alexa Fast-Tracking of the HIV Response: Do the Metros Lead t
ISSN 2155-6113

Journal of AIDS & Clinical Research
Open Access

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Research Article

Fast-Tracking of the HIV Response: Do the Metros Lead the Way to Reaching 90-90-90 in South Africa?

Nicole Fraser-Hurt1*, William MacLeod2,3, Tendesayi Kufa-Chakezha4, Mokgadi Phokojoe5, Sergio Carmona6, Adrian Puren4, Zara Shubber1, Paolo Belli1, Melusi Ndhlalambi1 and Marelize Gorgens1

1The World Bank, Washington DC, USA

2Department of Global Health, Boston University School of Public Health, Boston, USA

3 Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

4National Institute for Communicable Diseases (NICD), Johannesburg, South Africa

5National Department of Health, Pretoria, South Africa

6National Health Laboratory Service, Johannesburg, South Africa

*Corresponding Author:
Nicole Fraser-Hurt
The World Bank, 1818 H Street
NW, Washington, DC 20433, USA
Tel: +44 1732773844
E-mail: [email protected]

Received date: November 28, 2016; Accepted date: December 07, 2016; Published date: December 14, 2016

Citation: Fraser-Hurt N, MacLeod W, Kufa-Chakezha T, Phokojoe M, Carmona S, et al. (2016) Fast-Tracking of the HIV Response: Do the Metros Lead the Way to Reaching 90-90-90 in South Africa? J AIDS Clin Res 7:642. doi: 10.4172/2155-6113.1000642

Copyright: © 2016 Fraser-Hurt N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Objective: This secondary data analysis determined how far the eight South African metropolitan municipalities have progressed in the expansion of HIV treatment. The framework of HIV care cascades (HCC) was used. Methods: We collated data sources to understand the HCC in metro and non-metro populations including demographic, HIV prevalence and laboratory data (2014-2015) that we linked to unique individuals using a probabilistic matching algorithm. We defined the HCC using: number of persons living with HIV (PLHIV); total remaining on ART; numbers with a CD4 count and viral load (VL) test results in the past year and the number of suppressed VL tests. Results: 37% of South Africa’s PLHIV live in metros. Progress along the HCC for metro and non-metro populations was 53% of PLHIV in care and 45% on ART for both populations and 27% of metro/26% of non-metro populations virally suppressed. Achievement varied widely by metro, 35%-63% of PLHIV were on ART, 21%-48% of ART clients were virally suppressed. The largest treatment gap was in Ekurhuleni metro. The metros spend approximately US$383 million per year on ART. Annual VL testing of all ART clients in the eight metros would amount to approximately US$ 42 million or 11% of ART programme cost. Conclusion: South Africa sees rapid growth of its urban centres which are chiefly affected by HIV. There are currently large gaps in the metro’s 90-90-90 level of achievements. The District Implementation Plans offer a mechanism to focus investment on ART scale-up. Supporting factors are the existing expertise, service integration and infrastructure for largescale ART, the close network of service delivery sites and service delivery solutions. Ensuring scale and quality of the HIV treatment programmes is vital for the metros’ economic prosperity - and for South Africa as a whole.


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