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Towards UNAIDS Fast-Track goals

targeting priority geographic areas for HIV prevention and care in Zimbabwe

Cuadros, Diego F.a,b; Li, Jingjinga; Mukandavire, Zindogac; Musuka, Godfrey N.d; Branscum, Adam J.e; Sartorius, Bennf; Mugurungi, Oweng; Tanser, Frankf,h

doi: 10.1097/QAD.0000000000002052
Epidemiology and Social
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Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

aDeparment of Geography and Geographic Information Science

bHealth Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio, USA

cDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK

dICAP at Columbia University, Harare, Zimbabwe

eDepartment of Biostatistics, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA

fDepartment of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa

gMinistry of Health and Child Care, Harare, Zimbabwe

hAfrica Health Research Institute, University of KwaZulu-Natal, Durban, South Africa.

Correspondence to Diego F. Cuadros, PhD, Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, OH 45221, USA. Tel: +1 513 556-3423; fax: +1 513 556-3370; e-mail: diego.cuadros@uc.edu

Received 23 April, 2018

Accepted 21 September, 2018

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