Background: The UNAIDS 90-90-90 objectives have gained a lot of momentum globally and are considered the key measures against which countries gauge their progress towards HIV epidemic control. The Zimbabwe population HIV impact assessment (ZIMPHIA), implemented in 2015/16, included population estimates for each of the 90-90-90 objectives. Here we explore progress towards 90-90-90 at national and provincial levels, and relevance to programmatic decision-making.
Methods: Consenting participants provided demographic, behavioral and clinical information and blood samples for household HIV testing using the national serial rapid test algorithm. HIV+ results were confirmed in a central laboratory and viral load was performed on all HIV+ samples. Viral load suppression (VLS) was defined as HIV RNA < 1000 c/ml.
Results: 22,496 adults (>15 years) consented to participate and 3,503 (15.6%) were confirmed HIV-positive. Of all HIV-infected adults, 73.9% (95% CI 72.0-75.8) knew their HIV status; of those who knew their status, 86.5% (95% CI 85.0-88.0) reported being on ART, and 86.2% (95% CI 84.5-87.9) of those reporting to be on ART were virally suppressed (Figure 1). At provincial level, known-positive HIV status ranged from 70.4% to 78.9% (95% CI 64.5-76.3 and 74.5-83.4 respectively); HIV-positives self-reported on ART ranged from 82.2-92.3% (95% CI 76.4-87.9 and 88.3-96.3 respectively), and VLS ranged from 82.6-91.6% (95%CI 77.1-88.1% and 87.3-96.0% respectively).
Conclusions: Zimbabwe has made remarkable progress towards 90-90-90. Notably however, the first of the three 90''s is under 80% in every province. The Zimbabwe Ministry of Health reported 19-59% of patients receiving care had an HIV test at the point of service. In order to ensure the three 90''s are achieved in this widely generalized epidemic, it is critical that Zimbabwe ensure that routine opt-out HIV testing is aggressively rolled out beyond antenatal care and tuberculosis clinics to include all patients at all points of service.

ZIMPHIA Provincial 90-90-90
[ZIMPHIA Provincial 90-90-90]