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Original Research
Comparison of treatment outcomes of adolescents on HIV treatment before and during the coronavirus disease 2019 pandemic in Cape Town, South Africa: A retrospective cohort study
Submitted: 14 August 2025 | Published: 13 March 2026
About the author(s)
Nazreen Khan, School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South AfricaBrian van Wyk, School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
Talitha Crowley, School of Nursing, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems, posing risks for adolescents living with HIV (ALHIV) in resource-limited, high HIV-prevalence settings. These disruptions threatened antiretroviral therapy (ART) adherence, viral load suppression (VLS) and retention in care (RiC).
Aim: This study aimed to compare treatment outcomes of ALHIV on ART in the Khayelitsha and Eastern Substructure (KESS) before and during the COVID-19 pandemic.
Setting: The study was performed in KESS, Cape Town, South Africa.
Methods: A retrospective cohort analysis was conducted among ALHIV aged 10–19 years receiving ART at public health facilities, pre-COVID-19 (before 01 March 2020) and during COVID-19 (01 March 2020–31 December 2021). Sociodemographic, clinical, and treatment data were analysed. Descriptive and inferential statistics compared outcomes and determined factors associated with VLS (< 1000 copies/mL) using SPSS v.30.
Results: Data from 1702 ALHIV (pre-COVID-19) and 2733 ALHIV (during COVID-19) were analysed. Viral load suppression declined from 82.1% to 64.8%, while full VLS (< 50 copies/mL) from 70.8% to 53.7% (p = 0.065). Antiretroviral therapy adherence fell from 96.4% to 70.0% (p < 0.001), and RiC 80.3% to 76.3% (p < 0.001). In multivariate analysis, higher CD4 count, and consistent ART adherence predicted VLS.
Conclusion: Antiretroviral therapy adherence and VLS rates among ALHIV declined during COVID-19. Adolescent-centred healthcare delivery models are needed to ensure continuity of HIV treatment during public health emergencies.
Contribution: This study provides local evidence on the pandemic’s impact in a high-burden South African context. By quantifying declines in ART adherence, RiC, and VLS, it highlights ALHIV vulnerabilities and the need to strengthen adolescent-responsive, resilient healthcare systems.
Keywords
Sustainable Development Goal
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