Abstract
Zimbabwe has made substantial progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) targets of 90-90-90 by 2020, with 73% of people living with HIV diagnosed, 87% of those diagnosed on antiretroviral therapy (ART) and 86% of those on ART virally suppressed. Despite this exceptional response, more effort is needed to completely achieve the UNAIDS targets. Here, we conducted a detailed spatial analysis of the geographical structure of the HIV epidemic in Zimbabwe to include geographical prioritization as a key component of their overall HIV intervention strategy. Data were obtained from Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2015 as well as estimations from the Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2016 report, and other published literature. Data were used to produce high-resolution maps of HIV prevalence. Using these maps combined with the population density maps, we mapped the HIV-infected population lacking ART coverage and viral suppression. HIV maps for both sexes illustrated similar geographical variation of HIV prevalence within the country. HIV-infected populations lacking ART coverage and viral suppression were concentrated in the main cities and urban settlements such as Bulawayo, Harare, Ruwa and Chitungwiza. Our study showed extensive local variation in HIV disease burden across Zimbabwe for both women and men. The high-resolution maps generated here identified areas wherein high density of HIV-infected individuals are lacking ART coverage and viral suppression. These results suggest that there is need to tailor HIV programmes to address specific local needs to efficiently achieve epidemic control in Zimbabwe.
Highlights
Zimbabwe has the sixth highest HIV prevalence in sub-Saharan Africa (SSA), with approximately 1.2 million persons aged 15-64 years old living with HIV in 2016 [1]
Subjects were enrolled in the Zimbabwe Demographic and Health Survey (ZDHS) via a two-stage sampling procedure to select households
Estimates for additional spatial variables, including the percent of people living with HIV (PLHIV) who were diagnosed, the percent of people diagnosed with HIV who were treated by ART, and the percent on ART who were virally suppressed, were obtained at provincial scale from the 2016 Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) report [1]
Summary
Estimates for additional spatial variables, including the percent of people living with HIV (PLHIV) who were diagnosed, the percent of people diagnosed with HIV who were treated by ART, and the percent on ART who were virally suppressed, were obtained at provincial scale from the 2016 Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) report [1]. Ordinary kriging was used to predict values of the selected socio-economic and behavioral variables at unmeasured locations by estimating a variogram of weighted averages of the data [17,18,19,20], and generating continuous surface maps of the variables selected in the gender-specific final logistic regression models (Supplementary Figures S2 and S3).
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