Center for HIV and STI, National Institute for Communicable Diseases, Johannesburg, South Africa.
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2022 Jul 21;17(7):e0271564. doi: 10.1371/journal.pone.0271564. eCollection 2022.
OBJECTIVES: The UNAIDS 95-95-95 global targets for epidemic control aim to ensure by 2030 that 95% of HIV-positive people know their HIV status, 95% of people diagnosed with HIV receive sustained antiretroviral therapy (ART), and 95% of people on ART have viral suppression. While data on the first and second 95 targets are routinely reported nationally, data on the third 95 target are not available for pregnant women in South Africa. The lack of data on the third 95 target limits the inclusion of low viral suppression as one of the contributing factors in MTCT root cause analyses. This study assessed progress towards the 95-95-95 targets among pregnant women between the ages of 15-49 years attending public health facilities in South Africa. METHOD: Data were obtained from two consecutive national cross-sectional antenatal HIV sentinel surveys conducted between 1 October and 15 November in both 2017 and 2019. In each survey, data on age, knowledge of HIV status, ART initiation, and geographical location (province) were extracted from medical records. A blood specimen was collected from each woman and tested for HIV. Viral load tests were performed on HIV-positive specimens. Descriptive and multiple logistic regression analyses were performed to examine association between province and viral suppression (defined as viral load <50 copies/mL) using the combined dataset (i.e., both 2017 and 2019 data combined). All analyses considered the survey design. RESULTS: Of 10 065 and 11 321 HIV-positive women included in the 2017 and 2019 surveys, respectively, 96.0% (95% confidence interval (CI): 95.6-96.4%) and 97.6% (95% CI: 97.3-97.8%) knew their HIV-positive status; 86.6% (95% CI: 85.9-87.3%) and 96.0% (95% CI: 95.6-96.4%) of those who knew their HIV status were receiving ART; while 64.2% (95% CI: 63.2-65.2%) and 66.0% (95% CI: 65.1-66.8%) of those receiving ART were virally suppressed. Achievement of the third 95 target significantly varied by province ranging from 33.9-72.6% in 2017 and 43.4-77.3% in 2019. Knowledge of HIV-positive status, ART initiation, and viral suppression increased in both 15-24 and 25-49 year age groups between 2017 and 2019. In a multivariable analysis adjusting for survey year, gravidity, and education, the odds of viral suppression significantly varied by province (except KwaZulu-Natal and Western Cape, other provinces were less likely to attain viral suppression compared to Gauteng), age (adjusted odds ratio (AOR) for 15-24 years vs 25-49 years: 0.7, 95% CI: 0.6-0.8), and timing of ART initiation (AOR for ART initiation during pregnancy vs before pregnancy: 0.4, 95% CI: 0.5-0.6). CONCLUSION: Although in 2019 the first and second 95 targets were achieved among pregnant women, meeting the third 95 target remains a challenge. This study highlighted the importance of promoting early ART initiation and the need to target young women in efforts to improve progress towards the third 95 target. Additionally, the provincial variation in viral suppression could be further investigated in future studies to identify and address the root causes underlying these differences.
目标:UNAIDS 的 95-95-95 全球艾滋病防控目标旨在确保到 2030 年,95%的 HIV 阳性人群知晓其 HIV 状况,95%诊断为 HIV 的人群接受持续的抗逆转录病毒治疗(ART),95%接受 ART 的人群病毒得到抑制。虽然国家常规报告了前两个 95 目标的数据,但南非孕妇第三个 95 目标的数据尚不可用。缺乏第三个 95 目标的数据限制了将低病毒抑制率作为母婴传播根本原因分析的一个促成因素之一。本研究评估了南非 15-49 岁年龄组在公立卫生机构就诊的孕妇在实现 95-95-95 目标方面的进展。
方法:从 2017 年 10 月 1 日至 11 月 15 日期间连续进行的两次全国性横断面产前 HIV 哨点调查中获得数据。在每次调查中,从病历中提取年龄、HIV 状况知晓情况、ART 起始和地理位置(省份)的数据。从每位妇女采集血样进行 HIV 检测。对 HIV 阳性标本进行病毒载量检测。使用合并数据集(即 2017 年和 2019 年的数据合并),对省和病毒抑制(定义为病毒载量<50 拷贝/mL)之间的关系进行描述性和多因素逻辑回归分析。所有分析均考虑了调查设计。
结果:在 2017 年和 2019 年的调查中,分别纳入了 10065 名和 11321 名 HIV 阳性妇女,分别有 96.0%(95%置信区间(CI):95.6-96.4%)和 97.6%(95% CI:97.3-97.8%)知晓其 HIV 阳性状况;知晓其 HIV 状况的人群中,分别有 86.6%(95% CI:85.9-87.3%)和 96.0%(95% CI:95.6-96.4%)正在接受 ART;正在接受 ART 的人群中,分别有 64.2%(95% CI:95.1-96.4%)和 66.0%(95% CI:95.1-96.8%)病毒得到抑制。2017 年和 2019 年,第三个 95 目标的实现情况因省份而异,范围分别为 33.9%-72.6%和 43.4%-77.3%。2017 年至 2019 年期间,15-24 岁和 25-49 岁年龄组的 HIV 阳性状况知晓、ART 起始和病毒抑制率均有所增加。在调整调查年份、孕次和教育程度后,病毒抑制的可能性因省份而异(夸祖鲁-纳塔尔省和西开普省除外,与豪登省相比,其他省份达到病毒抑制的可能性较低),年龄(15-24 岁与 25-49 岁的调整优势比(AOR):0.7,95%CI:0.6-0.8),以及 ART 起始时间(妊娠期间与妊娠前起始 ART 的 AOR:0.4,95%CI:0.5-0.6)。
结论:尽管 2019 年孕妇实现了前两个 95 目标,但第三个 95 目标的实现仍然是一个挑战。本研究强调了促进早期 ART 起始的重要性,并需要针对年轻妇女采取措施,以改善第三个 95 目标的进展。此外,未来的研究可以进一步调查病毒抑制率的省级差异,以确定和解决导致这些差异的根本原因。
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