The Lesotho government has launched a four-year plan to reduce new HIV infections among children by 50 percent and ensure that all HIV-infected children have access to life-prolonging antiretroviral (ARV) treatment.

Mother-to-child transmission is the leading cause of HIV infection in children. Lesotho introduced prevention of mother-to-child HIV transmission (PMTCT) services in 2003 but, according to Dr Angela Benson of the World Health Organisation (WHO), only about five percent of HIV-positive pregnant women are making use of them.

The WHO and UNICEF are partnering with Lesotho's Ministry of Health and Social Welfare to implement a new plan that includes establishing universal access to PMTCT services and reducing the risk of mother-to-child transmission by 80 percent by 2011.

A review of Lesotho's PMTCT and paediatric ARV treatment has found that although all hospitals in the country as well as 20 health centres are providing PMTCT services, many of the local health clinics, where most women access antenatal services, still do not offer HIV testing, let alone PMTCT.

"It is imperative to scale up the PMTCT activities from the hospitals to the health centres, and from the health centres to the community and the family level, where women should receive the required support," said Aichatou Diawara-Flambert, UNICEF's Lesotho representative. Most women in Lesotho visit an antenatal clinic at least once during their pregnancy, but more than half still have their babies at home.

A shift to the "opt-out" testing approach, in which all pregnant women are tested for HIV unless they expressly refuse, has helped improve the number being tested, but Flambert suggested that the role of community health workers could be strengthened to reach more women. UNICEF plans to assist in training community health workers to follow up on HIV-positive pregnant women and their newborn children.

Dr Mphu Ramatlapeng, Minister of Health and Social Welfare, said the need to involve men was also critical to improving PMTCT outcomes, and strategies such as couples counselling and HIV testing would form part of the new plan.

With a population of just 1.8 million, UNAIDS estimates that 16,000 children in Lesotho are already living with HIV. Of the estimated 4,000 who need ARV treatment, about 1,160 are receiving the drugs.

The equipment to diagnose children younger than 18 months is not yet available in Lesotho, but UNICEF is supporting the transportation of blood samples to South Africa for testing, and is providing cotrimoxazole, an antibiotic that can protect HIV-infected babies from life-threatening opportunistic infections.

One of the major barriers to scaling up treatment for HIV-infected children in Lesotho has been the shortage of health workers trained in administering paediatric ARV treatment, but the new plan aims to reach all HIV-positive children needing treatment by 2011.

A key element in achieving this ambitious goal is training many more health care professionals, and the establishment of an accreditation process that will allow trained nurses and nursing assistants to manage paediatric medication, alleviating the burden on the country's tiny pool of doctors.