirenz-based ART regimen, 133 (42.9%) LPV/r, 27 (8.7%) DTG, 5 (1.6%) nevirapine; 1 child had incomplete records. By study end, 143 (46.1%) children were receiving LPV/r-based ART regimen, 109 (35.2%) DTG, and 58 (18.7%) were on efavirenz or nevirapine-based regimen. Of 116 children with viral load results after six months or more on a consistent regimen, viral suppression was seen in 35/53 (66.0%) children on LPV/r, 36/38 (94.7%) children on DTG and 19/24 (79.2%) children on efavirenz.ConclusionFollowing optimal ART introduction in Lesotho, most children in the cohort were transitioned and many attained or maintained viral suppression after transition; however, we recommend more robust viral load monitoring and patient tracking to reduce losses and improve outcomes after ART transition.</div

Demographic and treatment characteristics of 310 children (0–14 years of age) at ART initiation in 21 health facilities in Lesotho; January 2018-May 2022.

Demographic and treatment characteristics of 310 children (0–14 years of age) at ART initiation in 21 health facilities in Lesotho; January 2018-May 2022.</p

ART switches and substitutions by age category documented at 21 health facilities in Lesotho, January 2018–May 2022.

ART switches and substitutions by age category documented at 21 health facilities in Lesotho, January 2018–May 2022.</p

STROBE statement—Checklist of items that should be included in reports of observational studies.

STROBE statement—Checklist of items that should be included in reports of observational studies.</p

Changes in LPV/r formulations by type of enrolment at 21 health facilities in Lesotho; January 2018–ay 2022.

Changes in LPV/r formulations by type of enrolment at 21 health facilities in Lesotho; January 2018–ay 2022.</p

Study design showing period of cohort data collection and ART transition in 21 health facilities in Lesotho; January 2018–May 2022.

* Includes all cohort participants who initiated antiretroviral therapy between January 2018 and March 2020.</p