Protocol for Monitoring the Implementation of the 95-95-95 Strategy in Tshwane: A Quantitative Analysis of Local Progress 2018-2024.

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Abstract* Background South Africa has made substantial national progress toward the UNAIDS 95-95-95 HIV targets; however, sub-district and facility level performance varies, with persistent gaps in testing coverage, timely ART initiation, retention, and viral load suppression. Tshwane District (Gauteng), including Sub-district 1, serves urban and peri-urban communities with high mobility and socio-economic vulnerabilities, where programmatic disparities (e.g., incomplete viral load capture and inconsistent follow-up) challenge cascade outcomes. Objective To quantify progress toward the 95-95-95 HIV targets in Tshwane Sub-District 1 (2018-2024) using routine health information systems, and to identify health system and implementation factors (via health care worker surveys) associated with gaps in testing, timely ART initiation, retention, and viral suppression. Methods This protocol outlines a repeated cross-sectional analysis of secondary data (TIER.Net, DHIS2; 2018-2024) across all 23 public sector facilities in Sub-District 1, combined with a cross-sectional survey of health care workers (HCWs) in purposively selected clinics with low testing coverage or high treatment interruption. Primary measures include (1) testing coverage/positivity, (2) timely ART initiation, (3) loss to follow-up (LTFU)/treatment interruption, and (4) viral suppression (<50 copies/mL). Analyses will include descriptive statistics, chi-square or t-tests, logistic regression to identify predictors of non-achievement of 95-95-95 sub-targets, and comparative evaluation of routine performance vs. HCW-reported implementation challenges. Data will be de-identified and managed in accordance with POPIA. Ethical approval has been obtained. Results This is a protocol; no results are presented. Pilot testing of instruments and extraction templates commenced in November 2025; full secondary data extraction and HCW surveys are scheduled from December 2025 to January 2026. Analyses are planned for January 2026-February 2026, with dissemination in mid-2026. Conclusions This protocol describes a pragmatic approach to local monitoring of UNAIDS 95-95-95 performance using routine systems and frontline insights. Findings will inform targeted improvement strategies for testing, ART initiation, retention, and viral suppression in Tshwane and comparable districts.

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