Zimbabwe's progress toward the UNAIDS 90-90-90 targets: comparing 2016 and 2020 population-based surveys


BACKGROUND: Joint United Nations Programme on HIV/AIDS (UNAIDS) set the ambitious goal of ending the AIDS epidemic by 2030. To achieve this goal, UNAIDS set a three-part target, 90% of HIV-positive individuals know their status; of these, 90% are receiving antiretroviral therapy [ART], and of these, 90% have viral load suppress (VLS; HIV RNA<1000 copies/mL). The Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) assessed progress toward the 90-90-90 UNAIDS targets in 2016 and 2020. We compared the two surveys' results among adults aged 15'64 years living with HIV (ALWH).
METHODS: Consenting participants (20,577 in the 2016 and 17,728 in 2020 surveys) from randomly selected households provided demographic and clinical information and blood samples for household HIV testing per national guidelines, with HIV+ results confirmed via a supplemental assay. The analysis included 3,385 ALWH in 2016 and 2,820 in 2020 who tested positive in the survey. Estimates of HIV awareness and ART status were based on self-report or antiretroviral detection in blood. We applied multilevel logistic regression models to examine the correlation of time with each of these targets, using survey weights and estimated variances via jackknife series.
RESULTS: Among ALWH who tested HIV-positive in the survey, awareness of HIV-positive status increased from 76.8% (95% CI: 74.9%'78.7%) to 86.6% (95% CI: 84.8%'88.3%); those receiving ART increased from 88.4% (95% CI: 87.0%'89.7%) to 96.9% (95% CI: 95.9%'97.6%). VLS prevalence among those receiving ART increased from 85.3% (95% CI: 83.4%'87.0%) to 90.1% (95% CI: 88.6%'91.4%).
On multilevel analysis, controlling for demographic covariates, ALWH were significantly more likely to know their HIV-positive status in 2020 than in 2016 (adjusted odds ratio [aOR], 1.12 [95% CI: 1.08'1.16]; p<0.001), those aware of their status were more likely to be receiving ART (aOR, 1.31 [95% CI: 1.24'1.39]; p<0.001), and those receiving ART were more likely to have VLS (aOR, 1.07 [95% CI: 1.03'1.11]; p=0.001).
CONCLUSIONS: We found significant progress toward linking HIV-positive individuals with treatment and increased VLS rates in Zimbabwe. Expanding targeted HIV testing could help increase awareness of the HIV-positive status and end the AIDS epidemic in Zimbabwe by 2030.