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HIV testing and treatment campaigns need to target women and the under 35s, says research from South Africa
Michael Carter, 2016-06-16 08:00:00
A quarter of
HIV-positive individuals in KwaZulu-Natal are unaware of their infection
status, according to research published in the online edition of the Journal of Acquired Immune Deficiency
Syndromes. The study also revealed that approximately three-quarters of
patients eligible for antiretroviral therapy (ART) were taking this treatment
and just over half of all HIV-positive individuals had viral suppression. The
majority of individuals who were untested, unaware of their infection status,
untreated and unsuppressed were women and the under 35s. However, men had a
much greater risk of all these outcomes.
demographic sub-groups remain at higher risk for being untested, untreated and
virally unsuppressed, hence being at high risk for adverse health outcomes and
having a high potential for transmitting HIV,” write the investigators. “These
results highlight the first priority is to increase testing and treatment for
young people and women, as well as the need to adapt HIV testing strategies to
better target men.”
sub-groups have poor engagement with the HIV care continuum from diagnosis
through to viral suppression is essential so that appropriate strategies can be
designed to target those not accessing HIV services. However, relatively little
is known about the socio-demographic and behavioural characteristics associated
with being untested, lack of awareness of infection status, uptake of therapy
and viral suppression, especially in high-prevalence settings such as South
Africa. KwaZulu-Natal is the South African province with the highest HIV
prevalence and incidence.
wanted to gain a clear understanding of rates of engagement with the HIV care
continuum in this province and also the factors associated with not accessing HIV
designed a cross-sectional population-based study involving households in
Mbongolwane and Eshowe. A total of 5,649 individuals aged between 15 and 59
years were recruited to the study. Each participant had a face-to-face
interview with study staff when they were asked to provide demographic
information, sexual histories and details
of ART usage. All participants had a rapid HIV test and patients testing
positive provided blood samples, which were monitored for the presence of
antiretroviral drugs. CD4 cell count and viral load were also quantified.
collected in 2013. At this time, pregnant women and people with a CD4 count
below 350 cells/mm3 were eligible for ART.
Most (62%) of the
participants were women and the median age was 26 years.
HIV testing rates
were high, with 81% of patients reporting having been screened for the infection.
Testing rates were higher in women than men (88% vs. 70%). Participants aged
under 35 years and men accounted for three-quarters and two-thirds,
respectively, of untested individuals.
The overall HIV
prevalence rate was 25% but was higher in women than men (31% vs. 16%).
had been screened for HIV reported a median of three tests and 48% had been
tested in the previous six months.
ART-eligible patients were taking this treatment, and these individuals
represented 53% of all HIV-positive patients.
Analysis of the
patients eligible for ART but not on treatment showed that 65% were women and
66% were aged less than 35 years. Overall, ART coverage was lower in men
compared to women (64% vs. 79%, p < 0.001) and was also lower in younger
compared to older age groups. (p < 0.001).
Viral load was
suppressed (below 1000 copies/ml) in 57% of all HIV-positive individuals. Of
the patients who had unsuppressed viral load, 71% were women and 66% were aged
less than 35 years. Men and the under 35s were the groups most likely to have a
viral load above 100,000 copies/ml (18% men vs. 10% women; 15% of under 35s vs.
8% of older age groups).
patients with antiretrovirals in their blood showed that 94% had viral suppression
and 90% of participants who reported use of ART had a viral load below
significantly more likely than women to be untested, unaware of their infection
status, untreated and virally unsuppressed. In addition, patients with higher
numbers of sexual partners were more likely to have poor engagement with the
HIV care continuum.
survey helped to reveal gaps in HIV services provided in the area and identify
who needs to be targeted for HIV testing and treatment,” conclude the authors. “HIV
testing and treatment activities should be prioritized to target young people
and women, and a right balance should be found between increasing access to
test and treat for the bulk of people untested and untreated and specific
strategies for those who are more difficult to reach.”