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Who needs to be targeted for HIV testing and treatment in KwaZulu-Natal? Results from a population-based survey

  • 2016/05/26
Type of publication
  • Articles
  • Huerga H
  • Van Cutsem G
  • Ben Farhat J
  • Reid M
  • Bouhenia M
  • Maman D
  • Wiesner L
  • Etard JF
  • Ellman T
  • HIV


Identifying gaps in HIV testing and treatment is essential to design specific strategies targeting those not accessing HIV services. We assessed the prevalence and factors associated with being HIV untested, unaware, untreated and virally unsuppressed in KwaZulu-Natal, South Africa.

Cross-sectional population-based survey. People aged 15-59 years were eligible. Interviews, HIV testing and blood collection for antiretroviral drugs presence test, CD4, and viral load, were done at the participants' home.

Of the 5,649 individuals included, 81.4% (95%CI:79.8-82.9) had previously been tested. HIV prevalence was 25.2%. HIV positivity awareness rate was 75.2% (95%CI:72.9-77.4). Of all unaware, 73.3% were people aged <35years and 68.7% were women. ART coverage was 75.0% (95%CI:72.0-77.8) among those eligible for treatment (CD4<350, PMTCT-B) and 53.1% (95%CI:50.4-55.7) among all HIV-positive. Viral load was <1,000cp/mL in 57.1% of all HIV positive. While 66.3% and 71.7% of people with viral load ≥1,000cp/mL were people aged <35years and women respectively, men had 4.4, 1.8, 1.6 and 1.7 times the odds of being untested, unaware, untreated and virally unsuppressed. In addition, people with more than 1 sexual partner had 1.3, 2.2 and 1.9 times the odds of being untested, unaware and untreated.

The majority of HIV-positive people unaware of their status, untreated and virally unsuppressed were individuals aged <35 years and women. However, men were disproportionately untested, unaware HIV positivity, untreated and virally unsuppressed. In this context, HIV testing and treatment should be prioritized to target young people and women, while novel strategies are necessary to reach men.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.