Mphatlalatsane: Promotion of Cognitive Development, HIV Testing and Treatment Support, and Nutrition Education in Rural Lesotho

Lesotho has high levels of poverty, HIV, and malnutrition, all of which affect child development outcomes. There is a unique opportunity to address these complex issues through the widespread network of informal preschools in rural villages in the country, which are supported by the Ministry of Education and Training, as well as in partnership with existing health services. We conducted a cluster randomized controlled trial in Mokhotlong district, Lesotho, to evaluate a community-based intervention program to integrate HIV-testing and treatment services, early childhood care and development, and nutrition education for caregivers with children aged 1 to 5 years living in rural villages in partnership with preschool teachers, health services, and local nongovernment organizations. Caregivers and their children were randomly assigned by village to intervention or control condition. The intervention consisted of nine group-based sessions with caregivers and children over 12 weeks (eight weekly sessions, and a ninth top-up session one month later), followed by a locally hosted community health outreach day event. Group-based sessions focused on using early dialogic book-sharing to promote cognitive development and caregiver-child interaction, health-related messages, including motivation for HIV-testing and treatment uptake for young children, and locally appropriate nutrition education. Caregivers and their children were interviewed and assessed at baseline, after completion of the intervention, and 12 months post intervention. We will present some of the preliminary data from the trial (which will be ending in early 2018), describe the implementation of a complex intervention in an extremely remote and resource-poor setting, and chart future areas for project scale up.