Background: Zimbabwe has made great strides in combatting HIV, partially through increasing testing and treatment. To reach the UNAIDS 90-90-90 targets it is necessary to know who is unaware of their HIV infection, who is not on treatment, and who is not virally suppressed in order to engage or re-engage them in HIV services. We identify correlates of being outside this cascade.
Methods: The 2015-2016 Zimbabwe Population-based HIV Impact Assessment was a cluster-based nationally-representative household survey. Face-to-face interviews were conducted with 22,496 adults aged 15-64 years, and blood specimens collected from 20,572 of them for HIV testing following the national serial rapid testing algorithm of Determine, First Response and Stat-Pak. Treatment status was self-reported and viral load testing was conducted using Roche Taqman 96. Weighted analysis was conducted in SAS. Variables associated with being outside the 90-90-90 cascade at p< 0.1 in bivariate analysis were included in the multivariate model.
Results: HIV prevalence was 14.6% among 15-64 year olds. Among HIV-infected participants, 25.8% were unaware of their infection. Among those aware of their infection, 13.2% were not on treatment. Of those on treatment, 13.5% were not virally suppressed. In multivariate analysis, males were more likely than females to be unware of their HIV infection (AOR: 1.74, 95% CI: 1.43-2.10) as were those aged 15-24 years (AOR: 4.59, 95% CI: 3.13-6.72) and aged 25-34 (AOR: 2.43, 95% CI: 1.73-3.41) compared to those aged 55-64 years. Compared to those ages 55-64 years, those aged 15-24 and 25-34 years were least likely to be on treatment (AOR: 3.88, 95% CI: 1.93-7.80 and AOR: 5.03, 95% CI: 2.85-8.89, respectively). Being on treatment and virally unsuppressed was associated with being male (AOR: 1.57, 95% CI: 1.17-2.09) and being aged 15-24 and 25-34 years compared to 55-64 years (AOR: 2.99, 95% CI: 1.50-6.11, and AOR: 3.82, 95% CI: 2.09-7.01, respectively). Neither province nor urban residence were associated with being outside any step of the cascade. Sex was not associated with being aware and not on treatment.
Conclusions: People < 35 years and men should be further targeted for HIV testing and additional support for linkage to and retention on treatment.