Abstract
IntroductionTo 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.MethodsData 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.ResultsOverall, 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.ConclusionsOver 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.
Highlights
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
While we had hypothesized that HIV testing and care engagement would increase in the municipality receiving the combination prevention programme compared to the municipality not receiving these services, we found that changes in the 90-90-90 indicators between the two communities were equivalent
A total of 980 participants (92.5%) enrolled; six were later determined ineligible, data were lost for two surveys due to errors saving and uploading the survey files, and one survey was not matched to a household, resulting in an analytic sample of 971 participants
Summary
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. UNAIDS first introduced testing and treatment targets in 2014 which specify that by 2020, 90% of HIV-positive people are aware of their status, 90% of those diagnosed receive sustained antiretroviral therapy (ART) and 90% of those on ART achieve viral suppression [2]. Governments adopted these targets and have more than doubled the number of people on ART in recent years. Introduction of FDC, expanded ART eligibility, and new measures to streamline treatment and improve adherence are likely to make a large impact on care engagement and adherence, moving South Africa closer to meeting the 90-90-90 targets following these policy changes. Survey findings estimated that nationally, 78.0% and 88.9% of HIVpositive males and females respectively were aware of their status; 67.4% and 72.2% of males and females aware of their status were on ART; and 82.1% and 89.9% and of males and females on ART were virally suppressed [5]
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