New estimates from the Thembisa model (a leading mathematical model of HIV in South Africa) suggest that while KwaZulu-Natal is doing well in its HIV response, the North West province is struggling.
One widely endorsed set of measures to track a country or province's HIV response is UNAIDS's so-called 90-90-90 targets - a set of targets also adopted in South Africa's National Strategic Plan for HIV, TB and STIs 2017 - 2022.
The targets are that by 2020:
90% of people living with HIV must be diagnosed,
90% of those diagnosed must be receiving sustained antiretroviral therapy, and
90% of those diagnosed must achieve viral suppression (i.e. there must be so little virus in their blood that standard tests do not pick it up).
How are SA's provinces doing?
In addition to the 90-90-90 targets we added two extra columns to the right:
The ART coverage column shows the percentage of all people living with HIV (diagnosed and undiagnosed) who are on treatment - unlike the second 90 which reflects just the percentage of those who are diagnosed who are on treatment.
The column on the far right shows the percentage of all people living with HIV who are virally suppressed - unlike the third 90 which reflects only the percentage of people both diagnosed and on treatment who are virally suppressed. Of the five, this last column is probably the single column that tells us the most about the state of a province's HIV response (technically it is the product of the three 90s).
On the 90-90-90 measures KwaZulu-Natal performs better than any of South Africa's other provinces. This is particularly impressive given that the province has a large population and much of the province is rural. The Free State does second best on this set of indicators.
The worst performing of the nine provinces, at least based on these indicators, is the North West. This is not surprising given well-documented governance issues in the province's health department. That Gauteng ranks second worse may come as a surprise to some - especially when contrasted with the more rural KwaZulu-Natal. The Eastern Cape also clearly still faces very significant challenges - although that is probably less surprising.
Across the country HIV testing efforts have been impressive with all provinces exceeding or very close to meeting the first of the 90-90-90 targets.
The one clear short-coming across provinces is that many people who test positive either stop taking treatment or never start (the second 90). Helping more people who are living with HIV to start and stay on treatment must thus be a top priority for provincial departments of health.
Note: The numbers quoted in the table are the 2019 mean point estimates from the Thembisa model version 4.3 (confidence intervals are provided in the published outputs on the Thembisa website). Thembisa also includes estimates for 2020, but these are substantially more uncertain than the 2019 estimates. For viral load suppression we used the 1 000 threshold rather than 400 (Thembisa provides both).