There is significant attrition at each stage of the HIV care continuum in South Africa, according to a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The population-based research was conducted in North West Province and revealed that of those with HIV, only 48% of men and 76% of women were aware they were infected. Patients were then lost at each stage in the cascade of HIV care. Overall, just 22% of HIV-positive men and 56% of HIV-positive women had viral suppression, liberally defined as a viral load below 5000 copies/ml.
“These results provide a comprehensive picture of engagement with HIV care from diagnosis to viral suppression in a geographic area with little previous research but extremely high burden of disease,” write the investigators. “Based on the full HIV-positive population, it is quite clear that the greatest gap in engagement occurs at HIV diagnosis, indicating a critical need for improving case detection, particularly among men.”
South Africa has the largest antiretroviral therapy (ART) delivery programme in the world. Yet despite a massive scale-up in the delivery of ART, approximately 200,000 South Africans still die of AIDS each year and only half of those eligible for antiretroviral treatment are receiving appropriate treatment.
There are currently very limited data on engagement of patients in South Africa with the HIV care continuum. Population-based evidence is especially scarce.
A team of investigators therefore conducted a population-based study involving adults aged between 18 and 49 years in a rural districts of North West Province. The area is known to have a high HIV prevalence (in excess of 20%).
Data were gathered between January and March 2014 in Lewka-Teemane and Greater Taung sub-districts.
A total of 1044 individuals were included in the household-based survey and provided blood samples for rapid HIV testing, point-of-care CD4 cell monitoring and dried blood spots for viral load assessment. Participants were asked if they had ever tested for HIV, if they knew if they were HIV positive, and if so, whether they had ever been linked to care, if they were retained in care, if they were taking ART and if they were adherent to ART.