Trends in advanced HIV disease, treatment interruption, and viraemia in KwaZulu-Natal, South Africa
11 affiliations
- 1Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
- 2Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- 3Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- 4Mseleni Hospital, uMkhanyakude, KwaZulu-Natal, South Africa
- 5Bethesda Hospital, uMkhanyakude, KwaZulu-Natal, South Africa
- 6Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- 7Critical Care Medicine Department, NIH Clinical Center, Bethesda, Maryland, United State of America
- 8eThekwini Municipality Health Unit, Durban, South Africa
- 9Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa
- 10Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- 11Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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.
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BibTeX
@article{mbeje2026trends,
title = {{Trends in advanced HIV disease, treatment interruption, and viraemia in KwaZulu-Natal, South Africa}},
author = {Sanele S. Mbeje and Lilishia Gounder and Johan S. van der Molen and Lungile Hobe and Thulani Ngwenya and Mlungisi Khanyile and Kwena Tlhaku and Benjamin Chimukangara and Thokozani Khubone and Yukteshwar Sookrajh and Sharana Mahomed and Jennifer A. Brown and Nigel Garrett and Jienchi Dorward and Lara Lewis},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0005506},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005506},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Trends in advanced HIV disease, treatment interruption, and viraemia in KwaZulu-Natal, South Africa
AU - Sanele S. Mbeje
AU - Lilishia Gounder
AU - Johan S. van der Molen
AU - Lungile Hobe
AU - Thulani Ngwenya
AU - Mlungisi Khanyile
AU - Kwena Tlhaku
AU - Benjamin Chimukangara
AU - Thokozani Khubone
AU - Yukteshwar Sookrajh
AU - Sharana Mahomed
AU - Jennifer A. Brown
AU - Nigel Garrett
AU - Jienchi Dorward
AU - Lara Lewis
PY - 2026
DA - 2026/09/02
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0005506
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0005506
AB - 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.
SN - 2767-3375
ER -