HIV treatment indicators among children younger than 15 years in South Africa: Results from the 2017 National HIV Prevalence, Incidence, Behaviour, and Communication Survey

Abstract Background Early detection and initiation in care is crucial to the survival and long-term well-being of children living with HIV. However, there remain challenges regarding early testing and linking of infants and children who are positive for early treatment. This study examines the HIV treatment indicators and associated factors among children younger than 15 years in South Africa. Methods The data was collected as part of the 2017 National HIV survey using a multistage cluster randomised design. Multivariate generalised linear regression models were fitted to determine factors associated with the HIV care continuum. Results The sample had 12 237 children aged 0–14 years, the median age was 8 years (interquartile range of 4–11 years). HIV prevalence in this study population was 2.8% (95% CI: 2.4–3.3). Overall, 40.0% of the HIV-positive children knew their status, and among these, 72.6% (95% CI: 61.7–81.3) were on ART, and 90.0% (95% CI: 88.4–97.9) were virally suppressed. The odds of HIV diagnosis and knowing HIV-positive status were significantly higher among children whose health was rated as fair or poor than excellent or good AOR = 1.32 (95%CI: 1.05–1.67), p = 0.022, and were significantly lower among females than males AOR = 0.82 (95% CI: 0.71–0.95), p = 0.009, and those attending private healthcare facilities than public health facilities AOR = 0.64 (95% CI:0.57–0.74), p < 0.001. The odds of HIV diagnosis and knowing HIV-positive status and being on ART were significantly higher among children residing in rural formal/farm areas than urban areas AOR = 1.40 (95% CI:1.05–1.86), p = 0.017, and were significantly lower among children attending private healthcare facilities AOR = 0.44 (95% CI:0.36–0.54), p < 0.001. The odds of HIV diagnosis and knowing HIV-positive status, being on ART, and being virally suppressed were significantly higher among children with self-rated health as fair or poor than excellent/good AOR = 1.09 (95% CI:1.00-1.19), p = 0.05. Conclusion Awareness of HIV status and initiation of treatment in children was low. The findings highlight the need to improve HIV status awareness and disclosure to children. The findings underscore the need for targeted interventions and programs tailored for HIV- positive children in urban areas.