The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) - the U.S. Government initiative to help save the lives of those impacted by HIV/AIDS around the world - is the largest commitment by any nation in history to combat a single disease internationally.   Within the Department of State, the Office of the U.S. Global AIDS Coordinator (S/GAC) is responsible for coordinating the implementation of PEPFAR. Additional information about S/GAC and PEPFAR is available at www.pepfar.gov. In Lesotho, PEPFAR is implemented through the U.S. Department of State (DoS), the U.S. Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the Peace Corps (PC).  Lesotho has a total population of 2,007,201 people, 51% of whom are women and 32% of whom are under the age of 15. The country is divided into ten districts. Lesotho is classified as a lower middle-income country with a Human Development Index of 0.497 and a Gross National Income (GNI) per capita of $1,210.00. Sixty-six percent of the population lives in rural areas.    Lesotho ranks second in worldwide HIV prevalence among people aged 15-49 years at 25.6%. While a reduction in incidence has occurred, Lesotho still has the highest global HIV incidence among people aged 15-49 at 1.1%. The HIV response in Lesotho is primarily funded by the Government of Lesotho (GOL), The Global Fund, and PEPFAR. The HIV response in Lesotho remains largely uncoordinated and many programs remain at a scale that will not have an impact on the epidemic. The present Lesotho National Strategic Plan (NSP) does not address the financial constraints or prioritize activities against the available budget. Though the USG is the primary external donor to the HIV response, it still needs synergy with other funders’ programs for successful impact. This requires the USG to leverage its influence in order to facilitate program harmony and demonstrate efficiencies. The PEPFAR program actively engages the GOL to convene key stakeholders and advocates for high-level and technical coordination structures for the HIV response. Furthermore, the USG fosters partnerships for the smooth transition to five high-burden districts to ensure continuity and sustainability of the response.