title: Who Needs to Be Targeted for HIV Testing and Treatment in KwaZulu-Natal? Results From a Population-Based Survey.
abstract: BACKGROUND
  Identifying gaps in HIV testing and treatment is essential to design specific strategies targeting those not accessing HIV services. We assessed the prevalence and factors associated with being HIV untested, unaware, untreated, and virally unsuppressed in KwaZulu-Natal, South Africa.
  
  
  METHODS
  Cross-sectional population-based survey. People aged 15-59 years were eligible. Interviews, HIV testing, and blood collection for antiretroviral drug presence test, CD4, and viral load were done at the participants' home.
  
  
  RESULTS
  Of the 5649 individuals included, 81.4% (95% CI: 79.8 to 82.9) had previously been tested. HIV prevalence was 25.2%. HIV-positivity awareness rate was 75.2% (95% CI: 72.9 to 77.4). Of all unaware, 73.3% of people were aged <35 years and 68.7% were women. Antiretroviral therapy coverage was 75.0% (95% CI: 72.0 to 77.8) among those eligible for treatment (CD4 < 350, PMTCT-B) and 53.1% (95% CI: 50.4 to 55.7) among all HIV-positive individuals. Viral load was <1000 copies per milliliter in 57.1% of all HIV-positive individuals. Although 66.3% and 71.7% of people with viral load ≥1000 copies per milliliter were people aged <35 years and women respectively, men had 4.4, 1.8, 1.6, and 1.7 times the odds of being untested, unaware, untreated, and virally unsuppressed. In addition, people with more than 1 sexual partner had 1.3, 2.2, and 1.9 times the odds of being untested, unaware, and untreated.
  
  
  CONCLUSIONS
  The majority of HIV-positive people unaware of their status, untreated, and virally unsuppressed were individuals aged <35 years and women. However, men were disproportionately untested, unaware HIV positivity, untreated, and virally unsuppressed. In this context, HIV testing and treatment should be prioritized to target young people and women, whereas novel strategies are necessary to reach men.
authors.affiliation: *Epicentre, Paris, France; †Médecins Sans Frontières, Cape Town, South Africa; ‡Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; §Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa; and ‖Institut de Recherche pour le Développement, UMI 233-INSERM U1175-Montpellier University, Montpellier, France.
authors.forename: Helena
authors.initials: H
authors.lastname: Huerga
authors.forename: Gilles
authors.initials: G
authors.lastname: Van Cutsem
authors.forename: Jihane
authors.initials: J
authors.lastname: Ben Farhat
authors.forename: Matthew
authors.initials: M
authors.lastname: Reid
authors.forename: Malika
authors.initials: M
authors.lastname: Bouhenia
authors.forename: David
authors.initials: D
authors.lastname: Maman
authors.forename: Lubbe
authors.initials: L
authors.lastname: Wiesner
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.forename: Tom
authors.initials: T
authors.lastname: Ellman
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents