Attrition along the HIV care continuum slows gains in mitigating the South African HIV epidemic. Understanding population-level gaps in HIV identification, linkage, retention in care and viral suppression is critical to target programming.
We conducted a population-based household survey, HIV rapid testing, point-of-care CD4 testing, and viral load measurement from dried blood spots (DBS) using multi-stage cluster sampling in two sub-districts of North West Province from January-March, 2014. We used weighting and multiple imputation of missing data to estimate HIV prevalence, undiagnosed infection, linkage and retention in care, medication adherence, and viral suppression.
We sampled 1044 respondents ages 18-49. HIV prevalence was 20.0% (95% CI: 13.7-26.2) for men and 26.7% (95%CI: 22.1-31.4) for women. Among those HIV-positive, 48.4% of men and 75.7% of women were aware of their serostatus; 44.0% of men and 74.8% of women reported ever linking to HIV care; 33.1% of men and 58.4% of women were retained in care; and 21.6% of men and 50.0% of women had DBS viral loads < 5000 copies/mL. Among those already linked to care, 81.7% on ART and 56.0% of those not on ART were retained in care and 51.8% currently retained in care on ART had viral loads < 5000 copies/mL. CONCLUSIONS
Despite expanded treatment in South Africa, attrition along the continuum of HIV care is slowing prevention progress. Improved detection is critically needed, particularly among men. Reported linkage and retention is reasonable for those on ART, however failure to achieve viral suppression is worrisome.