UNAIDS 95-95-95 targets in older people living with HIV in urban and rural KwaZulu-Natal, South Africa

BACKGROUND: Data describing HIV prevalence, ART use and virological suppression, in older adults in urban or rural South Africa, are limited. We aimed to address this evidence gap. METHODS: In a population-based cross-sectional study, using age- and sex-stratified random sampling of adults aged ≥ 40 years, a researcher-administered questionnaire collected socio-demographic, and clinical data (03/2022-04/2024). HIV was confirmed using two point-of-care tests (discrepancies resolved by ELISA). The age- and sex-specific study prevalence was applied to the KwaZulu Natal (KZN) province population structure to provide an illustrative projection of HIV prevalence in KZN. Achievement of UNAIDS 95-95-95 targets was calculated in 10-year age bands. People living with HIV (PLHIV) were categorised as virologically suppressed (< 50copies/mL) vs. unsuppressed, and younger (40-49years) vs. older (≥ 50years). Logistic regression determined associations with HIV and virological suppression. RESULTS: 1,916 adults were recruited; 713 (37.2%) living with HIV, 36.7% men and 37.7% women. HIV prevalence was 68.1% among 40-49-year-olds, 49.4% among 50-59-year-olds, 26.0% among 60-69-year-olds and 9.8% age ≥ 70 years. In older adults (≥ 50 years), the prevalence was 27.9%. The overall projected standardised HIV prevalence in adults ≥ 40 years in KZN was 47.4% (44.8% men; 49.3% women). In our sample, 98% of PLHIV were aware of their status, 97.6% on ART, and 77.7% virologically suppressed. Men ≥ 70 years achieved highest virological suppression (88.2%). Overall, being female vs. male (57.8% vs. 42.2%; OR 1.6 [95%CI 1.1, 2.4]; p = 0.008), having HIV ≥ 3 years vs. < 3 years (62.2% vs. 55.1%; OR 3.0 [95%CI 1.6, 5.7]; p = 0.001), rural vs. urban living (50.9% vs. 49.1%; OR 1.5 [95%CI 1.0, 2.1]; p = 0.044) were associated with virological suppression. Older PLHIV (≥ 50years) vs. younger (40-49years) reported hypertension (51.0% vs. 30.0%), diabetes (10.0% vs. 5.0%), and polypharmacy (≥ 5 drugs) (13.2% vs. 6.3%). CONCLUSION: In KZN, the overall study prevalence of HIV in adults age ≥ 50 years was 27.9% in both urban and rural populations, the UNAIDS 95-95-95 targets were met for known status and being on treatment, but not virological suppression.