Mbongolwane and Eshowe HIV Impact in Population Survey
Type de publication
- Huerga Helena
The prevalence of HIV in KwaZulu-Natal is one of the highest in the world. Accurate data on HIV prevalence, HIV incidence and antiretroviral therapy (ART) coverage are essential to define appropriate strategies of intervention. We assessed HIV prevalence, HIV incidence and ART coverage in Mbongolwane and Eshowe in KwaZulu-Natal, South Africa. Other HIV care services indicators were also evaluated.
Cross-sectional population-based survey. A cluster sampling and geospatial random selection was used to identify the households visited. Persons aged 15-59 years living in the area were eligible. Face-to-face interviews were carried out followed by rapid HIV testing on site and blood collection for CD4 count, ART levels and viral load in HIV positive cases. ART coverage was defined as the proportion of HIV positive on ART (detectable blood levels) among those eligible according to current National Guidelines. Incidence was estimated using HIV LAg-Avidity assay corrected by viral load and ART status.
In total 3566 households were visited, 6688 individuals were eligible and 5649 (84.5%) were included: 62.3% women and 37.7% men. Overall HIV incidence was 1.2 (95%CI: 0.2-2.1) per 100 person-year (PY) and 2.9 (95%CI: 1.2-4.7) per 100PY in women aged 15 to 29 years. Overall HIV prevalence was 25.2% (95%CI: 23.6-26.9). Prevalence in women was twice that of men: 30.9% (95%CI: 29.0-32.9) vs 15.9% (95%CI: 14.0-18.0). Prevalence reached 56.0% (95%CI: 51.7-60.3) in women aged 30-39 years. Participants older than 19 years, female, not married, with a lower education level than tertiary, having moved residency in the past 10 years (migrant) and having more than one sexual partner were more likely HIV infected. ART coverage was 75.0% (741 on ART/988 eligible) and was higher in women than in men: 78.5% vs 63.9% (p<0.001). Coverage increased with age: 60.5% in younger than 30 years vs 81.3% in older (p<0.001). Only 11% (1/9) of eligible men aged 20 to 24 were on ART. Among all individuals, 81.4% declared to have had an HIV test previously (88.4% of women vs 69.8% of men, p<0.001). Young people 15-34 years, men and those with more than one partner or no partner in the previous 12 months were more likely not tested for HIV. Among HIV positive participants, 75.8% were aware of their status prior to the survey. In the 20 to 24 year age group, 43.1% and 83.3% of women and men respectively were not aware of their status. In addition the factors associated to being untested for HIV, never having married was associated to being unaware of the HIV infection. Overall 27.5% of HIV positive participants had a CD4 count below 350 cells/µl and 25.9% between 350 and 499 cells/µl. Of individuals not on ART, 33.1% had a CD4 count below 350 cells/µl and 26.7% had a CD4 between 350 and 499. Viral suppression (<1000 copies/ml) was achieved in 90.3% of individuals who self-reported being on ART for more than 6 months. Among those not virologically suppressed, resistance to at least one ARV drug was found in 61.2% (30/49). Of the total population HIV infected, 57.1% (796/1423) had less than 1000 copies/ml. ART intake and being a women were independently associated to virological suppression.
Overall HIV transmission is moderate in Mbongolwane and Eshowe areas. However a high number of new infections occur in young women. HIV remains an important health problem in the area with more than one quarter of the population affected by the disease. Overall, access to HIV testing and ART is relatively high in the area, as well as ART coverage for those in need of treatment. However, young people seem to have more difficulties to access HIV testing and treatment. HIV programmes should maintain quality of care while developing strategies to test, link and treat young people aged 20 to 30 years. Novel interventions for HIV prevention in young women are urgent.