Strengthening differentiated service delivery strategies for HIV services


June 2023 – present


Lesotho faces a high HIV prevalence rate of 23.6%, posing significant challenges despite progress towards the UNAIDS targets known as 95-95-95. These targets aim for 95% of people living with HIV to know their status, 95% of those diagnosed to receive antiretroviral therapy, and 95% of those on treatment to have suppressed viral loads. Ensuring access to treatment for all affected individuals remains a challenge due to limited public healthcare infrastructure and constraints posed by the predominantly rural population. These limitations include significant time and financial constraints in accessing healthcare services.

To tackle these persistent challenges and improve treatment accessibility for HIV patients, USAID, in partnership with the Ministry of Health, is identifying models that can expand private sector engagement in new and existing differentiated service delivery (DSD) approaches. Project Last Mile was engaged to recommend options for consideration and support the analysis.

Project Last Mile has focused on developing a range of DSD options to support expansion in rural and urban areas, focusing on increased private sector participation.

This phase included:

• Engaging stakeholders to gauge perceptions of DSD and private sector interest.

• Conducting geospatial mapping to understand the country’s layout and

population distribution in relation to health facilities and potential pick-up


• Surveying clients and clinicians to assess current medicine collection experiences and interest in DSD.

• Developing DSD models and business cases for recommended approaches.

“Project Last Mile’s private sector expertise in differentiated service delivery is supporting the Lesotho Ministry of Health and Mission to identify strategies for sustainable access to critical health commodities for people living with HIV, adolescent girls, and key population segments.”

– Ian Membe, Deputy Country Director, USAID Lesotho

This information originally appeared in the 2023 annual report.