Attrition and Opportunities along the HIV Care Continuum: Findings from a Population-Based Sample, North West Province, South Africa

June 2016 - Combination Prevention

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Lippman, S.A., Shade, S.B., El Ayadi, A.M., et al. Journal of Acquired Immune Deficiency Syndromes (April 2016), e-publication ahead of print.

From January to March 2014, the authors conducted a population-based survey (n=1,044), HIV rapid testing, point-of-care CD4 testing, and viral load measurement to characterize the HIV care continuum in a rural district of North West Province, South Africa. Overall, 20.0 percent of men and 26.7 percent of women were HIV-positive; prevalence was higher among females than males in every age group. Over half of men and one-quarter of women first learned their status at diagnosis. Men's prevalence increased with age, peaking at 40–49 years; women's prevalence peaked at 30–39 years. Throughout the HIV-positive population, there was major attrition along the HIV continuum of care for the full HIV-positive population. The most significant drop occurred at the gateway to the care continuum—HIV testing, particularly for men. Additionally, while most HIV-positive individuals began antiretroviral therapy, only 33.1 percent of men and 58.4 of women were retained in care. Of those receiving treatment, only 33.1 percent and 53.5 percent of HIV-positive men and women, respectively, reported adherence to medication, and only 21.6 percent and 50.0 percent had attained viral suppression. This study, the authors concluded, provided a comprehensive picture of the HIV care continuum in the North West Province, and should be used to inform targeted programming.

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