Durban — EThekwini continues to rank among the top three problem major cities with regards to HIV and hepatitis prevalence, despite concerted campaigns to fight these diseases.
TB HIV Care’s Bio-Behavioural Survey (BBS) found that hepatitis C prevalence was the highest in Mbombela (90.5%), followed by Tshwane (89.0%) and eThekwini (75.2%).
The study revealed high prevalence rates of HIV and hepatitis C in people who inject drugs (PWID) between May and September.
South Africa is just one year away from the 95-95-95 UN goal for HIV, which aims for 95% of people living with HIV to know their status, 95% of people who know their status to be receiving HIV treatment, and 95% of people on treatment to be virally suppressed.
The goal, which also aims to close gaps in HIV treatment coverage and outcomes by 95% in all sub-populations, age groups and geographic settings, may not be achieved. The goal set by UNAids was adopted by UN member states in June 2021.
In a statement released by the organisation, it said the survey was conducted in four sites and found that HIV prevalence among PWID was as high as 72.1% in Tshwane, 49.3% in eThekwini, 45.4% in Mashishing, and 30.3% in Mbombela.
Hepatitis C prevalence was the highest in Mbombela (90.5%), followed by Tshwane (89.0%), eThekwini (75.2%), and Mashishing (40.8%).
The survey also measured the prevalence of drug-susceptible tuberculosis (TB) in the study population, generating the first such data in South Africa.
Across the sites, statistics pointed to a notable burden and the need for intensified TB diagnosis and treatment by highlighting a prevalence of 7.2% in eThekwini, 2% in Tshwane and less than 1% in both the Mashishing and Mbombela sites.
Technical adviser at TB HIV Care, Andrew Scheibe, said hepatitis C is often called the silent killer because many people remain asymptomatic until the infection progresses, causing serious liver damage and life-threatening health issues.
“Today’s treatment with direct-acting antivirals (DAAs) is highly effective, but cost and access are an issue in South Africa. We need to continue to advocate for easier, cost-effective access to generic DAAs, especially for populations at risk,” said Scheibe.
However, experts still have hope that the South African Bio-Behavioural Survey highlighted the extremely high prevalence of HIV and hepatitis C in PWID, and significant gaps in progress towards the 95-95-95 treatment targets and the 10-10-10 social enabler targets.
A high percentage of PWID across all sites – Mashishing (66.8%), Tshwane (57.4%), eThekwini (51.6%), and Mbombela (48.9%) – indicated their willingness to take pre-exposure prophylaxis (PrEP), signalling optimism towards achieving the 95-95-95 goals in the study population.
Centers for Disease Control and Prevention (CDC) country director, Dr John Blandford, said this survey had given a deeper understanding of the challenges faced by people who inject drugs.
eThekwini stands at 63.3%, despite having the world’s largest antiretroviral therapy programme. This survey illuminates significant gaps in access to care and health service utilisation by PWID, and underscores the imperative to integrate viral hepatitis services into primary health care.
CEO at TB HIV Care, Professor Harry Hausler, said that there is an urgent need to scale up access to needle and syringe services, and OAT (opioid agonist therapy) by government and donor-funded civil society organisations to prevent exposure and new HIV and hepatitis C infections in PWID, considering the high HIV and hepatitis C prevalence.
For PWID, access to dignified care is a necessary imperative.
The UNAids 10-10-10 targets aim to remove social and legal impediments to accessing or using HIV services.
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