Background: With the goal of eliminating new HIV infections, the Joint United Nations Programme on HIV/AIDS (UNAIDS) set ambitious 90-90-90 targets to be achieved by 2020. Including 90% of people living with HIV knowing their HIV-status, 90% of these receiving antiretroviral therapy (ART) and 90% of these having viral suppression. Delivery of medical care to HIV-positive individuals requires a sequence of diagnostic tests, assessments and monitoring, termed the ''HIV treatment cascade''. The aim of this analysis is to quantify the current achievement and gaps in this cascade for participants enrolled in the HIV Incidence Provincial Surveillance System (HIPSS) in South Africa.
Methods: HIPSS is a household survey of HIV-prevalence and incidence in the uMgungundlovu District in KwaZulu-Natal in 2014 and 2015. Households within selected enumeration areas were randomly selected and a single randomly selected eligible (15-49 years) individual was invited to completed a questionnaire and provide blood samples for HIV-antibody and viral load testing.
Results: A total of 9812 participants, 3547(36.1%) males and 6265(63.9%) females was enrolled. HIV prevalence was 28.0%(95%CI:25.9-30.1) among males and 44.1%(95%CI:42.3-45.9) among females. First 90: 51.8% (95%CI: 47.4-56.3) of males and 64.6% (95%CI: 61.9-67.3) of females who are HIV positive knew their HIV status, p< 0.001. Second 90: 69.1% (95%CI: 63.4-74.9) of males and 70.3% (95% CI: 67.6-73.0) of females who knew their HIV status were on ART. Third 90: 85.5% (95% CI: 80.1-90.1) of males and 89.7% (95%CI: 87.3-92.0) of females on ART had suppressed viral load
(< 1000 copies/mL). Among all HIV positive participants 44.1% of males and 58.2% of females had suppressed viral load. More than 80% of both males and females who have not tested for HIV reported that they did not test for HIV because they were afraid to know their results.
Conclusions: All three elements of UNAIDS 90-90-90 targets were below 90%. The gap was largest for the first 90, especially amongst men where only half knew their status. Campaigns to increase HIV-testing are needed and reduce fear, especially amongst men. The target best accomplished is achieving suppressed viral load on ART; highlighting the success of ART in achieving viral suppression, if accessed.

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