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Trop Med Int Health. 2020 Feb;25(2):186-192. doi: 10.1111/tmi.13334. Epub 2019 Nov 21.

Quantifying the HIV treatment cascade in a South African health sub-district by gender: retrospective cohort study.

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Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Department of Environmental Health, Tufts University, Medford, OR, USA.
Department of Health, Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.


in English, French


To quantify the HIV care cascade in a Cape Town sub-district to understand rates of linkage to and engagement in HIV care.


We used routinely collected data to reconstruct the treatment cascade for 8382 infected individuals who tested HIV + in 2012/2013. We obtained data on patient gender, year of initial HIV-positive test, age at testing and initial CD4 cell count and defined five stages of the HIV care cascade. We quantified attrition across cascade stages.


Two-thirds of the sample (5646) were women. Men were older at time of first testing (36.5 vs. 31.3 years) and had more advanced HIV disease at diagnosis (298 vs. 404 CD4 cells/µL for women). The median duration of follow-up was 818 days. Among women, 90.5% attended an initial HIV care visit, 54.6% became eligible for antiretroviral therapy under local guidelines during follow-up, 49.3% initiated ART and 45.6% achieved a therapeutic response. Among men, 88.0% attended an initial HIV care visit, 67.4% became ART eligible during follow-up, 48.0% initiated ART and 42.4% achieved a therapeutic response. Approximately 3% of women and 5% of men died during follow-up.


We were able to reconstruct the HIV treatment cascade using routinely collected data. In this setting, rates of engagement in care differ by gender in key stages of the cascade, with men faring worse than women at each cascade point. This highlights the need for interventions aimed at encouraging earlier testing, linkage, ART initiation and retention among men.


Afrique du Sud; HIV treatment cascade; South Africa; cascade de traitement du VIH; différences entre les sexes; gender differences; lien avec les soins; linkage to care

[Available on 2021-02-01]

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