Progress of UNAIDS 90-90-90 targets in a district in KwaZulu-Natal, South Africa, with high HIV burden, in the HIPSS study: a household-based complex multilevel community survey

Grobler, Anneke; Cawood, Cherie; Khanyile, David; Puren, Adrian; Kharsany, Ayesha B. M.

doi:10.1016/s2352-3018(17)30122-4

Cited by 59 publications

(76 citation statements)

References 18 publications

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“…Current literature and analyses focus on gender differentials in health seeking behavior and linkage and retentionin the HIV care cascade in Southern Africa as a threat to achieving UNAIDS 90:90:90 targets [25, 26, 31]. Our findings further display the gender differential among newly-diagnosed PLHIV and ART initiation seen in similar studies [15, 20, 32].…”

Section: Discussionsupporting

confidence: 73%

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Larsen

Cheyip

Tesfay³

et al. 2018

AIDS Behav

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Despite a decade of advancing HIV/AIDS treatment policy in South Africa, 20% of people living with HIV (PLHIV) eligible for antiretroviral treatment (ART) remain untreated. To inform universal test and treat (UTT) implementation in South Africa, this analysis describes the rate, timeliness and determinants of ART initiation among newly diagnosed PLHIV. This analysis used routine data from 35 purposively selected primary clinics in three high HIV-burden districts of South Africa from June 1, 2014 to March 31, 2015. Kaplan-Meier survival curves estimated the rate of ART initiation. We identified predictors of ART initiation rate and timely initiation (within 14 days of eligibility determination) using Cox proportional hazards and multivariable logistic regression models in Stata 14.1. Based on national guidelines, 6826 patients were eligible for ART initiation. Under half of men and non-pregnant women were initiated on ART within 14 days (men: 39.7.0%, 95% CI 37.7-41.9; women: 39.9%, 95% CI 38.1-41.7). Pregnant women initiated at a faster rate (within 14 days: 87.6%, 86.1-89.0). ART initiation and timeliness varied significantly by district, facility location, and age, with little to no variation by World Health Organization stage, or CD4 count. Men and non-pregnant women newly diagnosed with HIV who are eligible for ART in South Africa show suboptimal timeliness of ART initiation. If treatment initiation performance is not improved, UTT implementation will be challenging among men and non-pregnant women. UTT programming should be tailored to district and location categories to address contextual differences influencing treatment initiation.

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Section: Discussionsupporting

confidence: 73%

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Larsen

Cheyip

Tesfay³

et al. 2018

AIDS Behav

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“…High income, less educated, and single groups were all less likely to be aware of their HIV status relative to low income, secondary educated and married persons respectively [26]. In South Africa, women were found to have more than two‐fold greater odds of Awareness of HIV‐Positive Status relative to men (95% CI 1.75 to 2.57) [27]. Furthermore, those aged 15 to 19 years had 0.16‐fold lower odds of Awareness of HIV‐Positive Status relative to those aged 45 to 49 years (95% CI 0.09 to 0.29).…”

Section: Resultsmentioning

confidence: 99%

“…We included 53 studies that reported data on ART Use , with six studies that produced statistical measures of association across demographic strata. Men were found to be more likely than women to use ART in Botswana while they were less likely to be on ART in Zambia; and no statistically significant association by gender was found in two South African studies [26,27,29,30]. Two studies found older age groups to be significantly more likely to be on ART compared to younger age groups [26,31], while two studies failed to find any association between age and ART Use [30,32].…”

Section: Resultsmentioning

confidence: 99%

“…However, in the general population, two studies found married groups to be more likely than single and never married groups to be on ART [25,27], and a third study found those reporting having a regular partner were more likely to use ART than those without a regular partner [30]. Finally, two studies failed to find an association between mobility and ART Use [25,27], and the study of MSM and transgender women found no association between immigrants and non‐immigrants [31].…”

Section: Resultsmentioning

confidence: 99%

“…Groups with higher than senior secondary education had lower prevalence of Population‐wide Viral Suppression compared to those with non‐formal education in this study setting (PR 0.81; 95% CI 0.73 to 0.89). Women in a South African study had 2.11‐fold greater odds of Population‐wide Viral Suppression relative to men (95% CI 1.69 to 2.63) [27]. They also identified a monotonic decrease in odds of Population‐wide Viral Suppression across decreasing 5‐year age bands comparing 45 to 49 to 40 to 44, 35 to 39, 30 to 34, 25 to 29, 20 to 24 and 15 to 19 (OR of 0.94, 0.76, 0.51, 0.32, 0.23 and 0.22 respectively).…”

Section: Resultsmentioning

confidence: 99%

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Evidence of sociodemographic heterogeneity across the HIV treatment cascade and progress towards 90‐90‐90 in sub‐Saharan Africa – a systematic review and meta‐analysis

et al. 2020

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Introduction Heterogeneity of sociodemographics and risk behaviours across the HIV treatment cascade could influence the public health impact of universal ART in sub‐Saharan Africa if those not virologically suppressed are more likely to be part of a risk group contributing to onward infections. Sociodemographic and risk heterogeneity across the treatment cascade has not yet been comprehensively described or quantified and we seek to systematically review and synthesize research on this topic among adults in Africa. Methods We conducted a systematic review of peer‐reviewed literature in Embase and MEDLINE databases as well as grey literature sources published in English between 2014 and 2018. We included studies that included people living with HIV (PLHIV) aged ≥15 years, and reported a 90‐90‐90 outcome: awareness of HIV‐positive status, ART use among those diagnosed or viral suppression among those on ART. We summarized measures of association between sociodemographics, within each outcome, and as a composite measure of population‐wide viral suppression. Results and discussion From 3533 screened titles, we extracted data from 92 studies (50 peer‐reviewed, 42 grey sources). Of included studies, 32 reported on awareness, 53 on ART use, 32 on viral suppression and 23 on population‐wide viral suppression. The majority of studies were conducted in South Africa, Uganda, and Malawi and reported data for age and gender. When stratified, PLHIV ages 15 to 24 years had lower median achievement of the treatment cascade (60‐49‐81), as compared to PLHIV ≥25 years (70‐63‐91). Men also had lower median achievement of the treatment cascade (66‐72‐85), compared to women (79‐76‐89). For population‐wide viral suppression, women aged ≥45 years had achieved the 73% target, while the lowest medians were among 15‐ to 24‐year‐old men (37%) and women (49%). Conclusions Considerable heterogeneity exists by age and gender for achieving the HIV 90‐90‐90 treatment goals. These results may inform delivery of HIV testing and treatment in sub‐Saharan Africa, as targeting youth and men could be a strategic way to maximize the population‐level impact of ART.

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Trends in HIV Prevention, Treatment, and Incidence in a Hyperendemic Area of KwaZulu-Natal, South Africa

et al. 2019

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Progress of UNAIDS 90-90-90 targets in a district in KwaZulu-Natal, South Africa, with high HIV burden, in the HIPSS study: a household-based complex multilevel community survey

Abstract: Centers for Disease Control and Prevention and the US Presidents Emergency Plan for AIDS Relief (PEPFAR).

Cited by 59 publications

References 18 publications

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Timing and Predictors of Initiation on Antiretroviral Therapy Among Newly-Diagnosed HIV-Infected Persons in South Africa

Evidence of sociodemographic heterogeneity across the HIV treatment cascade and progress towards 90‐90‐90 in sub‐Saharan Africa – a systematic review and meta‐analysis

Trends in HIV Prevention, Treatment, and Incidence in a Hyperendemic Area of KwaZulu-Natal, South Africa

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