Reaching for 90:90:90 in correctional facilities in South Africa and Zambia: Virtual cross-section of coverage of HIV testing and antiretroviral therapy during universal test and treat implementation

Abstract

People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat (UTT) in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis. We used routine data on two dates: at the start of UTT implementation (time 1, T1) and one year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators. In the South African site, there were 4,193 and 3,868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1,386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1,467 and 1,366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART. This virtual cross-sectional analysis identified gaps in HIV testing coverage and ART initiation not clearly demonstrated by prior cohort-based studies.