Insights from a trend analysis of HIV indicators using Population-based HIV Impact Assessment (PHIA) surveys in Zimbabwe

To fight HIV, the Universal Test and Treat (UTT) HIV program was introduced and has been praised for improving HIV outcomes in many settings but also faces criticism for abbreviated counselling impacting adherence, and implementation challenges in resource-limited settings. Therefore, we aimed to assess the changes in ART enrollment, HIV viral load suppression, and adherence to ART between 2015 and 2020, a period that coincided with the implementation of the UTT program in Zimbabwe. We used data from nationally representative surveys before (2015, n = 2,792) and after (2020, n = 2,617) the national launch of the UTT program in 2016 in Zimbabwe. By applying survey weights, the prevalence of the HIV indicators was estimated and compared between the two survey years and within subgroups after stratification. Adjusted Odds ratios were also calculated to assess differences in the HIV indicators between the surveys. Importantly, our analyses were observational and did not establish a causal relationship between the UTT program and the observed changes in HIV indicators. HIV-positive status awareness of HIV-positive adults (15 years and older) was 76.8% (95% CI: 75.0-78.5) in 2015 and 86.8% (95% CI: 85.2–88.3) in 2020. Of those who were aware of their HIV-positive status, ART enrollment improved in all subgroups, with overall enrollment increasing from 88.7% (95% CI: 87.3–89.9) in 2015 to 97.0% (95% CI: 96.1–97.7) in 2020, adjusted odds ratio (aOR), 3.7 (p < 0.001). Overall viral load suppression also improved significantly from 85.4% (95% CI: 83.6–87.0) to 90.3% (95% CI: 88.9–91.6), aOR,1.5 (p < 0.001). However, young people didn’t show an increase in viral load suppression. Also, men had lower rates than women in all HIV indicators, and there was no significant change in adherence to ART between the survey years. In general, there were significant improvements in ART enrollment rates and viral load suppression rates, with no change in ART adherence. These improvements might be attributed to several factors, including the 2016 UTT program. The existing gender and age disparities can be addressed by expanding ART services during weekends and unconventional hours, as well as by utilizing mobile and community-based HIV services for young individuals and men.