The number of South African adolescents receiving HIV care and treatment in South
Africa is growing. We used routinely collected laboratory data from South Africa’s
National HIV Programme to: 1) quantify the numbers of adolescents accessing HIV care
and treatment over time; 2) characterize the role of perinatal infection in these
trends; and 3) estimate proportions of adolescents seeking HIV care and antiretroviral
treatment (ART) in South Africa’s public sector. National Health Laboratory Service
(NHLS) conducts all laboratory monitoring for South Africa’s National HIV Programme.
We conducted a descriptive cohort study of children and adolescents (aged 1-19 years)
accessing care in South Africa’s public sector HIV treatment program from 2005-2016
with a CD4 count or viral load recorded in the NHLS database. We estimated the total
number entering HIV care (number with CD4/viral load test result) by calendar period,
as well as proportion in care and on ART (at least one VL test result). We stratified
analyses by gender and by whether the patient entered care <15 years (likely perinatally
infected) or at 15-19 years (likely infected in adolescence). The cohort included
730,882 patients aged 1-19 years at entry to care. Fifty-four percent of patients
(n=209,205) entering care <15 years were female while 88% (n=301,242) of those entering
care aged 15-19 were female. During the study period, the number of virologically
monitored ART patients aged 15-19 years increased 10-fold, from 7,949 in 2005-2008
to 80,918 in 2013-2016. Still, just two-thirds (n= 92,783/140,028) of 15-19-year olds
seeking care started ART by 2016, well below UNAID’s target of ART for 90% of those
diagnosed. We project the number of adolescents on ART will continue to rise. Large
increases in numbers of adolescents (aged 15-19 years) on ART reflect aging of children
entering care at ages 1-14 years and increases in care-seeking care among 15-19 year-olds,
presumably horizontally infected. However, many adolescents seeking care do not start
ART, suggesting an urgent need for interventions to increase uptake of ART and improve
services for this growing population.