Progress towards the 2020 targets for HIV diagnosis and antiretroviral treatment in South Africa

Leigh F Johnson, Rob E Dorrington, Haroon Moolla, Leigh F Johnson, Rob E Dorrington, Haroon Moolla

Abstract

Background: The UNAIDS targets for 2020 are to achieve a 90% rate of diagnosis in HIV-positive individuals, to provide antiretroviral treatment (ART) to 90% of HIV-diagnosed individuals and to achieve virological suppression in 90% of ART patients.

Objectives: To assess South Africa's progress towards the 2020 targets and variations in performance by province.

Methods: A mathematical model was fitted to HIV data for each of South Africa's provinces, and for the country as a whole. Numbers of HIV tests performed in each province were estimated from routine data over the 2002-2015 period, and numbers of patients receiving ART in each province were estimated by fitting models to reported public and private ART enrolment statistics.

Results: By the middle of 2015, 85.5% (95% CI: 84.5% - 86.5%) of HIV-positive South African adults had been diagnosed, with little variation between provinces. However, only 56.9% (95% CI: 55.3% - 58.7%) of HIV-diagnosed adults were on ART, with this proportion varying between 50.8% in North West and 72.7% in Northern Cape. In addition, 78.4% of adults on ART were virally suppressed, with rates ranging from 69.7% in Limpopo to 85.9% in Western Cape. Overall, 3.39 million (95% CI: 3.26-3.52 million) South Africans were on ART by mid-2015, equivalent to 48.6% (95% CI: 46.0% - 51.2%) of the HIV-positive population. ART coverage varied between 43.0% in Gauteng and 63.0% in Northern Cape.

Conclusion: Although South Africa is well on its way to reaching the 90% HIV diagnosis target, most provinces face challenges in reaching the remaining two 90% targets.

Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

FIGURE 1
FIGURE 1
Provincial progress towards the 90–90–90 targets in 2015: (a) Proportion of HIV-positive adults diagnosed; (b) Proportion of diagnosed adults on ART; (c) Proportion of ART patients virally suppressed; (d) Proportion of HIV-positive adults on ART and virally suppressed.
FIGURE 2
FIGURE 2
ART enrolment ratio (new ART initiation divided by new HIV infections): (a) National average; (b) Comparison of adults and children.

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