Mapping out HIV viral loads in KwaZulu-Natal Province, South Africa

What is it about?

South Africa is one of the countries known to have the highest rates of HIV worldwide, and in 2019, the potent antiretroviral (ARV) drug dolutegravir was rolled out as fixed-dose combination therapy for people living with HIV in South Africa. In view of this programmatic change, we decided to look at trends in HIV viral loads in KwaZulu-Natal, the province with the highest prevalence of HIV in South Africa. This study analysed detectable HIV viral loads (≥400 copies/millilitre (mL)) in public-sector healthcare facilities in KwaZulu-Natal (KZN) province, South Africa. A HIV viral load database was compiled using routine viral load results from the National Health Laboratory Service for the period January 2018 to June 2022. The viral load results per healthcare facility were mapped across the 11 districts of KZN province to look for hotspots and trends in HIV viraemia. We found that the overall proportion of high HIV viral loads (≥1000 copies/mL) decreased over time. Nevertheless, there was an increase in low-level viraemia (HIV viral loads between 400 and 999 copies/mL). There were specific coastal and northern districts of KZN with persistently higher viral loads and emergent hotspots. We concluded that the overall decrease in HIV viral loads over time shows good progress towards achieving UNAIDS 95-95-95 targets in KZN, South Africa. The transition to dolutegravir-based therapy has been associated with a reduction in viral loads; however, there is a need for pre-emptive monitoring of low-level viraemia. Furthermore, our findings highlight that specific districts will need intensified HIV care despite dolutegravir rollout.

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Photo by Lilishia Gounder on Unsplash

Photo by Lilishia Gounder on Unsplash

Why is it important?

The application of geospatial analysis and visualization of the HIV epidemic by mapping routinely collected programmatic viral load data highlights potential weaknesses in healthcare facilities across KwaZulu-Natal province, South Africa. By identifying facilities with high proportions of people with low- and high-level viraemia, we provide data to both clinicians and policymakers, emphasizing the need for ongoing HIV viral load monitoring coupled with HIV drug resistance surveillance. Furthermore, our findings show that, amid the promising HIV programmatic changes in South Africa, there is a need for pre-emptive monitoring of low-level viraemia to better understand whether this phenomenon could compromise dolutegravir-based antiretroviral therapy.

Perspectives