Description
Background:
HIV is a major global public health problem that has claimed millions of lives in the world as at 2021, Sub-Saharan Africa continues being most affected. Despite major investments in HIV prevention, testing and treatments programmes, only one quarter of adult Africans have had a recent HIV test, and half of people living with HIV in Sub-Saharan Africa do not know they are HIV positive.
The incidence rates among the general population are relatively low, however, evidence shows rising infection rates among key populations, threatening current efforts at controlling the disease. This study aimed to describe the epidemiology of HIV infection in The Gambia.
Method:
A cross-sectional study was conducted among hospital attendees who had HIV services offered to them from 2017 – 2021. This study was conducted in the Gambia that has seven health regions. There are 67 HIV counseling and testing sites, 14 antiretroviral treatment/therapy sites located across the country.
Data extracted from the District Health Information System 2 included demographic information, HIV testing approaches, HIV status (positive, negative), linkage into care and treatment. We analyzed descriptively and presented the results in proportions and tables.
Results:
Of the 177,832 persons tested for HIV, 14,863 (8.4%) were positive, however, only 8,358 (56.2%) were enrolled into treatment. Test positivity rate was higher among the females (15.5%) compared to the males (5.5%) while treatment enrolment rates were higher for the females (60.6%) compared to the males (48.6%). The largest proportion of positive cases was recorded in 2018 (2953, 10.2%), and the lowest in 2021 (2482, 6.6%). The highest enrolment was registered in 2018 (1993, 67.5%), the lowest enrolment (1430, 36.6 %) was recorded in 2017.
For the stereotype, the prevalence rate for HIV-1 was (12523, 84.26%), HIV-2 (1248, 8.3%) and HIV-3 (1092, 7.35%). By gender, female (n=9055) recorded (7721, 85.3%) for HIV-1, (751, 8.3%) for HIV-2 and (583, 6.4%) was recorded for HIV-3 (Table 2). For the male respondent (n=5808), HIV-1 registered (4802, 82.7%), HIV-2 registered (497, 8.6%) HIV-3 registered (509, 8.8%).
Test positivity rate has been decreasing since 2018 while enrolment in care has been fluctuating. Western 2 Health Region (47.6%) had the highest test positivity rate (13.9%) while NBER had the lowest (3.8%). Enrolment was higher among 24 years and below (67.3%) as compared than 25 years and above (53.8 %) [PR=1.7 (95% CI 1.6148-1.9411)]; females (60.6%) enrolled more than males (48.4%) [PR: 1.6 (95% CI 1.5344-1.7517)]; and Western 1&2 regions (68.1%) enrolled for treatment more as compared to other regions (39.9%) [PR: 1.1 (95% CI 1.0272-1.0929)]
Conclusion:
In this study, female tested more positive, and among those only few enrolled in treatment for HIV and mostly among older age group. The Gambia did not meet the 90% target for enrolment into treatment. 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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