Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey

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dc.contributor.authorHuerga, Helena
dc.contributor.authorVan Cutsem, Gilles
dc.contributor.authorBen Farhat, Jihane
dc.contributor.authorPuren, Adrian
dc.contributor.authorBouhenia, Malika
dc.contributor.authorWiesner, Lubbe
dc.contributor.authorDlamini, Linda
dc.contributor.authorMaman, David
dc.contributor.authorEllman, Tom
dc.contributor.authorEtard, Jean-François
dc.date.accessioned2018-05-03T13:13:43Z
dc.date.available2018-05-03T13:13:43Z
dc.date.issued2018-03-02
dc.date.updated2018-04-09T15:10:05Z
dc.description.abstractAbstract Background The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed an ambitious strategy to end the AIDS epidemic. After eight years of antiretroviral therapy (ART) program we assessed progress towards the UNAIDS 90–90-90 targets in Mbongolwane and Eshowe, KwaZulu-Natal, South Africa. Methods We conducted a cross-sectional household-based community survey using a two-stage stratified cluster probability sampling strategy. Persons aged 15–59 years were eligible. We used face-to-face interviewer-administered questionnaires to collect information on history of HIV testing and care. Rapid HIV testing was performed on site and venous blood specimens collected from HIV-positive participants for antiretroviral drug presence test, CD4 count and viral load. At the time of the survey the CD4 threshold for ART initiation was 350 cells/μL. We calculated progression towards the 90–90-90 UNAIDS targets by estimating three proportions: HIV positive individuals who knew their status (first 90), those diagnosed who were on ART (second 90), and those on ART who were virally suppressed (third 90). Results We included 5649/6688 (84.5%) individuals. Median age was 26 years (IQR: 19–40), 62.3% were women. HIV prevalence was 25.2% (95% CI: 23.6–26.9): 30.9% (95% CI: 29.0–32.9) in women; 15.9% (95% CI: 14.0–18.0) in men. Overall progress towards the 90–90-90 targets was as follows: 76.4% (95% CI: 74.1–78.6) knew their status, 69.9% (95% CI: 67.0–72.7) of those who knew their status were on ART and 93.1% (95% CI: 91.0–94.8) of those on ART were virally suppressed. By sex, progress towards the 90–90-90 targets was: 79%–71%–93% among women; and 68%–68%–92% among men (p-values of women and men comparisons were < 0.001, 0.443 and 0.584 respectively). By age, progress was: 83%–75%–95% among individuals aged 30–59 years and 64%–58%–89% among those aged 15–29 years (p-values of age groups comparisons were < 0.001, < 0.001 and 0.011 respectively). Conclusions In this context of high HIV prevalence, significant progress has been achieved with regards to reaching the UNAIDS 90–90-90 targets. The third 90, viral suppression in people on ART, was achieved among women and men. However, gaps persist in HIV diagnosis and ART coverage particularly in men and individuals younger than 30 years. Achieving 90–90-90 is feasible but requires additional investment to reach youth and men.
dc.identifier.apacitationHuerga, H., Van Cutsem, G., Ben Farhat, J., Puren, A., Bouhenia, M., Wiesner, L., ... Etard, J. (2018). Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey. <i>BMC Public Health</i>, http://hdl.handle.net/11427/27918en_ZA
dc.identifier.chicagocitationHuerga, Helena, Gilles Van Cutsem, Jihane Ben Farhat, Adrian Puren, Malika Bouhenia, Lubbe Wiesner, Linda Dlamini, David Maman, Tom Ellman, and Jean-François Etard "Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey." <i>BMC Public Health</i> (2018) http://hdl.handle.net/11427/27918en_ZA
dc.identifier.citationBMC Public Health. 2018 Mar 02;18(1):303
dc.identifier.ris TY - Journal Article AU - Huerga, Helena AU - Van Cutsem, Gilles AU - Ben Farhat, Jihane AU - Puren, Adrian AU - Bouhenia, Malika AU - Wiesner, Lubbe AU - Dlamini, Linda AU - Maman, David AU - Ellman, Tom AU - Etard, Jean-François AB - Abstract Background The Joint United Nations Programme on HIV/AIDS (UNAIDS) has developed an ambitious strategy to end the AIDS epidemic. After eight years of antiretroviral therapy (ART) program we assessed progress towards the UNAIDS 90–90-90 targets in Mbongolwane and Eshowe, KwaZulu-Natal, South Africa. Methods We conducted a cross-sectional household-based community survey using a two-stage stratified cluster probability sampling strategy. Persons aged 15–59 years were eligible. We used face-to-face interviewer-administered questionnaires to collect information on history of HIV testing and care. Rapid HIV testing was performed on site and venous blood specimens collected from HIV-positive participants for antiretroviral drug presence test, CD4 count and viral load. At the time of the survey the CD4 threshold for ART initiation was 350 cells/μL. We calculated progression towards the 90–90-90 UNAIDS targets by estimating three proportions: HIV positive individuals who knew their status (first 90), those diagnosed who were on ART (second 90), and those on ART who were virally suppressed (third 90). Results We included 5649/6688 (84.5%) individuals. Median age was 26 years (IQR: 19–40), 62.3% were women. HIV prevalence was 25.2% (95% CI: 23.6–26.9): 30.9% (95% CI: 29.0–32.9) in women; 15.9% (95% CI: 14.0–18.0) in men. Overall progress towards the 90–90-90 targets was as follows: 76.4% (95% CI: 74.1–78.6) knew their status, 69.9% (95% CI: 67.0–72.7) of those who knew their status were on ART and 93.1% (95% CI: 91.0–94.8) of those on ART were virally suppressed. By sex, progress towards the 90–90-90 targets was: 79%–71%–93% among women; and 68%–68%–92% among men (p-values of women and men comparisons were < 0.001, 0.443 and 0.584 respectively). By age, progress was: 83%–75%–95% among individuals aged 30–59 years and 64%–58%–89% among those aged 15–29 years (p-values of age groups comparisons were < 0.001, < 0.001 and 0.011 respectively). Conclusions In this context of high HIV prevalence, significant progress has been achieved with regards to reaching the UNAIDS 90–90-90 targets. The third 90, viral suppression in people on ART, was achieved among women and men. However, gaps persist in HIV diagnosis and ART coverage particularly in men and individuals younger than 30 years. Achieving 90–90-90 is feasible but requires additional investment to reach youth and men. DA - 2018-03-02 DB - OpenUCT DO - 10.1186/s12889-018-5208-0 DP - University of Cape Town J1 - BMC Public Health LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey TI - Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey UR - http://hdl.handle.net/11427/27918 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s12889-018-5208-0
dc.identifier.urihttp://hdl.handle.net/11427/27918
dc.identifier.vancouvercitationHuerga H, Van Cutsem G, Ben Farhat J, Puren A, Bouhenia M, Wiesner L, et al. Progress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey. BMC Public Health. 2018; http://hdl.handle.net/11427/27918.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentCentre for Infectious Disease Epidemiology and Research (CIDER)en_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Public Health
dc.source.urihttps://bmcpublichealth.biomedcentral.com/
dc.subject.otherHIV
dc.subject.otherCascade of care
dc.subject.otherViral load
dc.subject.otherUNAIDS targets
dc.subject.otherAfrica
dc.titleProgress towards the UNAIDS 90–90-90 goals by age and gender in a rural area of KwaZulu-Natal, South Africa: a household-based community cross-sectional survey
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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