Abstract
BackgroundSouth Africa is home to the world’s largest HIV epidemic. Throughout the world, incarcerated individuals have a higher prevalence of HIV than the general public, and South Africa has one of the highest rates of incarceration in sub-Saharan Africa. In spite of this, little has been published about the burden of HIV and how care is delivered in South African correctional facilities.ObjectiveTo estimate the prevalence of people living with HIV and identify initiation and retention in the HIV cascade of care across five correctional facilities.MethodsCross-sectional retrospective analysis of 30,571 adult inmates who participated in a tuberculosis screening and HIV counseling and testing campaign in South African correctional facilities (January 1, 2014—January 31, 2015). Descriptive statistics were used to estimate the proportion and 95% confidence intervals of HIV. Proportions of persons retained and lost at each step in the HIV cascade of care under this intervention were calculated. Poisson regression with robust variance estimates were used, and clustering by facility was accounted for in all analyses.ResultsResults of the screening campaign found previously undiagnosed HIV among 13.0% of those consenting to screening, with a total estimated HIV prevalence of 17.7% (n = 3,184, 95% CI: 17.2–18.3%) in the sample. When examining the overall cascade of care, 48.3% of those with HIV initiated care, and overall 45.6% of persons who entered care qualified for ART initiated treatment. A Poisson regression accounting for clustering by facility found HIV high risk groups within the population such as women (aRR = 1.72, 95% CI: 1.57, 1.89), those over 35 years of age (aRR = 2.43, 95% CI: 1.53, 3.85), and people incarcerated less than one year (aRR = 1.41, 95% CI: 1.19, 1.67).ConclusionIn this setting, routine screening is recommended, and measures are needed to ensure that persons diagnosed are adequately linked to and retained in care.
Highlights
South Africa is home to the world’s largest HIV epidemic, with an estimated 7 million people living with HIV and 180,000 deaths due to AIDS in 2015 [1, 2]
HIV in South African prisons those over 35 years of age, and people incarcerated less than one year
The current analysis utilized data collected by a South African non-governmental organization as part of a programmatic intervention to conduct enhanced TB screening and HIV counseling and testing (HCT) at five correctional facilities located in Gauteng, Mpumalanga, Limpopo, and North West provinces in South Africa [13]
Summary
South Africa is home to the world’s largest HIV epidemic, with an estimated 7 million people living with HIV and 180,000 deaths due to AIDS in 2015 [1, 2]. Throughout the world, incarcerated individuals tend to have a higher prevalence of HIV than the general public [4] This increased HIV prevalence is often exacerbated by high rates of other infectious diseases, such as TB, and an increased incidence of high risk behaviors among inmates [4]. Limited data suggest these global trends are mirrored in the sub-Saharan African region, with HIV prevalence among inmate populations being greater than that found among non-incarcerated populations [4, 5]. Little has been published about the burden of HIV and how care is delivered in South African correctional facilities
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