What were the issues with enrolment for treatment after testing positive for HIV, The Gambia, 2017-2021?

Sexually Transmitted Diseases

In 2016, the United Nations General Assembly’s Political Declaration on Ending AIDS committed countries to the 90–90–90 targets, which aim to bring HIV testing and treatment to many people living with HIV by the end of 2020. Globally as of 2019, 81% of people living with HIV knew their HIV status, and more than two thirds (67%) were on antiretroviral therapy (ART). This study assessed if HIV/AIDS intervention in The Gambia met the enrolment target between 2017-2021.

We conducted a study among those who sort healthcare at the 45 HIV sentinel sites in The Gambia. The data we extracted from the DHIS 2 included demographic information, HIV test results (positive/negative), and treatment enrollment. We conducted univariate and bivariate analyses.

Of the 177,832 persons tested for HIV, 14,863 (8.4%) were positive. Of the positive clients, female was 60.9%, Western 1&2 had 66.9% and ages <49 years formed 15.5%. Of the 14,863 persons who were positive for HIV, 56.7% have enrolled in HIV treatment. Of those who enrolled, 60.9% are female, 68.1% were from Western 1&2 regions and 70.7% were age 15-24 years. ART enrolment was higher among clients aged 24 years and below (67.3%) than ages 25 years and above (53.8 %) [PR: 1.3 (1.2124-1.2930)]; females (60.6%) more than males (48.4%) [PR: 1.2 (95%CI 0.1581-0.1701)]; and Western 1&2 regions (68.1%) as compared to other regions (39.9%) [PR: 1.1 (95%CI 1.0272-1.0929)].

The Gambia did not meet the 90% target for enrolment into treatment because about half of those who tested positive enrolled for ART. Further studies need to be conducted to know why there were low enrolment among males, ages less than 25years and among those living in Western 1&2 Regions. We recommend to National AIDS Secretariat to develop innovative strategies to motivate positive cases to enroll in treatment.

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