# Promoting HIV Testing and Linkage to Care in Cross-Border Migrants in Lesotho

> **NIH NIH R21** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $196,051

## Abstract

PROJECT SUMMARY/ABSTRACT
In this R21 application (PA-20-145: Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize
HIV Prevention and Care Continuum Outcomes), we propose to explore the use of community or home-based
testing, including self-testing (HIVST) and preferences for linkage to confirmatory testing and treatment in cross-
border migrants in Lesotho, a country with very high HIV prevalence as well as high rates of mobility. Through our
research done as part of the Lesotho Population-based HIV Impact Assessment (LePHIA) in 2020, we found that
Lesotho has made great gains in terms of HIV viral load suppression overall, but those who had recently migrated
were significantly less likely to be virally suppressed, mainly due to lack of awareness. The Ministry of Health has
been rolling out HIVST as a strategy to reach men and populations who do not normally access health care.
However, an increase in testing is insufficient as a public health strategy if the barriers to treatment mean that
knowledge of status does not translate into engagement in antiretroviral treatment and viral suppression,
diminishing the clinical and epidemic control benefits. In order to determine the best strategy for increasing testing
and linkage to treatment rates in migrants, we aim to determine preferences for confirmatory testing and treatment
in cross-border migrants who report that HIV testing outside the facility is acceptable. First, we will conduct
formative research to explore determinants of migrant health and to understand the barriers and facilitators to
testing and accessing treatment or prevention in cross-border migrants, exploring preferences regarding location,
types of services, and opportunities to use health services in South Africa. Second, we will contact participants in
the LePHIA 2020 who identified as recent cross-border migrants and consented to be contacted for future research.
Eligible participants will be invited to complete a discrete choice experiment (DCE) on their preferences for
confirmatory testing after self- or other community-based testing, and linkage to treatment. The proposed study is
innovative because it is the first known attempt to use a DCE in a diverse panel of cross-border migrants, recruited
from the community rather than at health facilities. We will use findings to develop an intervention to support testing
and linkage in cross-border migrants.

## Key facts

- **NIH application ID:** 10483680
- **Project number:** 1R21MH130284-01
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Yael R Hirsch-Moverman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $196,051
- **Award type:** 1
- **Project period:** 2022-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10483680

## Citation

> US National Institutes of Health, RePORTER application 10483680, Promoting HIV Testing and Linkage to Care in Cross-Border Migrants in Lesotho (1R21MH130284-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10483680. Licensed CC0.

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