A new randomised controlled trial conducted in the Eastern Cape has shown that adding structured patient navigation to same-day antiretroviral therapy (ART) can make a meaningful difference for people newly diagnosed with HIV. The trial found that patients who received support from trained navigators were far more likely to stay in care and keep their viral load low over six months. Those with navigator support had a 79 percent retention rate, compared with 64 percent under standard care.
Among patients who achieved a viral load of fewer than 50 copies per millilitre, 64 percent remained in care, compared to just 39 percent without this extra support. Patient navigation combines personal support, such as home or virtual check-ins and WhatsApp reminders, with practical help like linking people to services and monitoring their progress. It was especially effective for people who started treatment on the same day as their diagnosis.
“This approach humanises HIV care. It builds a bridge between the clinic and the community, helping patients stay connected to treatment and ultimately saving lives,” said lead author Siyakudumisa Nontamo, Facility Team Lead: Care and Treatment Programme at TB HIV Care.
In August 2024 the Human Sciences Research Council released findings from the Sixth South African HIV Prevalence, Incidence, and Behaviour Survey (SABSSM VI) for the Eastern Cape. The results show that HIV prevalence in the province stabilised, moving from 15.9 percent in 2017 to 13.7 percent in 2022. This is an estimated 980,000 people living with HIV, down from about 1 million in 2017. Access to treatment has improved significantly. ART coverage increased from 67.8 percent in 2017 to 83.5 percent in 2022, meaning about 723,000 people in the province are now receiving treatment. However, gaps remain among young people. Only 70.9 percent of adolescents and youth aged 15 to 24 living with HIV are on ART, compared to 84.8 percent of adults aged 25 to 49. Among females, coverage is much lower for young women at 68.7 percent than for women aged 25 to 49 at 88.2 percent. ART use also varies across districts, ranging from 69.4 percent in Nelson Mandela Bay to 92.0 percent in Alfred Nzo. Nationally, the proportion of people living with HIV who are currently on antiretroviral treatment rose to 80.9 percent in 2022, up from 63.7 percent in 2017.
Despite major advances in HIV treatment, retention in care remains a persistent challenge within South Africa’s HIV programme, especially in rural provinces such as the Eastern Cape. Many patients initiate treatment but later disengage due to stigma, transport difficulties, and limited ongoing support. The study shows that low-cost, human-centred interventions can significantly strengthen treatment outcomes. The trial, titled “Impact of Patient Navigation on Retention in Care and HIV Viral Load Suppression Among Newly Diagnosed Persons Living with HIV in the Eastern Cape,” compared standard HIV care to an approach where trained patient navigators provided ongoing support to patients starting ART. Beyond improved retention and viral suppression, the trial also showed that patients supported by navigators experienced fewer deaths and dropouts, with substantially lower losses to follow-up and reduced mortality than those receiving standard care.
Patient navigation helps bridge the gap by pairing practical healthcare coordination with empathy and community-based follow-up. Navigators assist patients with managing appointments, maintaining adherence, and accessing psychosocial services, fostering trust, continuity, and sustained engagement in care. This approach aligns with South Africa’s national HIV strategy, which prioritises patient-centred models of care aimed at achieving the UNAIDS 95-95-95 targets.
At scale, TB HIV Care’s programmes are grounded in person-centred, integrated service models that reflect the real lives and needs of people affected by HIV and tuberculosis. This study reinforces TB HIV Care’s belief that support beyond clinic walls is essential for achieving lasting impact. In the 2024/25 reporting period, the organisation reached more than 1.9 million people with HIV testing services and initiated 27,873 individuals on ART, achieving a 95 percent viral suppression rate among clients in care.
“By bridging the gap between diagnosis and ongoing care, patient navigation aligns with our outreach for key populations and our shift toward holistic service delivery. We look forward to translating this evidence into practice, ensuring fewer people fall through the cracks and more sustain treatment success,” said Professor Harry Hausler, CEO at TB HIV Care.
Additional findings from the SABSSM VI survey for the Eastern Cape show that HIV remains most common among adults aged 25 to 49, with a prevalence of 27.7 percent, and women in this age group are especially affected at 35.4 percent compared to 17.1 percent for men. The survey found geographic differences: HIV prevalence among men was highest in urban areas at 8.7 percent, while among women it was highest in rural informal or tribal areas at 19.8 percent. By district, prevalence was highest in Chris Hani at 14.4 percent, followed by Amathole at 14.1 percent, Alfred Nzo at 13.9 percent, and lowest in Nelson Mandela Bay at 9.7 percent. At national level, 81.4 percent of all people living with HIV were virally suppressed. In the Eastern Cape, viral load suppression increased from 66.3 percent in 2017 to 79.3 percent in 2022. However, children aged 0 to 14 years had much lower suppression levels at 61.4 percent. Among people aged 15 to 49 living with HIV, 78.6 percent were virally suppressed. Women had far higher suppression rates at 83.9 percent than men at 65.4 percent.
The randomised controlled trial involved participants from HIV testing sites in the O.R. Tambo District including Flagstaff, Mthatha Gateway, and Tsolo Clinics. It was approved by the Eastern Cape Health Research Committee and the Walter Sisulu University Ethics Committee. The study was supported by the Chemical Industries Education and Training Authority and the South African Medical Research Council’s Strategic Health Innovation Partnerships.
