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

Abstract

Background: During the era of the Millennium Development Goals (MDG), children were shown to have less access to human immunodeficiency virus (HIV) services than their adult counterparts; hence the call to prioritise children in the implementation of the Sustainable Development Goals (SDGs). However, South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults.Objectives: To evaluate the access of children to HIV services and record the viral load (VL) suppression rates during the implementation of the 90-90-90 strategy in the City of Johannesburg (COJ), South Africa.Methods: This study applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2020, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data were extracted from these databases into MS Excel 2010 spreadsheets and analysed with Stata 15 software from Stata Corp using a two-tailed t-test at a 5% level of significance.Results: Overall, a significant increase was observed in the number of individuals tested for HIV, n = 757, p = 0.0086, and retained in care n = 2523, p = 0.001 over the whole period of analysis beginning in April 2015. Adult HIV testing, antiretroviral treatment (ART) initiation and retention in care had been decreasing in absolute numbers over a 10-month period before the intervention. An increase in these three data elements was observed following the implementation of the 90-90-90 program. On the other hand, children aged 0–15 years had demonstrated a significant increase in absolute numbers tested for HIV, n = 171, p = 0.001, but an insignificant increase in number of ART initiations, n = 14.33, p = 0.252, before implementation but a decrease after this. The overall VL suppression rates for children were lower than those of adults.Conclusion: Although the COJ has recorded progress in adult HIV testing, ART initiation and retention, children living with HIV aged 0–15 years continue to experience less access to HIV services and lower VL suppression than youths and adults of ≥ 15 years. Therefore, to ensure that the 90-90-90 targets are achieved across different age groups, children must be prioritised so that they can equally access these services with adults.

HIV viral load suppression before and after COVID-19 in Kinshasa and Haut Katanga, Democratic Republic of the Congo

“…The importance of PLHIV being on an antiretroviral treatment (ART) has been well established, contributing to viral load (VL) suppression as well as reduced odds of advanced HIV disease and mortality. 1,2 Viral load suppression below 1000 copies/mL is an important indicator of successful ART treatment. Innovative techniques to reduce the risk of VL non-supression are of importance during COVID-19.…”

Progress towards 90-90-90 and 95-95-95 strategy implementations and HIV positivity trends in the City of Johannesburg

“…[6] The concern is the discrepancy among different age groups, as reported in our previous publication, where children were less likely to be HIV tested and become virally suppressed in CoJ compared with their adult counterparts. [8,9] In addition, men have consistently been reported to lag behind in accessing HIV services over decades, [21,22] and several interventions and innovations to retain them in care have been tried and tested. There is need for more male and children-centred interventions, as they are so far limited.…”

“…[6] By 2020 the CoJ strategy implementation data showed an improvement in HIV services uptake even though children have been shown to be less likely to access the services and virally suppress compared with their adult counterparts. [8] This calls for action to prioritise children by creating innovative ways to ensure access to HIV services in CoJ and globally. [9] Evidence has shown that ensuring that those who are HIV positive are initiated on ART and virally suppressed will contain the HIV pandemic and reduce transmission, a move towards HIV elimination.…”

SAHCS 2021 Conference Summary

“…We have made mistakes. In aiming at the 2020 targets, children lagged behind, particularly the very young and adolescents, 6 and also young women. The seroprevalence range of antenatal HIV in Soweto, South Africa, is currently at 27% – 30%.…”