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dc.contributor.authorConan, N
dc.contributor.authorCoulborn, RM
dc.contributor.authorSimons, E
dc.contributor.authorMapfumo, A
dc.contributor.authorApollo, T
dc.contributor.authorGarone, DB
dc.contributor.authorCasas, EC
dc.contributor.authorPuren, AJ
dc.contributor.authorChihana, ML
dc.contributor.authorMaman, D
dc.date.accessioned2020-11-19T17:35:38Z
dc.date.available2020-11-19T17:35:38Z
dc.date.issued2020-09-24
dc.date.submitted2020-11-04
dc.identifier.pmid32969602
dc.identifier.doi10.1002/jia2.25613
dc.identifier.urihttp://hdl.handle.net/10144/619780
dc.description.abstractIntroduction: Gutu, a rural district in Zimbabwe, has been implementing comprehensive HIV care with the support of Médecins Sans Frontières (MSF) since 2011, decentralizing testing and treatment services to all rural healthcare facilities. We evaluated HIV prevalence, incidence and the cascade of care, in Gutu District five years after MSF began its activities. Methods: A cross-sectional study was implemented between September and December 2016. Using multistage cluster sampling, individuals aged ≥15 years living in the selected households were eligible. Individuals who agreed to participate were interviewed and tested for HIV at home. All participants who tested HIV-positive had their HIV-RNA viral load (VL) measured, regardless of their antiretroviral therapy (ART) status, and those not on ART with HIV-RNA VL ≥ 1000 copies/mL had Limiting-Antigen-Avidity EIA Assay for cross-sectional estimation of population-level HIV incidence. Results: Among 5439 eligible adults ≥15 years old, 89.0% of adults were included in the study and accepted an HIV test. The overall prevalence was 13.6% (95%: Confidence Interval (CI): 12.6 to 14.5). Overall HIV-positive status awareness was 87.4% (95% CI: 84.7 to 89.8), linkage to care 85.5% (95% CI: 82.5 to 88.0) and participants in care 83.8% (95% CI: 80.7 to 86.4). ART coverage among HIV-positive participants was 83.0% (95% CI: 80.0 to 85.7). Overall, 71.6% (95% CI 68.0 to 75.0) of HIV-infected participants had a HIV-RNA VL < 1000 copies/mL. Women achieved higher outcomes than men in the five stages of the cascade of care. Viral Load Suppression (VLS) among participants on ART was 83.2% (95% CI: 79.7 to 86.2) and was not statistically different between women and men (p = 0.98). The overall HIV incidence was estimated at 0.35% (95% CI 0.00 to 0.70) equivalent to 35 new cases/10,000 person-years. Conclusions: Our study provides population-level evidence that achievement of HIV cascade of care coverage overall and among women is feasible in a context with broad access to services and implementation of a decentralized model of care. However, the VLS was relatively low even among participants on ART. Quality care remains the most critical gap in the cascade of care to further reduce mortality and HIV transmission.en_US
dc.language.isoenen_US
dc.publisherWiley Open Accessen_US
dc.rightsWith thanks to Wiley.en_US
dc.subjectART
dc.subjectHIV
dc.subjectcascade of care
dc.subjectincidence
dc.subjectprevalence
dc.subjectviral suppression
dc.titleSuccesses and gaps in the HIV cascade of care of a high HIV prevalence setting in Zimbabwe: a population-based survey.en_US
dc.typeArticle
dc.identifier.eissn1758-2652
dc.identifier.journalJournal of the International AIDS Societyen_US
dc.source.journaltitleJournal of the International AIDS Society
dc.source.volume23
dc.source.issue9
dc.source.beginpagee25613
dc.source.endpage
refterms.dateFOA2020-11-19T17:35:38Z
dc.source.countrySwitzerland


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