UNAIDS 95-95-95 targets in older people living with HIV in urban and rural KwaZulu-Natal, South Africa

Background

Data describing HIV prevalence, ART use and virological suppression, in older adults in urban or rural South Africa, are limited. We aimed to address this evidence gap.

Methods

In a population-based cross-sectional study, using age- and sex-stratified random sampling of adults aged ≥ 40 years, a researcher-administered questionnaire collected socio-demographic, and clinical data (03/2022-04/2024). HIV was confirmed using two point-of-care tests (discrepancies resolved by ELISA). The age- and sex-specific study prevalence was applied to the KwaZulu Natal (KZN) province population structure to provide an illustrative projection of HIV prevalence in KZN. Achievement of UNAIDS 95-95-95 targets was calculated in 10-year age bands. People living with HIV (PLHIV) were categorised as virologically suppressed (< 50copies/mL) vs. unsuppressed, and younger (40-49years) vs. older (≥ 50years). Logistic regression determined associations with HIV and virological suppression.

Results

1,916 adults were recruited; 713 (37.2%) living with HIV, 36.7% men and 37.7% women. HIV prevalence was 68.1% among 40–49-year-olds, 49.4% among 50–59-year-olds, 26.0% among 60–69-year-olds and 9.8% age ≥ 70 years. In older adults (≥ 50 years), the prevalence was 27.9%. The overall projected standardised HIV prevalence in adults ≥ 40 years in KZN was 47.4% (44.8% men; 49.3% women). In our sample, 98% of PLHIV were aware of their status, 97.6% on ART, and 77.7% virologically suppressed. Men ≥ 70 years achieved highest virological suppression (88.2%). Overall, being female vs. male (57.8% vs. 42.2%; OR 1.6 [95%CI 1.1, 2.4]; p = 0.008), having HIV ≥ 3 years vs. < 3 years (62.2% vs. 55.1%; OR 3.0 [95%CI 1.6, 5.7]; p = 0.001), rural vs. urban living (50.9% vs. 49.1%; OR 1.5 [95%CI 1.0, 2.1]; p = 0.044) were associated with virological suppression. Older PLHIV (≥ 50years) vs. younger (40-49years) reported hypertension (51.0% vs. 30.0%), diabetes (10.0% vs. 5.0%), and polypharmacy (≥ 5 drugs) (13.2% vs. 6.3%).

Conclusion

In KZN, the overall study prevalence of HIV in adults age ≥ 50 years was 27.9% in both urban and rural populations, the UNAIDS 95-95-95 targets were met for known status and being on treatment, but not virological suppression.