HIV prevalence and the cascade of care in five South African correctional facilities

Abstract

Background South 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. Objective To estimate the prevalence of people living with HIV and identify initiation and retention in the HIV cascade of care across five correctional facilities. Methods Cross-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. Results Results 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),

Overview of the epidemiological conditions of HIV among key populations in Africa

“…The HIV prevalence estimates reported in peer‐reviewed academic journals consistently reported higher prevalence estimates relative to what was reported in the UNAIDS report. A systematic review published in the Lancet in 2016 reported prevalence estimates ranging from 4.2% (Ethiopia) to 23.0% (Malawi) in East Africa, 7.2% (South Africa) to 34.9% (Swaziland) in Southern Africa and 2.3% (Ghana) to 10.2% (Congo) in West and Central Africa [7] Additionally, a cross‐sectional study of five correctional facilities across South Africa estimated that the HIV prevalence among prisoners was 17.7% (95% CI = 17.2% to 18.3%) [73].…”

Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review

“…Six studies assessed interventions involving screening campaigns that estimated the prevalence of HIV in prisons across different countries. 8,17,24,26,34,36 On the one hand, the studies suggest weak HIV infection control practices in SSA prisons in terms of screening at entry, during incarceration, and at exit from prison. This is reflected in the low proportion of inmates who knew their HIV status prior to screening.…”

Cross-sectional assessment of tuberculosis and HIV prevalence in 13 correctional facilities in Zambia

“…Other countries in sub-Saharan Africa with results involving multiple correctional facilities report TB prevalence ranging from 457 to 888 per 100 000 population. [23][24][25] However, a direct comparison to the prevalence reported in the other countries can not be done due to differences in definitions of TB used and differences in prevalence in the general population.…”