Can HIV viral load monitoring help measure South Africa’s progress towards the 95-95-95 targets?

Achieving the United Nations’ 95-95-95 targets is central to ending the HIV/AIDS epidemic by 2030. While increasing access to antiretroviral therapy is essential, routine HIV viral load monitoring provides critical insight into whether people living with HIV remain in care and achieve sustained viral suppression. Tracking these trends over time helps assess the effectiveness of treatment programmes and identify where additional efforts are needed to improve patient outcomes.

In South Africa, the National Health Laboratory Service performs the majority of HIV viral load testing for the public health sector. Although HIV diagnoses are primarily made using rapid tests outside the laboratory setting, annual viral load testing provides a valuable measure of treatment retention and virological suppression. Together with national estimates of people living with HIV, these data can be used to monitor progress towards the second and third UNAIDS 95-95-95 targets.

This report reviews HIV viral load testing data from 2019 to 2025, examining trends in testing coverage, viral suppression, and treatment outcomes across South Africa’s national HIV treatment programme. The findings provide evidence to support programme monitoring, strengthen retention in care, and guide interventions needed to accelerate progress towards achieving the 95-95-95 targets by 2030.

Methods

To assess VL monitoring trends, the VL test data for this analysis were accessed on 14 January 2026 from the SDW at the NICD, a division of the NHLS, for the period 01 January 2019 to 31 December 2025. Both valid and rejected HIV viral load VL tests were included for reporting the annual number of HIV VL tests registered, whereas reporting on the number of patients undergoing VL monitoring and suppression rates were restricted to valid results. All ages were included in the analysis, including tests registered with an unknown date of birth, with taken date used to describe the period of testing.

Results

Between 2019 and 2025, the estimated annual number of PLHIV increased from 7.46 to 8.12 million, and the number on ART increased from 5.17 to 6.39 million. Over the same period, the number of VL tests submitted rose from 5.84 million to 6.83 million, and the number of unique patients receiving a VL test increased from 4.81 million to 5.73 million. National HIV VL monitoring coverage increased from 64.5% in 2019 to 70.5% in 2025, with a peak of 71,4% reached in 2023. The average number of VL tests performed per patient per year decreased slightly from 1.21 in 2019 to 1.19 in 2025. Expressed as a proportion of patients on ART with a VL done, this decreased from 93,1% in 2019 to 89,6% in 2025.

For a more in-depth look into this study, download the full PDF below