HIV System Assessment with Longitudinal Treatment Cascade in Kwazulu-Natal, South Africa

Noah Haber, Harvard University
Kevi Naidu, University of KwaZulu-Natal
Deenan Pillay, Africa Centre for Health and Population Studies
Till Barnighausen, Harvard University

This study constructs a longitudinal HIV treatment cascade based in non-parametric survival analysis using the population-based cohort data that combines the information in population surveillance with clinical informatics systems in rural KwaZulu-Natal, South Africa using the Africa Centre Demographic Information System. Six stages are defined: first positive HIV test, knowing status, linkage to care, eligibility for ART, initiation of ART, and immunological recovery. Five years after testing positive in surveillance in the study population (n=5,205), 78% know their status, 39% are linked to care, 32% are eligible for ARTs, 27% initiate ARTs, and 23% are immunologically recovered. There is a striking difference in the character of early stages of the cascade as compared to later stages. Linkage to care appears to be the most important current bottleneck in the cascade, with slow transitions into latter stages, while transitions are consistent to and from later stages.