New research published in the Lancet HIV shows that linking HIV infected people to clinical care and treatment is a critical gap in the South African Health Department’s HIV treatment programme in rural KwaZulu-Natal.

The research utilises one of the most comprehensive clinical and population surveillance databases in the world in order to quantify each stage in the HIV cascade of care. The HIV cascade of care describes discrete, consecutive stages through which people with HIV pass within a healthcare system. The HIV care cascade is now recognised as an essential factor in determining how effectively infected individuals are diagnosed, linked into clinical care for antiretroviral treatment, and how well that treatment is working to improve their health. This paper is the first that uses longitudinal (across time), individual-level data across all stages of the cascade, from infection through to therapeutic response.

From 2006, after the initial rollout of antiretroviral therapy, until 2014 Africa Health Research Institute (AHRI) scientists followed up with 5 205 people living with HIV in the mostly rural area of Hlabisa in KZN. During this time, researchers recorded 598 deaths, 4 539 people learned of their HIV positive status, 2 818 were linked to care, 2 151 became eligible for antiretroviral treatment (ART), 1 839 began ART, and 1 456 had a successful response to therapy.

However, in this study statistics show that two years after testing positive in the population study, of the 66% who knew their status only 25% were linked to care. On average, linking to care took over four years. The researchers’ findings show that while there have been significant improvements to the HIV diagnosis process, a bottleneck in the system is the immediate linking of HIV positive people to clinical care.

“Because this dataset utilises HIV positivity determined in the population – before individuals even know they are infected – we provide unique insights into the success and challenges of the HIV treatment programme in KwaZulu-Natal,” explains Professor Deenan Pillay, AHRI Director and a lead author on the paper.

“These data suggest that a critical research agenda for the future is how to develop health systems appropriate to enable infected people, whether men or women, young or old, to be able to access care and antiretroviral treatment.”

Read the paper here.