Monitoring the implementation of the 95-95-95 in Tshwane: Quantitative local progress

Abstract

South Africa continues to carry a high HIV burden, and achieving the UNAIDS 95-95-95 targets is critical to ending AIDS as a public health threat by 2030. Despite progress, Tshwane Sub-District 1 continues to face challenges in HIV service delivery that affect continuity of care. This study assessed the implementation of the 95-95-95 HIV targets by exploring healthcare workers’ perceptions of barriers to HIV testing, antiretroviral therapy (ART) initiation, and lost to follow-up that affects retention in care. A quantitative cross-sectional study was employed using a structured self-administered questionnaire among HIV Testing Services (HTS) counsellors, Nurse-Initiated Management of Antiretroviral Therapy (NIMART)-trained nurses, and other HIV programme staff from facilities with low HIV testing coverage and high loss-to-follow-up rates. Data were analysed using descriptive and inferential statistics, including regression analysis. Most participants had more than six years of experience. Stigma and fear of discrimination were identified as the main barriers to HIV testing, while refusal to accept an HIV-positive diagnosis and lack of treatment readiness were the leading barriers to ART initiation. Most facilities had patient tracing systems in place to address loss to follow-up. Regression analysis showed that professional cadre was significantly associated with perceived barrier scores, with NIMART nurses reporting lower scores than lay counsellors (β = -0.377; p = 0.023). The findings suggest that discrimination, stigma, and challenges related to treatment acceptance continue to affect HIV service uptake. Strengthening counselling services and patient support may improve HIV testing, ART initiation, and retention in care in Tshwane Sub-District 1.