Improvements in the South African HIV care cascade: findings on 90‐90‐90 targets from successive population‐representative surveys in North West Province

Abstract

Introduction To achieve epidemic control of HIV by 2030, countries aim to meet 90‐90‐90 targets to increase knowledge of HIV ‐positive status, initiation of antiretroviral therapy ( ART ) and viral suppression by 2020. We assessed the progress towards these targets from 2014 to 2016 in South Africa as expanded treatment policies were introduced using population‐representative surveys. Methods Data were collected in January to March 2014 and August to November 2016 in Dr. Ruth Segomotsi Mompati District, North West Province. Each multi‐stage cluster sample included 46 enumeration areas ( EA ), a target of 36 dwelling units ( DU ) per EA , and a single resident aged 18 to 49 per DU . Data collection included behavioural surveys, rapid HIV antibody testing and dried blood spot collection. We used weighted general linear regression to evaluate differences in the HIV care continuum over time. Results Overall, 1044 and 971 participants enrolled in 2014 and 2016 respectively with approximately 77% undergoing HIV testing. Despite increases in reported testing, known status among people living with HIV ( PLHIV ) remained similar at 68.7% (95% Confidence Interval ( CI ) = 60.9–75.6) in 2014 and 72.8% (95% CI = 63.6–80.4) in 2016. Men were consistently less likely than women to know their status. Among those with known status, PLHIV on ART increased significantly from 80.9% (95% CI = 71.9–87.4) to 91.5% (95% CI = 84.4–95.5). Viral suppression (<5000 copies/mL using DBS) among those on ART increased significantly from 55.0% (95% CI = 39.6–70.4) in 2014 to 81.4% (95% CI = 72.0–90.8) in 2016. Among all PLHIV an estimated 72.0% (95% CI = 63.8–80.1) of women and 45.8% (95% CI = 27.0–64.7) of men achieved viral suppression by 2016. Conclusions Over a period during which fixed‐dose combination was introduced, ART eligibility expanded, and efforts to streamline treatment were implemented, major improvements in the second and third 90‐90‐90 targets were achieved. Achieving the first 90 target will require targeted and improved testing models for men.

Trends and determinants of ever having tested for HIV among youth and adults in South Africa from 2005–2017: Results from four repeated cross-sectional nationally representative household-based HIV prevalence, incidence, and behaviour surveys

“…These targets are aimed to increase knowledge of HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression by 2020 [1,5,6]. Changes in HIV testing overtime has implications for the UNAIDS targets and for evaluating the impact of national policies [7].…”

Access to HIV services and viral load suppression among children during the 90-90-90 strategy implementation in South Africa: A time series analysis

“…Other studies support this assessment. 12 , 13 The roll-out of ‘Universal Test and Treat’ (UTT) in September 2016 would have contributed to this outcome as this removed the CD4 count ‘barrier’ to care. 14 , 15 Furthermore, the roll-out of the 90-90-90 strategy was accompanied by HIV testing campaigns that raised awareness in the community.…”

Associations Between Key Psychosocial Stressors and Viral Suppression and Retention in Care Among Youth with HIV in Rural South Africa

“…The most recent country estimates suggest that only 39.9% of youth with HIV (YWH) in this age range are on antiretroviral treatment (ART) [ 1 , 3 ]. Despite improvements in ART accessibility over the past decade and adoption of the World Health Organization’s Universal Test and Treat recommendation in September 2016 [ 4 ], poor HIV care outcomes persist among South African YWH [ 5 ].…”