Title: High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study
Authors: Vandormael A, de Oliveira T, Tanser F, Barnighausen T, Herbeck JT.
Journal: J Epidemiol Community Health,:doi: 10.1136/jech-2017-209713 (2018)
Undiagnosed HIV infections could undermine efforts to reverse the global AIDS epidemic by 2030. In this study, we estimated the percentage of HIV-positive persons who remain undiagnosed within a hyperendemic South African community.
The data come from a population-based surveillance system located in the Umkhanyakude district of the northern KwaZulu-Natal province, South Africa. We annually tested 38?661 adults for HIV between 2005 and 2016. Using the HIV-positive test results of 12?039 (31%) participants, we then back-calculated the incidence of infection and derived the number of undiagnosed cases from this result.
The percentage of undiagnosed HIV cases decreased from 29.3% in 2005 to 15.8% in 2011. During this period, however, approximately 50% of the participants refused to test for HIV, which lengthened the average time from infection to diagnosis. Consequently, the percentage of undiagnosed HIV cases reversed direction and steadily increased from 16.1% to 18.9% over the 2012-2016 period.
Results from this hyperendemic South African setting show that the HIV testing rate is low, with long infection times, and an unsatisfactorily high percentage of undiagnosed cases. A high level of repeat HIV testing is needed to minimise the time from infection to diagnosis if the global AIDS epidemic is to be reversed within the next two decades.