Background: A third (14% - 58%) of people who inject drugs (PWID) in South Africa are living with HIV. For HIV epidemic control among PWID UNAIDS recommends 300 needles per PWID per year, 40% opioid substitution therapy (OST) coverage and reaching the 90-90-90 treatment targets. By 2018, PWID programming in the country included needle/syringe services (NSS), HIV testing and linkage to care, and opioid substitution therapy (OST). To estimate service coverage, we assessed needle distribution, OST coverage and HIV treatment cascades among PWID accessing harm reduction services in Cape Town, Durban, Johannesburg, Port Elizabeth and Pretoria.
Methods: We combined programmatic data from city services between January and June 2018. For this period, we:
(1) consolidated counts of PWID accessing NSS;
(2) calculated the average number of needles distributed per PWID accessing NSS,
(3) divided the number of PWID on OST by the number of PWID accessing NSS as a proxy for OST coverage and
(4) counted the numbers tested and treated to develop cascades.
Results: During this period, 7 316 unique PWID accessed services (700 in Cape Town, 541 in Durban, 1 365 in Johannesburg, 361 in Port Elizabeth and 4 349 in Pretoria). Overall, 558 983 needles and syringes were distributed (ranging from 60 634 in Port Elizabeth to 225 709 in Pretoria); an average of 76 needles per PWID (ranging from 52 in Pretoria to 174 in Cape Town). 260 PWID were on OST at the end of the period, representing 4% coverage across cities (from 0% in Port Elizabeth to 8% in Cape Town). In total, 1 773 (24%) PWID tested for HIV (ranging from 15% in Pretoria to 57% in Cape Town). HIV positivity was 23% (from 3% in Cape Town to 45% in Johannesburg), 20% of whom were initiated onto antiretroviral therapy (ranging from 6% in Durban to 65% in Port Elizabeth). Viral suppression data was unavailable.
Conclusions: To reach HIV epidemic control among PWID in these cities, needle distribution needs to double, OST coverage expand ten-fold and access to HIV testing and treatment increase five-fold. The viral suppression data gaps need to be filled.