{ "abstract": "Advanced HIV disease (AHD), treatment interruption and viraemia remain key challenges to effectiveness of HIV programmes in South Africa. Understanding the trends of these measures and their variation across geographic regions can inform more targeted and responsive interventions. We conducted a retrospective cohort study using routine, de-identified data from TIER.Net, a national HIV electronic register. We curated data from 116 primary care clinics in eThekwini, uMgungudlovu, and uMkhanyakude Districts in KwaZulu-Natal province. We included people living with HIV aged ≥16 years, who initiated or collected ART between 1 July 2018 and 30 June 2023. We examined trends in the annual clinic-level prevalence of AHD, treatment interruption and viraemia, and mapped these outcomes using inverse distance weighted interpolation restricted to 3 nearest neighbours to preserve local influence. Among 123,473 clients initiating ART with CD4 count measurements, the overall prevalence of AHD ranged between 20.0% and 22.2%. The prevalence of treatment interruptions ranged between 11.3% and 13.2% among the 544,066 clients who had scheduled visits. Of the 446,899 clients who had viral load results, overall viraemia, defined as ≥50 copies/mL, increased from 12.9% to 20.2%, whereas high-level viraemia defined as ≥1000 copies/mL remained stable at approximately 6%. Spatial analyses highlighted geographic disparities in AHD, treatment interruption, and viraemia across and within the districts. The persistence of AHD, treatment interruption and viraemia require further investigation and highlight ongoing challenges for HIV control. The observed spatial variation across and within districts spanning urban, peri-urban and rural settings highlight the need for geographically tailored interventions to improve programmatic effectiveness, particularly in hyper-endemic settings.", "abstract_shown": true, "affiliations": [ "Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa", "Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa", "Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa", "Mseleni Hospital, uMkhanyakude, KwaZulu-Natal, South Africa", "Bethesda Hospital, uMkhanyakude, KwaZulu-Natal, South Africa", "Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa", "Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, United State of America", "eThekwini Municipality Health Unit, Durban, South Africa", "Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa", "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom", "Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa" ], "article_type": "Research Article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0 ], "name": "Sanele S. Mbeje" }, { "affs": [ 1 ], "name": "Lilishia Gounder" }, { "affs": [ 2 ], "name": "Johan S. van der Molen" }, { "affs": [ 3 ], "name": "Lungile Hobe" }, { "affs": [ 4 ], "name": "Thulani Ngwenya" }, { "affs": [ 5 ], "name": "Mlungisi Khanyile" }, { "affs": [ 6 ], "name": "Kwena Tlhaku" }, { "affs": [ 7 ], "name": "Benjamin Chimukangara" }, { "affs": [ 8 ], "name": "Thokozani Khubone" }, { "affs": [ 9 ], "name": "Yukteshwar Sookrajh" }, { "affs": [ 10 ], "name": "Sharana Mahomed" }, { "name": "Jennifer A. Brown" }, { "name": "Nigel Garrett" }, { "name": "Jienchi Dorward" }, { "name": "Lara Lewis" } ], "bibtex": "https://research.draconitic.com/paper/5pkf10mhrg74p.bib", "cited_by": 0, "doi": "10.1371/journal.pgph.0005506", "fulltext_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005506", "id": "5pkf10mhrg74p", "issns": [ "2767-3375" ], "landing_url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005506", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|HIV/AIDS Research and Interventions" ], [ "plos", "/Biology and life sciences/Immunology/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Virology/Viral transmission and infection/Viral load" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Virus testing" ], [ "plos", "/Medicine and health sciences/Epidemiology/HIV epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Immunology/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/Viremia" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy" ], [ "plos", "/People and places/Geographical locations/Africa/South Africa" ] ], "openalex": "W4416052930", "pdf_url": "https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0005506&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-02", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/5pkf10mhrg74p.ris", "sources": [ { "first_seen": "2026-10-30T12:18:02Z", "native_id": "10.1371/journal.pgph.0005506", "source": "plos", "url": "https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005506" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Trends in advanced HIV disease, treatment interruption, and viraemia in KwaZulu-Natal, South Africa", "title_text": "Trends in advanced HIV disease, treatment interruption, and viraemia in KwaZulu-Natal, South Africa", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:02Z", "url": "https://research.draconitic.com/paper/5pkf10mhrg74p", "venue": "PLOS Global Public Health", "versions": [] }