Background: Findings from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA) indicate that Zambia has achieved significant progress towards meeting UNAIDS 90-90-90 goals. To better target expansion of HIV treatment services, ZAMPHIA data can be used to identify gaps in uptake of HIV testing counseling, initiation of antiretroviral therapy (ART), and adherence leading to viral load suppression (VLS).
Methods: A nationally representative, household-based sample of adults and children was recruited in all 10 Zambian provinces. Consenting participants provided demographic and clinical information and blood samples for household HIV testing per national guidelines. HIV-seropositive results were confirmed via a supplemental assay; viral load and limiting antigen (LAg) avidity testing were performed on all HIV-seropositive samples. VLS was defined as HIV RNA < 1000 c/ml.
Results: In 2016, 19,029 adults (15-59 y) from 10,959 selected households provided interviews and blood samples. One-third (32.7% [95% CI 30.2-35.3]) of persons living with HIV (PLHIV) reported being unaware of their HIV status; this was highest among adults ages 15-24 y (58.2% [52.0-64.3]). HIV-seropositive males ages 25-34 y (58.2% [49.5-66.9]) and 35-44 y (32.2% [25.9-38.4]) had higher prevalence of unknown HIV status relative to females of the same age (25-34 y: 29.0% [24.5-33.4]; 35-44 y: 20.8%[16.9-24.7]). Among PLHIV who reported being aware of their status, 14.6% (95% 12.5-16.7) reported they were not receiving ART; this was highest among adults ages 15-24 y (21.5% [13.2-29.7]) and 25-34 y (22.1% [17.2-27.0]). VLS among PLHIV who reported receiving ART was 89.2% [87.4-91.0]. VLS was lowest among 15-24 y males; 48.5% (23.0-73.9) were not virally suppressed. Gender differences did not reach statistical significance for reported receipt of ART and VLS.
Conclusions: Young adults (15-34 y) living with HIV in Zambia had the lowest prevalence for each of the 90''s: awareness of their HIV status, receipt of ART, and VLS. Results from ZAMPHIA confirm the need to increase HIV testing, treatment, retention and adherence for both young men and young women, in an effort to make further progress in controlling Zambia''s HIV epidemic.