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Background Lesotho is a nation in Southern Africa with an HIV prevalence of 25%. Males are less likely to access HIV services and there is a need for strategies to improve male participation in HIV care. This paper describes the development and implementation of the Male Initiative to increase male participation in HIV services. Methods A combination of qualitative and quantitative methods were used to describe the components, process, organization, participation and potential impact of the Male Initiative. Results The Male Initiative was developed in partnership with local village chiefs, traditional healers and spiritual leaders. It used the traditional male meeting structure known as the Pitso-ea-banna to deliver messages about HIV care. 1311 men participated in five Male Initiative meetings over a 30 month period from June 2006-31 December, 2008. Male enrollment increased from 32% in 2006 to 36.8% in 2008, a trend which approached statistical significance (p = 0.07) and suggests potential programmatic impact that merits further study. Conclusion Gender inequalities in enrollment in HIV care can be addressed through programs developed in partnership with local leaders and delivered in culturally accepted settings. [ABSTRACT FROM PUBLISHER]

Objectives: This study evaluated a novel early childhood development (ECD) programme integrated it into the primary healthcare system., Setting: The intervention was implemented in a rural district of Lesotho from 2017 to 2018., Participants: It targeted primary caregivers during routine postnatal care visits and through village health worker home visits., Intervention: The hybrid care delivery model was adapted from a successful programme in Lima, Peru and focused on parent coaching for knowledge about child development, practicing contingent interaction with the child, parent social support and encouragement., Primary and Secondary Outcomes Measures: We compared developmental outcomes and caregiving practices in a cohort of 130 caregiver-infant (ages 7-11 months old) dyads who received the ECD intervention, to a control group that did not receive the intervention (n=125) using a case-control study design. Developmental outcomes were evaluated using the Extended Ages and Stages Questionnaire (EASQ), and caregiving practices using two measure sets (ie, UNICEF Multiple Indicator Cluster Survey (MICS), Parent Ladder). Group comparisons were made using multivariable regression analyses, adjusting for caregiver-level, infant-level and household-level demographic characteristics., Results: At completion, children in the intervention group scored meaningfully higher across all EASQ domains, compared with children in the control group: communication (δ=0.21, 95% CI 0.07 to 0.26), social development (δ=0.27, 95% CI 0.11 to 0.8) and motor development (δ=0.33, 95% CI 0.14 to 0.31). Caregivers in the intervention group also reported significantly higher adjusted odds of engaging in positive caregiving practices in four of six MICS domains, compared with caregivers in the control group-including book reading (adjusted OR (AOR): 3.77, 95% CI 1.94 to 7.29) and naming/counting (AOR: 2.05; 95% CI 1.24 to 3.71)., Conclusions: These results suggest that integrating an ECD intervention into a rural primary care platform, such as in the Lesothoan context, may be an effective and efficient way to promote ECD outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)