Challenges and successes in the implementation of the 90-90-90 hiv strategy in the city of johannesburg, south africa: a qualitative study
1
Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
2
Clinical Trials Unit, Africa Health Research Institute, Durban, South Africa
3
Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1826
ABSTRACT
INTRODUCTION:
The Joint United Nations Programme on HIV and AIDS (UNAIDS) implemented the 90-90-90 HIV strategy, aimed at achieving 90% of people living with HIV knowing their status, 90% of those who knew their status being on treatment, and 90% of those on treatment being virally suppressed by 2020, in line with the global plan to end the HIV epidemic by 2030. However, by the end of 2020, these targets were not met in South Africa. This study aimed to explore the challenges and successes in implementing the 90-90-90 strategy in Johannesburg, South Africa.
METHODS:
An exploratory qualitative study was conducted using in-depth semi-structured interviews with thirteen health managers from Region F of the City of Johannesburg Health District. Purposive sampling was used to identify the appropriate health managers from the district. The interviews were recorded, transcribed, coded manually, and analysed using thematic content analysis.
RESULTS:
Findings were grouped into two main categories: challenges and successes. The challenges category generated three themes: health system , programmatic, and societal challenges. These included subthemes such as the effects of COVID-19, staff shortages, stigma, mobility (migration), low parent responsibility, and personal factors like patients' education and readiness to start ART. The successes category yielded two themes: patient outcomes and programme outcomes. Here, respondents discussed how implementing the 90-90-90 HIV strategy improved patient health outcomes and provided direction for the HIV programme.
CONCLUSIONS:
Johannesburg's implementation of the UNAIDS 90-90-90 HIV strategy encountered challenges, including clinic infrastructure constraints and staff shortages. The City needs to enhance its Adolescent- and Youth-Friendly Services, build internal capacity for high-quality HIV services, and develop ICT solutions to connect its clinics, ensuring continuous care for its mobile migrant population. Collaboration is also vital to remove barriers for children accessing HIV services.
The Joint United Nations Programme on HIV and AIDS (UNAIDS) implemented the 90-90-90 HIV strategy, aimed at achieving 90% of people living with HIV knowing their status, 90% of those who knew their status being on treatment, and 90% of those on treatment being virally suppressed by 2020, in line with the global plan to end the HIV epidemic by 2030. However, by the end of 2020, these targets were not met in South Africa. This study aimed to explore the challenges and successes in implementing the 90-90-90 strategy in Johannesburg, South Africa.
METHODS:
An exploratory qualitative study was conducted using in-depth semi-structured interviews with thirteen health managers from Region F of the City of Johannesburg Health District. Purposive sampling was used to identify the appropriate health managers from the district. The interviews were recorded, transcribed, coded manually, and analysed using thematic content analysis.
RESULTS:
Findings were grouped into two main categories: challenges and successes. The challenges category generated three themes: health system , programmatic, and societal challenges. These included subthemes such as the effects of COVID-19, staff shortages, stigma, mobility (migration), low parent responsibility, and personal factors like patients' education and readiness to start ART. The successes category yielded two themes: patient outcomes and programme outcomes. Here, respondents discussed how implementing the 90-90-90 HIV strategy improved patient health outcomes and provided direction for the HIV programme.
CONCLUSIONS:
Johannesburg's implementation of the UNAIDS 90-90-90 HIV strategy encountered challenges, including clinic infrastructure constraints and staff shortages. The City needs to enhance its Adolescent- and Youth-Friendly Services, build internal capacity for high-quality HIV services, and develop ICT solutions to connect its clinics, ensuring continuous care for its mobile migrant population. Collaboration is also vital to remove barriers for children accessing HIV services.
| eISSN: | 2654-1459 |
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