• J C Y Nyasulu and I Maposa.
• Division of Health Systems and Public Health, Department of Global Health, Faculty of Clinical Medicine, Stellenbosch University, Cape Town, South Africa; Health Systems Strengthening, AFRIQUIP, Johannesburg, South Africa. jnyasulu@sun.ac.za.
• S. Afr. Med. J. 2023 Dec 31; 114 (1): 515551-55.

BackgroundThe 95-95-95 strategy implementation is a positive initiative for moving the HIV tide towards elimination, with a focus on addressing the huge inequalities in existence in access to HIV services.ObjectivesTo establish performance towards the 90-90-90 and 95-95-95 targets and trends in HIV positivity rates since strategy implementation rollout in the City of Johannesburg (CoJ), South Africa.MethodsThis was a descriptive study, part of the bigger quasi-experimental study using the monthly District Health Information System during the implementation and rollout of the 90-90-90 strategy. HIV access trends were tracked and compared with the set strategy implementation targets. In addition, the HIV positivity rate was analysed to observe trends. A time trend analysis for aggregated data was performed on all the measured indicators to determine whether the decrease or increase was statistically significant. P<0.05 was used to indicate statistical significance.ResultsThe study has shown that by March 2022, 15 months after December 2020, CoJ had reached 91-65-88. There were significant steady increases in the number of people who knew their HIV status (slope = 0.044, p<0.001) and initiating on antiretroviral therapy (ART) (slope = 0.001, p<0.001), and significant decreases for overall HIV positivity rate (slope = -0.016, p<0.001), adolescent positivity rate (slope = -0.0087, p<0.001) and antenatal care HIV positivity rate (slope = -0.013, p<0.001).ConclusionThis study has established positive progress made by the CoJ towards HIV testing, ART initiation, viral load suppression and HIV positivity rate. On the other hand, gaps in linkage to care after testing positive have been highlighted. It is therefore critical in the 95-95-95 strategy implementation era to focus on finding those missed during the 90-90-90 phase through revised and renewed innovative approaches.

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