Research

HIV care coverage among HIV-positive adolescent girls and young women in South Africa: Results from the HERStory Study

C Mathews, M Cheyip, R Beauclair, A Puren, C Lombard, K Jonas, K A Ayalew, D Govindasamy, C Kuo, J Dietrich, F Abdullah, G Gray

Abstract


Background. Health service coverage cascades measure the proportion of a population in need of a service that experienced a positive health outcome from the service, and enable tracking of progress in achieving universal health coverage and inequities in care coverage.

Objectives. To investigate HIV care coverage among HIV-positive adolescent girls and young women (AGYW) living in six South African districts, compare coverage by age and socioeconomic status (SES), and investigate other associated factors including participation in a combination HIV prevention intervention.

Methods. The HERStory Study was an evaluation of the combination intervention, comprising a representative household survey of AGYW aged 15 - 24 years living in six intervention districts. From September 2017 to November 2018, biological, sociodemographic and behavioural data were collected. HIV-positive status, initiation of antiretroviral therapy (ART) and viral suppression were determined through laboratory tests (enzyme-linked immunosorbent assay for HIV antibodies, antiretroviral (ARV) metabolites and viral load (VL) testing). Viral suppression was defined as a VL <1 000 copies/mL. Knowledge of HIV-positive status was self-reported, and participants testing positive for ARV metabolites were assumed to have known their HIV-positive status. Unconditional HIV care cascades were created, stratified by age and SES. We used Pearson’s χ2 tests corrected for survey-based analysis to describe factors associated with knowledge of HIV status, and being on ART.

Results. Of the 4 399 participants, 568 were HIV-positive (12.4%), of whom 60.8% (95% confidence interval (CI) 57.1 - 64.5) knew their status, 50.6% (95% CI 46.6 - 54.0) were on ART, and 62.1% (95% CI 58.4 - 65.9) were virally suppressed. Most participants (84.9%) were in the lower SES group, and they had better coverage than the higher SES group: 61.9% (95% CI 58.3 - 65.4) knew their status, 52.1% (95% CI 48.4 - 55.9) were on ART, and 64.9% (95% CI 61.3 - 68.4) were virally suppressed, compared with 55.0% (95% CI 42.1 - 68.0), 40.0% (95% CI 29.2 - 50.8), and 46.6% (95% CI 34.5 - 58.7), respectively. Participants aged 15 - 19 years had slightly inferior coverage to the 20 - 24-year-old group: 57.5% knew their status, 46.1% were on ART and 59.5% were virally suppressed, compared with 62.3%, 52.2% and 63.3%.

Conclusions. These findings emphasise the need to close the gaps in HIV care coverage among AGYW, of whom only 61% knew their HIV-positive status and only 62% were virally suppressed. There is pro-poor inequality in HIV care coverage, with those in lower socioeconomic groups more likely to be virally suppressed.


Authors' affiliations

C Mathews, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa

M Cheyip, Centers for Disease Control and Prevention, Pretoria, South Africa

R Beauclair, South African Department of Science and Technology/National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, South Africa

A Puren, National Institute of Communicable Diseases, Johannesburg, South Africa; Division of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

C Lombard, Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

K Jonas, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa

K A Ayalew, Centers for Disease Control and Prevention, Pretoria, South Africa

D Govindasamy, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Adolescent Health Research Unit, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa

C Kuo, Brown University, Providence, RI, USA; Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa

J Dietrich, Perinatal HIV Research Unit (PHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

F Abdullah, Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa; Division of Infectious Diseases, Department of Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa

G Gray, Office of the President, South African Medical Research Council, Cape Town, South Africa

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Keywords

HIV treatment; Adolescent girls; Young women; Care coverage

Cite this article

South African Medical Journal 2021;111(5):460-468. DOI:10.7196/SAMJ.2021.v111i5.15351

Article History

Date submitted: 2021-04-30
Date published: 2021-04-30

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