Thusa-Thuso

South Africa has nearly 7 million people living with HIV and 400,000 new infections annually.1,2 In September 2016, South Africa began the implementation of WHO’s Universal Test and Treat (UTT) policy in hopes of reaching the 90-90-90 targets by 2020 and reducing HIV- related morbidity, mortality and HIV transmission rates.1,3 Although 3.8 million HIV positive patients are currently receiving antiretroviral therapy (ART) (March 2017), over 2 million patients will have to be enrolled on HIV treatment for South Africa to reach the 90% on ART target.1,4 While the Department of Health officially launched the policy in September 2016, current system leaks could impede the country’s ability to achieve the targeted numbers on ART5-7 and accelerated ART initiation could shift in attrition downstream in the HIV cascade.

Early attrition from HIV care is a form of silent refusal, and many eligible patients never initiate ART at all. Less than 30% of HIV positive individuals in sub-Saharan Africa remain in care until ART eligibility is established.8,10 Current evidence suggests that merely improving access to testing services and ART will not translate into high ART uptake unless health system and patient-related barriers are addressed.