Significant attrition at each stage of HIV care cascade in South Africa

Michael Carter

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.

July 11, 2016
Year of publication
Resource types
Journal and research articles
AIDS, HIV prevention, HIV, treatment, HIV care, HIV positive women, CD4, ART

Similar Resources


Attrition along the HIV care continuum slows gains in mitigating the South African HIV epidemic. Understanding population-level gaps in HIV identification, linkage, retention in care and viral suppression is critical to target programming.

Adolescents newly diagnosed with HIV need to be rapidly incorporated into HIV care networks to have the best chances of remaining in care in the long term, research from the United States published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes shows.

Baylor-Malawi, with USAID funding, has developed a special JAIDS supplement featuring 11 articles which highlight lessons and best practices from the Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative, a public-private partnership that expanded pediatric HIV services in nine sub-Saharan

Initiation of antiretroviral therapy (ART) following diagnosis of HIV infection at birth is an emerging area of paediatric HIV care. We present outcomes of HIV-infected infants identified at birth at Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa.

In 2013, Uganda updated its prevention of maternal-to-child transmission of HIV program to Option B+, which requires that all HIV-infected pregnant and breastfeeding women be started on lifelong antiretroviral therapy (ART) regardless of CD4 count…

Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown.

Remarkable progress is being made on HIV treatment. Ahead of World AIDS Day, UNAIDS has launched a new report showing that access to treatment has risen significantly. In 2000, just 685 000 people living with HIV had access to antiretroviral therapy.

To understand the uptake of HIV services by adolescent women, the authors conducted a retrospective analysis of patient-level data (2011–2013) on services for antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) in 36 facilities in 5 districts in Zimbabwe.

This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges.

Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low.