Beyond HIV prevalence: identifying people living with HIV within underserved areas in South Africa

Abstract

Introduction: Despite progress towards the Joint United Nations Programme on HIV/AIDS 95-95-95 targets, South Africa is still suffering from one of the largest HIV epidemics globally. In this study, we generated high-resolution HIV prevalence maps and identified people living with HIV (PLHIV) in underserved areas to provide essential information for the optimal allocation of HIV-related services.

Methods: The data come from the South Africa Demographic and Health Survey conducted in 2016 and spatial variables from other published literature. We produced high-resolution maps of HIV prevalence and underserved areas, defined as a greater than 30 min travel time to the nearest healthcare facility. Using these maps and the population density, we mapped PLHIV and the PLHIV within underserved areas for 30, 60 and 120 min thresholds.

Results: There was substantial geographic variation in HIV prevalence, ranging from 1.4% to 24.2%, with a median of 11.5% for men, and from 2.1% to 48.1%, with a median of 20.6% for women. Gauteng province showed the highest density for both HIV prevalence and PLHIV. 80% of all areas in the country were identified as underserved areas (30 min threshold), which contained more than 16% and 20% of the total men and women living with HIV, respectively. KwaZulu-Natal province had the largest number of PLHIV in underserved areas (30 min threshold) and showed less than one healthcare facility per 1000 PLHIV.

Conclusion: Our study showed extensive spatial variation of HIV prevalence and significant numbers of PLHIV in underserved areas in South Africa. Moreover, we identified locations where HIV-related services need to be intensified to reach the ~1.5 million PLHIV in underserved areas, particularly in KwaZulu-Natal province, with less than one healthcare facility per 1000 PLHIV.

Keywords: HIV; cross-sectional survey; epidemiology; health services research; public health.

Figure 1

Sample locations. (A) Demographic and Health Survey sample locations for South Africa Demographic and Health Survey (SADHS) in 2016, and (B) healthcare facility locations. Map was created using ArcGIS by ESRI V.10.5 (http://www.esri.com).

Figure 2

High-resolution maps of HIV prevalence and people living with HIV (PLHIV) in South Africa. High-resolution maps of HIV prevalence in South Africa for (A) men and (B) women in 2016; geographic dispersion of men (C) and women (D) living with HIV in South Africa. HIV prevalence for women is higher in the north-eastern part of the country from Limpopo to Eastern Cape province, whereas HIV prevalence for men is more concentrated in the mid-eastern part of the country among the Gauteng and KwaZulu-Natal provinces. The density of PLHIV for both genders shows similar spatial patterns, concentrating in Gauteng province. Maps were created using ArcGIS by ESRI V.10.5 (http://www.esri.com).

Figure 3

People living with HIV (PLHIV) within underserved areas (30, 60 and 120 min thresholds) in South Africa. Estimated men living with HIV within 30 min threshold (A), 60 min threshold (B), and 120 min threshold (C) underserved areas; estimated women living with HIV within 30 min threshold (D), 60 min threshold (E), and 120 min threshold (F) underserved areas. Maps were created using ArcGIS by ESRI V.10.5 (http://www.esri.com).