Quantifying the HIV Treatment Cascade in a South African Health Sub-district by Gender: Retrospective Cohort Study

M Lurie*, Kipruto Kirwa, Julia Callaway, Morna Cornell, Andrew Boulle, Angela Bengtson, Mariette Smith, Natalie Leon, Christopher Colvin

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Objectives: To quantify the HIV care cascade in a Cape Town sub-district to understand rates of linkage to and engagement in HIV care. Methods: We used routinely collected data to reconstruct the treatment cascade for 8382 infected individuals who tested HIV + in 2012/2013. We obtained data on patient gender, year of initial HIV-positive test, age at testing and initial CD4 cell count and defined five stages of the HIV care cascade. We quantified attrition across cascade stages. Results: Two-thirds of the sample (5646) were women. Men were older at time of first testing (36.5 vs. 31.3 years) and had more advanced HIV disease at diagnosis (298 vs. 404 CD4 cells/µL for women). The median duration of follow-up was 818 days. Among women, 90.5% attended an initial HIV care visit, 54.6% became eligible for antiretroviral therapy under local guidelines during follow-up, 49.3% initiated ART and 45.6% achieved a therapeutic response. Among men, 88.0% attended an initial HIV care visit, 67.4% became ART eligible during follow-up, 48.0% initiated ART and 42.4% achieved a therapeutic response. Approximately 3% of women and 5% of men died during follow-up. Conclusions: We were able to reconstruct the HIV treatment cascade using routinely collected data. In this setting, rates of engagement in care differ by gender in key stages of the cascade, with men faring worse than women at each cascade point. This highlights the need for interventions aimed at encouraging earlier testing, linkage, ART initiation and retention among men.

Original languageEnglish
JournalTropical Medicine & International Health
Issue number2
Pages (from-to)186-192
Publication statusPublished - Feb 2020
Externally publishedYes


  • HIV treatment cascade
  • South Africa
  • gender differences
  • linkage to care
  • Humans
  • Middle Aged
  • Anti-HIV Agents/therapeutic use
  • Male
  • CD4 Lymphocyte Count
  • HIV Infections/drug therapy
  • South Africa/epidemiology
  • Adolescent
  • Sex Factors
  • Adult
  • Female
  • Retrospective Studies


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