title: Level of viral suppression and the cascade of HIV care in a South African semi-urban setting in 2012.
abstract: In 2012, 7 years after the introduction of antiretroviral treatment (ART) in the South African township of Orange Farm, we measured the proportion of HIV-positive people who were virally suppressed, especially among high-risk groups (women 18-29 years and men 25-34 years).
  
  
  
  A community-based cross-sectional representative survey was conducted among 3293 men and 3473 women.
  
  
  
  Study procedures included a face-to-face interview and collection of blood samples that were tested for HIV, 11 antiretroviral drugs and HIV-viral load.
  
  
  
  HIV prevalence was 17.0% [95% confidence interval: 15.7-18.3%] among men and 30.1% [28.5-31.6%] among women. Overall, 59.1% [57.4-60.8%] of men and 79.5% [78.2-80.9%] of women had previously been tested for HIV. When controlling for age, circumcised men were more likely to have been tested compared with uncircumcised men (66.1 vs 53.6%; P < 0.001). Among HIV+, 21.0% [17.7-24.6%] of men and 30.5% [27.7-33.3%] of women tested positive for one or more antiretroviral drugs. Using basic calculations, we estimated that, between 2005 and 2012, ART programs prevented between 46 and 63% of AIDS-related deaths in the community. Among antiretroviral-positive, 91.9% [88.7-94.3%] had viral suppression (viral load <400 copies/ml). The proportion of viral suppression among HIV+ was 27.0% [24.3-29.9%] among women and 17.5% [14.4-20.9%] among men. These proportions were lower among the high-risk groups: 15.6% [12.1-19.7%] among women and 8.4% [5.0-13.1%] among men.
  
  
  
  In Orange Farm, between 2005 and 2012, ART programs were suboptimal and, among those living with HIV, the proportion with viral suppression was still low, especially among the young age groups. However, our study showed that, in reality, antiretroviral drugs are highly effective in viral suppression at an individual level.
authors.affiliation: aDepartment of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis, Imperial College, London, United Kingdom bINSERM U1018, Villejuif, France cHIV Department, National Institute for Communicable Diseases, National Health Laboratory Service dFaculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa eMédecins du monde, Paris, France fProgressus Research and Development gCHAPS, Johannesburg, South Africa hUNAIDS, Geneva, Switzerland iMedecins sans frontières, Paris, France jWestern Sydney Sexual Health Centre kUniversity of Sydney, Sydney, Australia lPharmacology, APHP - Bichat-Claude Bernard, Paris mAssistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt nFaculty of Medicine, University of Versailles-Saint Quentin, Versailles, France.
authors.forename: Kévin
authors.initials: K
authors.lastname: Jean
authors.forename: Adrian
authors.initials: A
authors.lastname: Puren
authors.forename: Ewaldé
authors.initials: E
authors.lastname: Cutler
authors.forename: Beverley
authors.initials: B
authors.lastname: Singh
authors.forename: Julie
authors.initials: J
authors.lastname: Bouscaillou
authors.forename: Reathe
authors.initials: R
authors.lastname: Rain-Taljaard
authors.forename: Dirk
authors.initials: D
authors.lastname: Taljaard
authors.forename: Eleanor
authors.initials: E
authors.lastname: Gouws
authors.forename: Pascale
authors.initials: P
authors.lastname: Lissouba
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.forename: Bertran
authors.initials: B
authors.lastname: Auvert
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D013019:South Africa; D013383:Suburban Population; D011795:Surveys and Questionnaires; D000072230:Sustained Virologic Response; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents