THE SIXTH SOUTH AFRICAN NATIONAL HIV PREVALENCE, INCIDENCE, AND

BEHAVIOUR SURVEY (SABSSM VI)

20 YEARS OF STRATEGIC HIV AND PUBLIC HEALTH DATA

Launch of the key findings

27 November 2023
OVERVIEW OF PRESENTATION
• Background about the SABSSM survey
series
• Main objectives of the study
• Study methods
• Results
• Response rates
• National HIV prevalence
• Viral load suppression
• Progress towards 95-95-95 targets
• Condom use
• Concluding remarks
 WAY BACK IN 2002

Expanded scope

Larger sample size

Increased biomarkers

Take all approach

Electronic data collection

Survey year
Major source of information for measuring
the progress of the implementation of the
South African National Strategic Plan (NSP)
for HIV, STIs and TB
 MAIN OBJECTIVES

To estimate at national, provincial and district levels (PEPFAR and

NDoH priority):
• HIV prevalence (adults and children)
• Exposure to ART
• Viral load suppression in HIV-infected individuals

To estimate at national level:

• HIV incidence (annualized rate
of new HIV infections)
 STUDY METHODS
Geographic scope
• National level: 9 provinces
• District level: 27 PEPFAR and 6 National Department of Health priority
districts
Study design and population
• A cross-sectional, population-based household survey, using multi-
stage stratified cluster random sampling
• The study design and methods are validated in the five previous
surveys
Survey population
• Persons of all ages living in South Africa at the time of the survey
• All members of the selected households were invited to participate
• Data collection occurred over 15 months, from January 2022 to April
2023
 Limpopo

GP Mpumalanga
North West

Free State
KZN

Northern Cape

Eastern Cape

Western Cape
QUESTIONNAIRES

Household Questionnaire
• This questionnaire was used to record a household listing of
members and other household-level information

Individual questionnaires
• Questionnaire for parent/guardian of children aged 0 to 11
years
• Questionnaire for children aged 12 to 14 years
• Questionnaire for persons aged 15 years and older
SPECIMEN COLLECTION

Dried blood spot (DBS) specimens

collected by
• finger-prick
• heel-prick in infants < 24
months
 SPECIMEN TESTING
Dried Blood
Spot

HIV Ab testing
Two 4th Generation EIA plus
confirmatory testing
Nucleic Acid Amplification
test < 24 months

HIV
Pos

*HIV
*HIV Incidence ARVs Viral Load
Drug Resistance
(> 2 years) HPLC coupled with HIV-1 RNA on
(VL>1000cl/ml)
LAg assay/ RITA plus Tandem Mass Abbott m2000 HIV
Next-generation
Spectrometry Real-Time System
sequencing

* Not reported in this presentation

 WEIGHTING PROCEDURE
• Small area layer (SAL) (primary sampling unit) weights reflect the allocation
of SALs according to the three stratification variables, namely race, province,
and locality type.
• In each sampled SAL, a systematic random sample of 15 visiting points (VPs)
was selected, with VPs in each SAL having the same base weight.
• SAL base weights were adjusted to correct for the invalid and unrealised SALs
• VP weights were computed as the counted number of VPs in the SAL,
corrected proportionally for invalid VPs, and divided by the number of VPs
participating in the survey.
• Final VP sampling weight was computed as the product of the SAL sampling
weight and the VP sampling weight.
• Demographic and HIV-testing information for all household members within
the responding SALs were gathered to calculate individual sample weights.
• These individual weights were further adjusted for questionnaire and HIV-
testing non-response.
• The final individual weights were benchmarked against the 2022 census
population by age, race, sex, and province.
RESULTS
 RESPONSE RATES

• 29 447 VPs were approached, where 27 005 (91.7%) were valid.

• Of 27 005 valid households, 80.0% completed a household
interview.
• Of the eligible 76 134 individuals, aged 0+ years and older, 94.1%
were interviewed, and 62.7% provided blood for HIV and
additional testing.
• Of the 30 718 eligible women, aged 15 years and older, 94.9%
were interviewed, and 69.0% provided blood for HIV and
additional testing.
• Of the 22 665 eligible men, aged 15 years and older, 90.6% were
interviewed, and 60.8% provided blood for HIV and additional
testing.
UNDERSTANDING THE HIV EPIDEMIC
 OVERALL HIV PREVALENCE,
SOUTH AFRICA, 2017 AND 2022

• The overall national estimate for HIV prevalence for all ages in
2022 was 12.7% (95% CI: 12.0–13.4), translating to 7.8 million
(95% CI: 7.2–8.4)

• The HIV prevalence was 1.3% lower than the estimate found in
2017, which was 14.0% (95%CI:13.2 – 14.8), translating to 7.9
million (95% CI: 7.2–8.6)

• This represents 107 000 fewer people living with HIV in 2022
HIV PREVALENCE AMONG PEOPLE AGED 15+ BY
PROVINCE, SOUTH AFRICA, 2022
 HIV PREVALENCE BY SEX AND AGE,
SOUTH AFRICA, 2022
Female Male
60

50
HIV prevalence (%)

40

30

20

10

0
0-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 plus
Female 2,2 5,7 8,0 19,5 26,2 34,2 33,8 28,8 29,1 16,1 11,3 6,1
Male 2,6 3,1 4,0 6,3 10,8 16,9 19,9 27,1 23,0 15,1 12,0 4,9
Age group (years)
 OVERALL HIV PREVALENCE AMONG MALES,
SOUTH AFRICA, 2017 AND 2022
Males
2017 2022
30 27,1
26,7
25 23,4 23,0
25,1
HIV prevalence (%)

20
17,0
20,0 20,8
15,1
15 16,9
11,9 12,0
13,0
10
10,8
5,4
4,2 7,1 3,8
5 2,6 6,3
4,0 4,9
0 2,6 3,1
0 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60-64 65+
Age group (years)
 OVERALL HIV PREVALENCE AMONG FEMALES,
SOUTH AFRICA, 2017 AND 2022
Females
2017 2022
45
39,4
40 35,9 35,4
35
29,1
HIV prevalence (%)

34,2 33,8 28,7

30 26,0
25 28,8
25,9
20 16,7
15,6 21,7 15,4
15 19,5
16,1
10
5,6 11,3
3,0 3,9
5 8,0
5,7 6,1
0 2,2
0 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60-64 65+
Age group (years)
 OVERALL HIV PREVALENCE BY AGE
SOUTH AFRICA, 2017 AND 2022
Age group
2017 2022
(years)
HIV-positive (%) Number of PLHIV HIV-positive (%) Number of PLHIV
Total 14.0 7 917 000 12.7 7 810 000

0–14 2.8 471 000 2.4 390 000

15–24 7.8 754 000 5.2 533 000

25–49 26.3 5 581 000 22.1 5 300 000

50+ 12.4 1 111 000 14.0 1 588 000

15–49 20.6 6 335 000 17.0 5 833 000

15+ 18.7 7 446 000 16.3 7 420 000

 HIV PREVALENCE AMONG 15 YEARS AND OLDER
BY PROVINCE, SOUTH AFRICA, 2017 AND 2022
BY
30

25
HIV prevalence (%)

20

15

10

0
KZN MP FS EC NW GP LP NC WC Total
2017 25,1 25,3 23,1 22,3 21,2 15,3 15,6 12,0 10,2 18,7
2022 21,9 20,8 19,2 18,8 16,4 15,0 11,9 10,0 8,3 16,3
Province

2017 2022
VIRAL LOAD SUPPRESSION AMONG PEOPLE AGED 15+
LIVING WITH HIV BY PROVINCE, SOUTH AFRICA, 2022
 VIRAL LOAD SUPPRESSION AMONG PEOPLE LIVING
WITH HIV BY AGE AND SEX, SOUTH AFRICA, 2022

Female Male
100

80
VL Supression(%)

60

40

20

0
15-24 25-34 35-44 45-54 55-64 65 plus
Female 68,2 75,9 85,9 88,4 91,4 88,8
Male 73,5 66,3 76,3 84,6 82,1 86,9
Age group (years)
 VIRAL LOAD SUPPRESSION (15 YEARS AND OLDER) LIVING WITH
HIV BY SEX, RACE, AND AGE, SOUTH AFRICA, 2017 AND 2022

2017 2022
n % 95% CI n % 95% CI
Total 5 617 62.2 59.5-64.8 7 050 81.2 78.5-83.6
Sex
Male 1 468 54.1 49.1-59.0 1 931 77.6 73.9-80.9
Female 4 149 66.9 64.3-69.5 5 117 82.9 79.8-85.7

Age group (years)

15–24 736 47.7 40.9–54.6 614 70.1 63.3–76.1
25–49 3 874 61.7 58.3–64.9 4 621 80.5 76.6–83.9
15–49 4 610 60.0 57.2–62.8 5 235 79.5 75.9–82.7
15+ 5 617 62.2 59.5-64.8 7 038 81.2 78.5-83.6
 95-95-95 INDICATOR DEFINITIONS
Diagnosed/know status if tested positive in the study and
Had self-reported being positive or
First
95 Tested positive for ART in the study or
Self-reported using ART

On ART
Second Tested positive for ARVs in the study
95 Self-reported using ART

Virally suppressed
Third
95 <1000 copies/ml
 95-95-95 INDICATORS FOR PEOPLE AGED 15+
LIVING WITH HIV, SOUTH AFRICA, 2022
100

90

80
Adults Living with HIV (%)

70

60 91.6% 91.0% 93.9% 85.1% 90.1% 93.8% 89.6% 90.7% 93.9% 2022

50

40

30
88.7% 72.3% 89.8% 78.2% 67.7% 82.3% 84.8% 70.7% 87.4% 2017
20

10

0
Females Males Total
Diagnosed with HIV On ART Virally suppressed
 CONDOM USE DURING MOST RECENT SEXUAL ENCOUNTER FOR
PEOPLE WITH MULTIPLE SEXUAL PARTNERS*, SOUTH AFRICA, 2022

Females Males
70

60
Condom use (%)

50

40

30

20

10

0
15-24 25-49 50 plus
Females 43,5 40,9 29,0
Males 50,6 44,0 27,9
Age group (years)

* Who reported having 2 or more partners in past 12 months

 CONCLUSIONS
• Promising decreases in HIV prevalence, coupled with high community VLS
(81%), point to the impact of South Africa’s National HIV Response, with
support from the PEPFAR program
• Marked progress has been made towards South Africa’s 95–95–95 adult
treatment targets:
• 90% of adults knew their status, 91% of those diagnosed were on ART,
and 94% of those on ART were virally suppressed
• Strategies to improve both HIV diagnosis and ART use are urgently
needed to achieve the 2025 national goals.
• The HIV epidemic continues to disproportionately affect specific geographical
regions and demographic groups, especially Black Africans and women
• SABBSM VI data will be used to target HIV programming to address the
remaining gaps
 NEXT STEPS

• Finalise the main study report

• Complete the analysis for new HIV infections
• Produce summary sheets for provinces and selected
districts
 CONSORTIUM AND PARTNERS

• U.S. Centers for Disease Control and Prevention (CDC)

• South African Medical Research Council (SAMRC)
• National Institute for Communicable Diseases (NICD)
• University of Cape Town (UCT)
• National Department of Health (NDoH)
• South African National AIDS Council (SANAC)
• United Nations Children’s Fund (UNICEF)
• United States Agency for International Development (USAID)
• Joint United Nations Programme on HIV/AIDS (UNAIDS)
 FUNDING SOURCE

President’s Emergency Plan for AIDS Relief

(PEPFAR) through the Centers for Disease
Control and Prevention (CDC).
THANK YOU
 LIST OF CONTRIBUTORS
Human Sciences Research Council U.S. Centers for Disease Control and Prevention (CDC)
Name Role Name Role
Prof Khangelani Zuma Overall Principal Investigator Dr Rachael Joseph Co-Investigator
Prof Leickness Simbayi Principal Investigator Dr Pelagia Murangandi Co-investigator
Dr Nompumelelo Zungu Principal Investigator Ms Nuha Naqvi Co-investigator
Prof Sizulu Moyo Principal Investigator South African Medical Research Council (SAMRC)
Dr Edmore Marinda Co-Principal Investigator Name Role
Dr Sean Jooste Co-Principal Investigator Dr Tarylee Reddy Statistician
Dr Shandir Ramlagan Project Director Dr Nonhlanhla Yende-Zuma Statistician
Dr Musawenkosi Mabaso Project Director Ms Mikateko Mazinu Statistician
Dr Lehlogonolo Makola Overall Project Manager Ms Yusentha Balakrishna Statistician
Mr Johan Van Zyl Project Manager: Quality Control National Institute for Communicable Diseases (NICD)
Dr Vuyelwa Mehlomakulu Project Manager: HIV Testing Services Name Role
Dr Rindidzani Magobo Project Manager: Laboratory Testing Prof. Adrian Puren Co-Investigator
Ms Yolande Shean Communications Manager Ms. Beverly Singh Co-Investigator
Mr Phaleng Maribe Data Manager Ms Ewalde Cutler Co-Investigator
Ms Goitseone Maseko Statistician Ms Zinhle Brukwe Co-Investigator
Ms Ronel Sewpaul Statistician University of Cape Town
Dr Inbarani Naidoo Co-Investigator Prof Gary Maartens Co-Investigator
Dr Jeremiah Chikovore Co-Investigator Ms Sandra Castel Co-Investigator
Mr Adlai Davids Co-Investigator
Ms Mafanato Maluleke Co-Investigator/Coordinator
Mr Lesiba Ofentse Molopa Co-Investigator/Coordinator